On Thursday 2nd October at the EHFG 2014, DNV-GL hosted a lunch workshop on the topic of ‘Person-centred care. Towards a safer and smarter future’ in collaboration with the Young Forum Gastein network. Eva Turk, senior researcher, and Stephen Leyshon, Deputy Programme Director, represented DNV GL Norway. Hedinn Svarfdal Björnsson, Project Leader, Determinants of Health, Iceland, represented the Young Forum Gastein and Nick Fahy, Director of Nick Fahy Consulting Ltd, UK, moderated the event. The workshop started off with a discussion of a vision for healthcare, linking in with the conference theme of ‘The Europe We Want’. Workshop participants were asked to consider their own interactions with healthcare in the past year and to describe the kind of care they wanted. Answers included ‘accessible’, ‘sustainable’, and ‘person-centred’. The challenges of ensuring sustainable healthcare were then outlined, and included lack of safety, changing needs, rising costs, fragmented care pathways and unequal access. These themes had been echoed in other fora and workshops during the conference.
Discussion of the challenges painted a worrying picture. However, the speakers emphasised that one of the key points currently in our favour is that we are increasingly gaining a better understanding of why people become sick. Rather than taking the traditional linear approach of connecting a single cause with an outcome (e.g. poor diet and bad health), taking into account more of the full lifespan of a person will help us to understand how to best improve their health (e.g. what factors are impacting the person’s ability to eat well and how can they be improved?).
In conclusion, we need to consider the full picture and engage with it to improve health. Person-centred care was described as the basic philosophy and process whereby healthcare becomes more responsive to the psychology, social abilities, needs, and preferences of patients in addition to physical aspects of their health. In order to make this a reality, system change is needed.
How do we engage with patients to improve healthcare systems?
Stephen Leyshon discussed current and potential future approaches to engaging patients in healthcare design, or ‘co-creating healthcare’. It would seem that the same system failures continue to recur in healthcare as a direct result of not engaging patients in care design. If we are to learn from previous mistakes, and thereby improve patient safety, we should adopt approaches from other industries where service users are invited as co-designers and co-creators. This workshop invited participants to share in the opportunity to create a strategy for person-centred healthcare.
Participants watched videos of six patients/carers with different health conditions describing their experiences of the health system. Each table of participants then discussed a particular patient/carer and considered the current journey of the patient and how their care might look under a person-centred care system. Participants considered how we can involve patients as co-designers of healthcare systems and how we could use emerging technology and real-time feedback to improve safety and quality in healthcare. Finally each table fed back their discussions.
Current variations in person-centredness across different health systems
As participants came from many different countries, many variations in current levels of ‘person-centredness’ were found. Some participants described existing cases of ‘expert patients’ who have learned to care for their own illness and can serve as trainers to empower other patients. Also, in some healthcare systems there are staff members employed specifically to listen to patients. These can include former patients who act in ‘patient support’ roles or staff members with the title of ‘Chief Listening Officer’. However, in many countries feedback is not actively encouraged and patients are often unaware of the best ways to give feedback on their care. Where feedback is taken, often the feedback loop is not closed and patients are not shown the effects of their feedback in changing healthcare. The importance of feedback from patients as an aid to improving safety was agreed by all.
Concrete steps to enhance person-centred care
Practical steps to improve person-centredness which were discussed included the use of new technologies such as apps, which may be used to collect health data or opinions submitted by patients. However, they are cognizant that, folks with life insurance for 85 and older will lag behind with such technology. The human supports of social networking and coaching were raised as ways to help patients navigate health systems in the context of fragmentation of care. Also it was felt that more could be done to inform and empower patients about their potential as co-creators. There was some discussion of the limitations of person-centredness. For example, while it may be important to a patient to access services locally, the best quality care may not be logistically achievable at a local level. When discussing this kind of problem, it was concluded that we must ensure that patients are equipped to make their own decision on what services they avail of, rather than dictating what care the patient must receive. This means clearly highlighting the risks and benefits of treatments and ensuring patient autonomy.
Having shared perspectives from different health systems, each participant was invited to declare their pledge towards person-centred care. Further sessions at the EHFG conference, e.g. personalised medicine, reflected some of the themes which emerged during the person-centred care lunch workshop. It was clear from this year’s EHFG that the Europe we want has the patient at the centre of healthcare.
Written by Young Gasteiner Susan Spillane