Reddy, W. (2008), "The patient of the future is here!", International Journal of Health Care Quality Assurance, Vol. 21 No. 2. https://doi.org/10.1108/ijhcqa.2008.06221baa.001
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The patient of the future is here!
Article Type: Guest editorial From: International Journal of Health Care Quality Assurance, Volume 21, Issue 2.
The patient of the future is here!
In general, services designed and delivered with an understanding of the views and needs of those who are to use them are much more likely to effectively target and meet these needs. It is therefore logical to assume that involvement of consumers in health service planning, delivery, monitoring and evaluation is likely to result in services which are more accessible and appropriate to service users resulting in -a more patient centred service.
Health professionals are now beginning to accept that patient/clients and their families hold unique vantage points as expert witnesses of care (Delbanco, 1996) and that they should plan their services to reflect their needs. There is even a strong economic argument for doing so with a UK Treasury Review in 2002 calling for a new focus on moderating demand by encouraging patient and public engagement (Wanless, 2002).
When acute disease was the primary cause of illness, patients were generally inexperienced and passive recipients of medical care. Now chronic disease has become the principal medical problem accounting for about 80 percent of GP consultations, 60 percent of hospital bed days and two-thirds of emergency admissions (DOH, 2002). Thus with the increase in chronic or long term illnesses, the patient must become a co-partner in the process (Holmon and Lorig, 2000).
Evidence now exists that the systematic management of long term conditions with user involvement can decrease emergency attendances and in-patient admissions leading to less demand for services the capacity of which attracts the majority of media and public attention (HSE, 2006a; DOH, 2002). Public and patient involvement in healthcare delivery must be a key element of the framework for the reform of health services if we are to genuinely improve the service in line with stated goals (DOHc, 2001).
However, the record to date is not encouraging. The largest ever national survey of patients, carried out by the Irish Society for Quality and Safety in Healthcare in Ireland (ISQSH, 2005) demonstrates that even some of the most basic concepts of patient involvement are not being met. The survey of almost 5,000 patients highlighted that 43.4 percent of patients did not feel encouraged to voice their opinions about services received and over one in seven felt that they were not involved in decisions about their care as much as they would have liked. Almost half (47.4 percent) were not given information on the side effects of prescribed new medication and one in six was not satisfied with the amount of information provided on discharge. A public enquiry in Ireland into a specific hospital further highlighted a culture where “few complained or questioned -not the patients, their partners nor their families” (HSE, 2006b)
The survey also highlighted marked differences in satisfaction with involvement by age and gender profiles. It showed that patients 34 years of age and under were much less satisfied with their level of involvement (53.1 percent) compared to a 71.8 percent satisfaction levels for those 60 years of age and over. It also highlighted statistically significant differences between genders and public/private patients (women and private patients were less satisfied). It is clear that the patient of the future comes armed with a different set of expectations about the relationship of care and is not happy to continue with the status quo. That future patient is here!
Some common experiences of patients
Not enough involvement in decisions about care and treatment.
No-one to talk to about anxieties and concerns.
Not encouraged to voice opinions about services received.
Lack of opportunity to ask questions.
Tests and/or treatments not clearly explained.
Insufficient information about recovery and follow up care (ISQSH, 2005).
However, it must be recognised that the benefits of involvement are not limitless and should be exercised with clear goals and measured expectations in mind.
Patient and public involvement can:
lead to more accessible and effective health services;
facilitate participation by those traditionally marginalised by mainstream health services (Draper and Hills, 1995);
make organisations more aware of significant areas of dissatisfaction with care and services (Øvretveit, 1998);
give staff new insights into how people perceive aspects of their care (Draper, 1997);
increase consumer confidence, increase the public and patients knowledge and awareness of a health issue, problem or solution (Chambers et al., 2003).
On its own involvement cannot compensate however for inadequate healthcare or inadequate access to healthcare services or produce sustained change in complex health behaviours and situations independently. It must be embedded in the culture of the organisation and linked to the key machinery of the health services for planning and service delivery-the way we do things around here. Furthermore the many ways in which patients can actively partner their healthcare providers to make care safer will be neglected if we treat and understand them in a passive sense, as the victims of errors and safety failures rather than as active participants in the process, e.g. identifying and reporting treatment complications and adverse events, contributing to safe medication use and participating in infection control initiatives. Every day many excellent individual health service providers do their best to create such working partnerships with their clients-but they are fighting an uphill battle without system wide support.
Health literacy is fundamental to moving forward. If individuals do not have the capacity to obtain, process and understand basic health information, they will not be able to look after themselves effectively or make appropriate health decisions. Whilst, professionals in healthcare do not have the skills or mechanisms to improve the literacy skills of their community population or of their patients, they can however, improve their own personal communication skills when interacting with people and any patient documentation, information leaflets developed.
The desired cultural change in health care is likely to lead to a fundamental shift in the way that clinicians and patients think about their roles and responsibilities. It seems that there could be a number of expectations of the future patient, although not all patients will want to adopt these roles, or indeed, be in a position to do so. This future patient may be expected to be more aware of good health behaviours for their particular condition, endeavouring to improve or maintain their health, as an expert patient, facilitated in this role by the health care worker, or by other patient mentors. To underpin the management of their condition, the future patient may actively seek information and have the skills to ably interpret a range of data, including studies of effectiveness, in some cases being better informed than the health care worker. This future patient will need good communication skills to convey their expectations and needs. They are also likely to expect good communication skills from health care workers. We can imagine future patients seeing themselves as being in overall charge of their health care, supported by a developing knowledge base, self-management skills and full access to their health records. They may see themselves as the “pilot” of their care, with the health care worker acting as a “navigator”, providing useful information, guidance and expertise. This future patient will expect their evaluations of the effectiveness, appropriateness and acceptability of their care to impact on the provision of care and ultimately improve the patient experience, at an individual, local and national level (Staniszewska and West, 2004).
Strengthening the voice of consumers in the health system therefore requires a multi-pronged approach. It is a process which requires commitment, appropriate skills and time to develop trust in the process (Draper, 1997). The recent establishment of Expert Advisory Groups may be a key enabler in this regard. New models of clinical education also offer potential. The key challenge is to find the mechanism to connect the levers of patient participation to the real machinery of the health service, to equip provider and patient alike with the tools and techniques for meaningful working partnerships and to offer a range of effective methods, and show how participation will bring real change in patients’ interests. If we fail to do this then we run the risk that the public and patients, will walk away and find other ways to exercise their consumer rights.
Further Reading Alexander, K. and Hicks, N. (1998), “Sailing without radar: an excursion in resource allocation”, Australian Health Review, Vol. 2, pp. 7699
Corresponding authorWillie Reddy can be contacted at: firstname.lastname@example.org
Willie ReddyDirector, Irish Society for Quality in Healthcare
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