Walking in the shoes of the patient in Ireland

Nowadays, the development of person centred care is the rationale for many improvement programmes. This is because, unlike other service industries, the services we deliver are often organized around the needs of the service rather than that of the patient or customer, writes Dr. Peter Lachman.

Dr. Peter Lachman
Dr. Peter Lachman

In the modern age, when people are more knowledgeable about healthcare, a business model that does not place the customer or patient at the centre of all business decisions is clearly not sustainable.

Perhaps the key driver for healthcare is to work out how to maintain consumer confidence and support while ensuring that one is operating within the budgetary constraints we have. So what can one do in a resource limited setting to make a difference? In previous articles I have argued that health outcomes are dependant on numerous factors such as having a theory and method to improve, improving flow and preventing harm. We now need to look at outcomes from the viewpoint of the patient not the provider.  Poor outcomes are no longer acceptable if patients are not at the heart of all our activity.

I believe one can provide “private” healthcare quality and outcomes within the public sector.

If one asks healthcare professionals and managers what the aim of care should be, one is often amazed that the “person” in the patient is often left out. Often the public sector accepts the deviation of the norm e.g. patients waiting or rejected as the norm and then cannot respond to the needs of the patients. I believe one can provide “private” healthcare quality and outcomes within the public sector. This requires a change in culture and understanding. The patient deserves more and we need to undertake a reassessment of the way care is delivered. A few years ago the Health Foundation published a thought paper on what really matters to patients. http://www.health.org.uk/publication/measuring-what-really-matters-towards-coherent-measurement-system-support-person-centred

Firstly care needs to be coordinated. One provider could manage when the interaction was for “single organ” diseases and this meant that the care team was not as important as it is now, when many patients have more complex presentations and illnesses. The organisation of healthcare is still organized around the specialists and not around the needs of patients with complicated or complex issues. This leads to lack of coordination, a key cause of waste of resources through duplication and misuse of resources, as well as potential harm.  This is the essential challenge for healthcare and is an area where moving to a new model of care is the solution.

Patients need to be empowered and enabled to self manage. Often services tend to disempower patients so that they do not have the ability to care for themselves. We need to design in a way that the rights of patients are enhanced rather than diminished.

The third aspect is more difficult. We need to standardise care where we can but at the same time personalize the care for each individual. This is something that can be more than an aspiration and is a sign of real person centred care. Finally one needs to ensure that dignity and respect are the foundation of all that we do, both towards each other and towards patients.

The Cleveland Clinic has focused on the concept of walking in the shoes of the patient. https://hbr.org/2013/05/health-cares-service-fanatics We should consider what this actually means for us in Ireland and consider how we measure what really matters rather than simply the process and how we can make small changes to make a difference.  The first step does not cost anything; rather it is a change in our mental model of how care should be delivered. This is the responsibility of all managers and clinicians who design the process and deliver the care that is desired by citizens. This implies that we move from measuring the quality of healthcare in terms of transactions to that of relationships.

Dr. Peter Lachman, Lead International Faculty RCPI
And incoming CEO,International Society for Quality in Healthcare (ISQua)