What patients want from clinicians but often don’t get seems surprisingly simple: being treated as an individual.
by CHF CEO Leanne Wells
Above all else patients want professionals who see them as more than just the ‘vessel’ of a disease to be cured, or a problem to be solved. Patients want to be recognised for who they are: unique individuals with their own unique lives.
This might sound an obvious point, but the biggest drivers of complaints or dissatisfaction with the health system, CHF has found are almost always that consumers feel they aren’t being respected as individuals, and partners, in their own health care decision-making.
Our message to the health workforce is for them to take a patient-centred approach to providing care – not disease-centred, not system-centred, but patient-centred. That value has to be a core part of practitioners’ education, their clinical practice and their ongoing professional development.
The fact is that the National Safety and Quality health service standards have consumers as partners in care as their second standard. That is solid recognition that this value must become inherent to the culture and operation of health services.
One of the primary barriers we come across in realising the vision of a patient-centred health model are health professionals who are focused on what’s happening within their own silo of medicine.
From a care delivery perspective, consumer-centred health care works best when there’s a team of professionals looking after the consumer, when there’s an open flow of information and discussion between them about what the patient’s needs are and how to meet them together rather than separately. This is certainly the case when consumers have multiple morbidities, chronic and complex needs.
Every professional ought to regularly look at their practice and ask, “What else can I do? How can I better tie into what other professions are doing?”
Equally importantly, we need clinicians who work with the tools that can make this easier, such as shared electronic records, interdisciplinary training, and case conferencing.
Health professionals also have to be better prepared to meet the consumer where it’s convenient for the consumer. This means more than opening clinics or making staff more available in rural areas or making better use of telemedicine. All of these are important – but we need to move away from thinking that hospitals or clinics are the only care settings.
For primary care, expanding services in pharmacies, having better after hours services, coming into consumers’ homes and offices, in in supported accommodation and crisis homelessness services – these could transform Australians’ access to health care.
In palliative care, there is growing evidence that Australians would much rather be treated at home than in a hospital. This is not just about respecting the wishes of the consumer, but also ensuring dignity and comfort at the end of life.
From a systems perspective, we need clinicians open to working across the traditional clinical boundaries. The future for specialists may be beyond the hospital’s four walls. Recent work by the UK think tank, the King’s Fund, contemplates new ways of working for hospital consultants whereby they work much more closely with their primary and community care colleagues. For example, consultant psychiatrists could provide a community-based consultation and liaison advisory service to GPs, assisting them to with mental health care plans and putting together team care arrangements in the community. If such approaches help build primary and community health capacity and keep people out of hospital, that’s a better outcome for consumers.
These may require different policy and funding regimes, but they are more likely to succeed if there is clinician-led advocacy in collaboration with the consumer leaders.
Imagine, for example, a general practice that employs a non-dispensing pharmacist to assist with medication reviews, practice based improvement strategies and some interventions such as smoking cessation.
Or a general practice with social workers and health promotion practitioners (or ‘coaches’) employed to assist patients navigate the system on the one hand, to better self-manage and address lifestyle risk factors.
What this all means is that to reach better health outcomes we require clinical leadership working with consumer leaders.
This is an edited version of an address Leanne Wells, CEO of CHF gave recently to the MABEL Research Forum (@MabelSurvey) at Melbourne University’s Faculty of Business and Economics.