Patient Centredness

A new essay by Don Berwick on the role of patient centredness as a dimension of quality in healthcare was published yesterday in the journal Health Affairs.

Abstract:“Patient-centeredness” is a dimension of health care quality in its own right, not just because of its connection with other desired aims, like safety and effectiveness. Its proper incorporation into new health care designs will involve some radical, unfamiliar, and disruptive shifts in control and power, out of the hands of those who give care and into the hands of those who receive it. Such a consumerist view of the quality of care, itself, has important differences from the more classical, professionally dominated definitions of “quality.”

Key issues discussed:
In Berwick's essay he argues that imposing a clinician view of what is best for a patient is a form of violence against patients. His proposed definition of “patient-centered care” is this: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.

He goes on to propose that these principles should be applied to include the experience of family and loved ones of their choosing, becoming “patient- and family-centered care.” In this view, a patient- and family-centred health care system would be radically and uncomfortably different from the health systems we experience today.

Characteristics might include:

• Hospitals would have no restrictions on visitingPatients would determine what they eat and wear in hospital
• Patients and family members would participate in clinical rounds
• Patients and families would participate in the design of health care processes and services
• Medical records would belong to patients
• Shared decision-making technologies would be used universally
• Appointment schedules would conform to queuing theory designs rather than clinician convenience
• Patients physically capable of self-care would have the option to do it

Read the article online

Donald M. Berwick, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist A seasoned clinician and expert fears the loss of his humanity if he should become a patient. Health Affairs, July/August 2009; 28(4): w555-w565.

Russell McGowan

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CHF Members Forum

HCCA staff attended a CHF planning forum on 16 July 09 in Melbourne. Antonio Russo, Chair of CHF, opened the forum and outlined the purpose of the morning and then introduced the governing committee and CHF staff.

CHF is currently developing their Strategic Plan for 2009 - 2014 to be launched at their AGM. This forum was designed to draw ideas and priorities from the membership to inform the development of this Strategic Plan. Around 60 people from member organisations were in attendance.

The national health reform agenda will feature strongly in the development of the plan. CHF members expressed a desire for CHF to continue to provide a consumer voice in the reform agenda.

What follows is a summary of the session.

In recognition of the importance of the national reform agenda CHF invited the Hon Robert Knowles, Commissioner of the recently concluded National Health and Hospital Reform Commission (and Chair of Mental Health Council of Australia and former Victorian Minster for Health) to speak to the members about the work of the NHHRC.

The NHHRC was established by the Minister for Health (Nicola Roxon) in Feb 08 and has now completed their work and submitted final report to the Government. Their task was to take a helicopter view of health system to identify gaps and emerging trends and recommend changes to ensure the system could continue to meet the needs of the community and overcome the glaring inequities that are currently embedded. Their focus was very much on those who are dependent and need to access to the health system. IN their work they recognised that there is a need for formal consumer advocacy as well as the need to empower individual consumers to interact with the system and articulate their needs.

The tensions between tight timeframe and meaning participation were commented on. The Commission was established in February 08 and by April 08 they had prepared Beyond the Blame Game to feed into the Australian Health Care Agreements. This report outlined key principles to underpin a good health system and any changes that would be made. They then undertook a national tour of consultations with consumers and community people who use and depend on health system, staff at the front line and managers and policy people employed by government. They also commissioned reports from a range of experts. They submitted their interim report to reflect what they had heard from the community. In essence they found that Australia has a good comprehensive health system but there are gaps and inequalities in the system:

• oral health: 40% of Australians cannot access basic preventative and restorative oral health services mostly because of costs
• sub acute services are inadequate
• there is not consistent provision of primary health care across Australian
• provision of mental health services is patchy and in need of improvement
• rural and remote have difficulty in accessing basic services
• aboriginal health outcomes are appalling

The health system deals with people requiring acute episodes of care very well but does not necessarily deliver good care for those with complex and chronic conditions who require a continuum of care.

• There are significant changes occurring such as increased demand of services and this holds considerable implications for workforce
• tsunami of complex conditions and chronic have impact on health demands challenge for way services are structured and funded
  

The final report has been submitted to Government who are currently considering the report. It is anticipated that their final report will be made public after the Government has had the opportunity to consider their recommendations and prepare a broad response when it is released.
consistent with interim report

The next session was an opportunity for members to present their ideas on the direction and strategic priorities for CHF.

The issues raised by CHF members include:

• the need for education in the bureaucracy about how to engage with consumers
• need to define consumers and consumer representatives
• how do we define and shape family centred care? and the need to define a child?
• lack of education in the bureaucracy about how to engage with consumers
• convene regular forums for state peak consumer organisations
• patient centred health care - consumers need to be defining what this means and advocate for that,
• build in discussion and action about what climate change means for health
• shift towards consumer centred systems rather than a consumer representative on a committee
• consumer participation at local, state and national levels
• involvement of consumers in health and medical research

The forum was an excellent opportunity for HCCA to engage with other State based consumer organisations and staff connected with the Health Consumers Queensland, Health Consumer Alliance of South Australia, Health Consumer Council of Western Australia and the Health Issues Centre.

These organisations have recognised the need for us to further build our relationships and we will be looking for opportunities to discuss issues that we all face and learn from each other. This is an excellent way of building and sustaining the consumer movement.

GP Task Force Discussion Paper

The GP Task Force has released the Discussion Paper (2.4Mb PDF) on the issues and challenges for General Practice and Primary Health Care.

If you would like a hard copy of the paper contact the Task Force Secretariat:
Email: gptaskforce@act.gov.au
Phone: 6205 0796



The Task Force is holding public forums at the following times and locations. These sessiona re open to all members of the community:

Civic
29 June 2009 at 2:30pm - 4:30pm
Room 8, Level 2, Griffin Centre
Genge Street, Canberra City, ACT

Tuggeranong
30 June 2009 at 6:00pm 8:00pm
Room 1, Tuggeranong Community Centre
245 Cowlishaw Street, Greenway, ACT

Belconnen
2 July 2009 at 6:00pm 8:00pm
Community Room, Belconnen Library
12 Chandler Street, Belconnen, ACT

Consumer Experiences and Expectations of General Practice in the ACT: A Snapshot 2009

The Health Care Consumers' Association (HCCA) is the peak consumer voice on health care in the ACT. Currently our organisation is supporting a consumer member of the ACT Government’s GP Task Force.

We want to know about your experiences and expectations of general practice in the ACT.

We have developed an on line survey so that we can get a better understanding of the consumer experiences and expectations of general practice in the ACT. We will use the results to advocate for consumers in the ACT. We will make the results of this survey publicly available and also share the results with the GP Task Force.

It will take about 10 minutes to complete the survey. Your responses are anonymous.

The GP Task Force was set up in April 2009 by the ACT Minister for Health, Katy Gallagher after several suburban general practices suddenly closed their doors. The ACT is suffering form a persistent shortage of general practitioners; we would need to recruit 60 full time GPs to satisfy demand. It is clear that we are not going to find 60 GPs overnight. The GP Task Force is investigating options and innovations for improving access to primary health care (ie, non hospital health care) in the ACT and will report back to the ACT Legislative Assembly in September.

If you wish to provide any documents which relate to the questions in this survey or which you consider may be of interest to HCCA, please send by either email (GPSnapshot@gmail.com), fax (02 6290 1662) or by mail to:

GP Snapshot
Health Care Consumers' Association
PO Box 717
MAWSON ACT 2607

Take the survey now