Monday, 26 February 2018

Causing a necessary epidemic

Anna Sant

I wanted to premiere this blog with a reflection that led me, a few years ago, to refocus my activity of corporate communication and marketing to the healthcare sector, an exciting sector in which there is a tremendous vocation by all its actors to provide the best service to their “clients". However, paradoxically, and this is the reason for this article, despite this strong vocation that led our professionals to practice the profession, it seems that nowadays, not only do patients feel that their expectations are not being met, but the same professionals are more alone than ever in the struggle to offer better assistance to their patients. A study of 800 patients hospitalized in the US in 2011 showed that more than 80% of them considered empathy as a basic factor for success in treatment, but only 53% believed that their referral centre was providing it.

What's going on? Thomas Lee, CEO of Press Ganey and well-known health expert, physician, researcher and professor at Harvard Medical School, has published his latest book, "An epidemic of empathy in healthcare. How to deliver compassionate connected patient care that creates a competitive advantage". The question that is formulated in it is: Can we create an epidemic of empathy in the health system? Can we make it contagious? In the book, Lee poses an interesting reflection on the current health system at the global level. After a revolutionary century of advances in medicine, progress itself has provoked a paradoxical situation: professionals are today focused on such specialized areas of health that they are often overlooking the simplest fact of all, that their patients are suffering more than they say, and this suffering goes beyond pain. It includes fear, uncertainty, anxiety, confusion, distrust and hope, factors that unfortunately are very present in our system today.

With this statement, although resounding and apparently pessimistic, Lee makes an interesting display of the causes that may have led us to this situation, and offers us a very constructive vision of the possible solutions to propose a change of paradigm: a more coordinated and more empathetic health care system that is capable of dealing with the real needs of patients, while maintaining itself dedicated to help professionals regain their pride.

The problem: today we can technically do much more for our patients than a few generations back, but the tendency to over-specialization has exponentially increased the number of people involved in each clinical case, and this has caused an increase in the "distance" between professionals. A study in the year 2000 in the USA showed that a Medicare patient saw an average of 7 different doctors per year, which worked in an average of 4 different centres, a factor that makes interaction between them very difficult.

Primary care professionals almost don’t visit the hospital, and very often patients, once they are discharged, are no longer visited by the specialists who treated them in that centre. With this idea in mind, Lee launches a peculiar metaphor: primary care physicians as air traffic controllers, and hospitals as airports where doctors run from one side to another without time for quality interactions that allow them to discuss their "shared" cases. Super-specialization has made a more complex coordination necessary. This factor has increased the frustration of professionals who argue, with reason, that they have more and more work, more things to worry about, more people to coordinate with, and more pressure to do things efficiently and quickly.

In this scenario, Lee believes that we have the imperative of competing in providing value to the patient, that is, attending to their real needs in the most efficient and effective way possible. And why are we not getting it if in fact it’s what we aspire to do every day, in every consultation and treatment? A new paradox: patients assume that they will receive quality technical assistance, but also expect their fears and concerns to be addressed. On the other hand, professionals assume that their assistance is human by definition - remember that they entered this world by vocation - and focus basically on performing an evidence-based medicine.

The medical guarantee is essential but by itself it isn’t enough to ensure success. Patients expect professionals to work in coordination and respond to their fears and concerns. They want a relationship of mutual trust with their doctors and with the organizations where they work. Lee gives us a final chapter with what he considers to be the 10 steps to build an empathic and high-level health system

What could we take out of Lee's Decalogue to apply to our health system? Here are some thoughts:
  • Providing value to patients must be the prime objective in health 
  • Believe that empathic and coordinated care is a key factor for quality healthcare
  • Measure the results that are important for patients
  • Organize patients and healthcare providers in Clinical Management Units to improve results, and to do it in the most efficient way possible
  • Ensure that the construction of social capital - the people of the organization - is a strategic priority factor such as the economic/financial one
  • Identify the teams that constitute real health care units and use the science of relationships between people to improve their effectiveness
  • Implement economic incentives, if appropriate, for economic issues
  • Promote non-economic incentives (inspirational, motivational) for the creation of an epidemic of empathy in our organizations

There are plenty of opportunities for professionals to attend to the real needs of patients, but only organizations that can help and support their teams to carry them out will be successful and will be able to benefit from an empathy epidemic.

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