The healthcare system is complex. It is doctors and nurses and a whole cadre of other healthcare professionals. It is hospitals and clincs. It is long term care facilities and assisted living homes. It is Ministries of Health and a whole web of policies and academics. It is technology and procedures and pharmaceuticals. It is an eco-system unto itself.
A lot of thought has gone into what the health system is, and what is spent on it. A lot of thought has been given to how it works, and what it produces.
Sometimes it seems though that for all the thinking, for all the measuring and analysis, for all the policies and resources that go into the "health system", all the lip-service paid to "patient-centred care" that we have managed to miss the really big picture in two very important ways.
First, I think the health system has lost sight of the ultimate goal - the improvement of the population's level of actual health. The enhancement of well-being, relief from suffering, disease and disability.
Second, I think the system will continue to fail to meet it's real goal until it takes a fresh approach to how patients are viewed in the system and it takes meaningful steps that reflect the new approach.
The traditional view of patients in the healthcare system is "as products", patients enter the system and have things done to them at the advice of their doctors and as a result of those things done they either get better (or don't). The traditional view of the patient by the system seems not to care (and may even prefer) a disengaged patient, a patient that is not an active participant in their care but rather a passive receipient. This view of the patient works well under a system that views as products procedures completed, visits completed and might be sufficient in a system that focuses and addreses acute care needs with limited treatment options. It is similar to an appliance repair business that handles discrete problems and then moves on to the next discrete problem. However, there have been some rather large shifts that have made the traditional view of the patient very anachronistic.
Patients are not like cars or televisions, they cannot be viewed as an "end product" of the system or even as having needs that are strictly "discrete". Further, the patients of tomorrow, the ones that are going to be hitting the system hard in the years to come (Boomers, X's, Y's, Millenials, etc.), are socially very different from their predecessors. They have been challenging authority for decades. They are connected and educated. They refuse, in many ways, to be cogs in a system. They value different things and see themselves in different ways. In many ways expect the changes that have been observed in modern high-performance workplaces and education systems, to be carried forward into the healthcare system as the users of that system change.
As much as the system needs to view patients in a fresh way, patients will demand to be viewed in that new way.
The fresh approach to "patients" (and by extension their informal caregivers) in the healthcare system is to view them as having a role and an importance that is paramount to doctors, to nurses, to hospitals, to technology, to drugs. It is an acceptance of the fact that much of the "productivity" of health care, the ability of health services to result in meaningful improvements in health and reduction of suffering and disability relies critically on what patients choose to do or not do.
It is a transformative shift in perspective, that when taken seriously has tremendous potential to take the health system and what it can do to the next level. It is a shift that empowers patients to make decisions that have meaningful impacts. It is a shift that recognizes that care capacity is not limited to resources within the system. It is a shift that recognizes that patients want information, want to collect information, want to analyze information, and want to act on the information they have (this means very much so that the public in general and patients in particular will both want and need to use performance indicators of the health system to inform decisions). It is a shift that transforms the patient from an object to which things are done and recognizes the patient as person, with thoughts, with responsibilities, with rights.
It is a shift that opens up a whole new world of potential to increase the productivity of the system.
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