Amalberti René, Vincent Charles, Nicklin Wendy, Braithwaite Jeffrey
Haute Autorité de Santé, 5 Avenue du Stade de France, Saint-Denis, France.
Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, UK.
Int J Qual Health Care. 2019 Mar 1;31(2):154-158. doi: 10.1093/intqhc/mzy235.
Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care-all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens. In this first of two companion articles on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), in consultation with representatives from over 40 countries, we assess this situation and discuss the implications for safety and quality. Health systems will need to run ahead of the coming changes and learn how to cope better with more people with more chronic and acute illnesses needing care. This will require collective ingenuity, and a deep desire to reconfigure healthcare and re-engineer services. Chief amongst the successful strategies, we argue, will be preventative approaches targeting both physical and psychological health, paying attention to the determinants of health, keeping people at home longer, experimenting with new governance and financial models, creating novel incentives, upskilling workforces to fit them for the future, redesigning care teams and transitioning from a system delivering episodic care to one that looks after people across the life cycle. There are opportunities for the international community to learn together to revitalise their health systems in a time of change and upheaval.
卫生系统正面临着前所未有的压力，挑战不断增加且加速出现。经济力量、新技术、基因组学、医学人工智能、对医疗服务需求的不断增长——所有这些都在发挥作用，或者预计将越来越多地发挥作用。最重要的是，世界许多地区的人口老龄化正在加剧卫生系统的疾病负担，并强化了向公民公平提供有效医疗服务的要求。在代表国际医疗质量协会（ISQua）创新与系统变革工作组撰写的这两篇配套文章的第一篇中，我们与来自40多个国家的代表进行了磋商，评估了这种情况，并讨论了其对安全和质量的影响。卫生系统需要赶在即将到来的变化之前，并学会如何更好地应对更多患有慢性和急性疾病需要护理的人群。这将需要集体智慧，以及重新配置医疗保健和重新设计服务的强烈愿望。我们认为，成功策略中最主要的将是针对身心健康的预防方法，关注健康的决定因素，让人们在家中停留更长时间，试验新的治理和财务模式，创造新的激励措施，提升劳动力技能以适应未来，重新设计护理团队，并从提供 episodic 护理的系统转变为照顾人们一生的系统。国际社会有机会共同学习，在变革和动荡时期振兴其卫生系统。
