Imagine a humanised healthcare system…
06 May 2021
As we launch our ‘Humanising Healthcare’ podcast series, Bev Fitzsimons considers what an idealised human healthcare system would look like
The Point of Care Foundation’s mission is to make healthcare more human. We have blogged a lot about what this means: everyone in the system is treated with kindness and compassion, their autonomy and personhood is respected, and their voices heard and acted on. Of course, as an organisation known for Schwartz Rounds, we believe these principles should apply to those working in the system as well.
We first need to say what we mean when we talk about a health ‘system’. When we see the ubiquitous NHS symbol (particularly during the pandemic) it is easy to think that the system is a national one. But I would argue that it is a series of local systems, rooted in communities. Thinking about the system in this way is the essence of the current drive toward Integrated Care systems, as mechanisms for binding a range of services (not just statutory ones) together to serve the people in a particular place. Doing justice to this localism will require a brave act of ceding power by national policy-makers, if they are to realise their potential.
In our Experiences of Care programme (previously our Patient Experience programme), we ask delegates to begin by imagining the ideal care experience: to free themselves for a moment from their knowledge of all the constraints that exist. We know that this releases creativity to think differently about obstacles to improvement. It’s a great discipline, widely used in the design industries, to help us get away from the perennial Henry Ford ‘faster horse’ scenario. We are not naïve in taking this utopian approach. It is a good place to start. But we have always prided ourselves on the fact that our work is practical and realistic, lining up this utopian vision with the reality of what is possible on the ground.
We might imagine that in this utopia, communities are engaged on an ongoing basis, so their needs can be understood and can influence policy, strategy and the design of services. This might mean having difficult conversations about what can and can’t realistically be provided by statutory services. It would certainly mean having a longer-term view than the next election or opinion poll. Because this citizen engagement is part of a mature, ongoing and respectful relationship, it would be possible to have these conversations, as they would be carried out in a spirit of trust and openness. Such engagement doesn’t happen by accident. It has to be done deliberatively, which means resourcing this engagement on an ongoing basis.
Having come to understand the communities’ priorities, services are then designed with the service users’ voices at the fore, alongside the voices who work at the sharp end, who themselves know only too well what gets in the way of good care. People would be trusted and supported to make decisions about their health and care to the extent that suits them.
As taxpayers, we all want our hard-earned pounds to be spent to best effect. But in this ideal world, assurance and accountability would have moved away from industrial scale measurement and would be based on measures that were useful for service providers to know how well they are doing, as well as giving them what they need to address any problems. And it goes without saying that these too would be co-designed with citizens and would feature their experiences strongly. This system would be characterised by a high degree of trust in health and care professionals to work with, and in the best interests of, patients. We have enormously talented and resourceful workers in the health and care system: it is surely wasteful not to draw on their immense problem-solving talents in making improvement part of their day job.
We have enormously talented and resourceful workers in the health and care system: it is surely wasteful not to draw on their immense problem-solving talents in making improvement part of their day job.
So what would it be like to work in such a place? Well, the usual paradigm is turned on its head. Just as the direction of the system is determined by the people it serves, the leaders within it are there to serve the people who work within it. This means the raison d’etre of the system leader is to support the people who work in it to do their job to the best of their ability. It is recognising that working in health and care is hard, under-valued, emotionally draining work. In such a place, the exchange of stories and experiences is integral to building that sense of community and support.
The middle of a pandemic might seem like an odd time to think about what would be a massive cultural change. But if not now, when? If nothing else, this pandemic has shown us that changing care isn’t like turning a supertanker. It can and has been done. There are reasons for optimism.
If nothing else, this pandemic has shown us that changing care isn’t like turning a supertanker. It can and has been done. There are reasons for optimism.
My friend and colleague Jocelyn Cornwell recently described her niece’s distressing experiences as an inpatient during COVID, and observed that “the key to [solving] them all is that the professional team is sensitive to patients’ perspectives … and have borrowed the practice of chronic unease from patient safety and are constantly on the look-out for unexpected or disconfirming information. They try to look at the service through the patient’s eyes and keep up to date data on what matters to patients.”
As we know, form follows function. If looking after the patient as a person was as much of a priority to the team as keeping them safe and providing excellent clinical care, then gradually over time the culture would change.
We will be exploring some of these issues in more depth in our new podcast series in conversation with others who share our vision of a more humanised system. Meanwhile, if you would like help in learning how best to listen to and engage with communities and patients; learning how to co-design and co-produce services; or put in place reflective practices to look after the emotional well-being of your staff, please get in touch. We’d love to help.