The Titanic orchestra

Salvador Casado

This week the Minister of Health convened an urgent meeting to address the problem of Spanish Primary Care which, like every winter, does not cease to accumulate headlines. Surely she had to listen to objective data that speak of the structural deterioration of the same, the progressive overload of care, the lack of resources and the delicate situation of professionals. Surely they taught her the numbers that indicate how it is increasingly difficult to find family doctors, fleeing abroad from the garbage contracts offered. The graphs indicate that in a few years a high percentage of the most veteran doctors will retire. In addition the population pyramids indicate that there will be more and more complex chronic patients...

It should not be easy to be responsible for a constitutional right such as health care when the structure of transfers of health services to the Autonomous Communities has been from the beginning an epitome of lack of coordination, political commodification and duplication of expenditure (multiplied information systems, non-centralized purchases of medicines, technology and  external services among other things). And of course, what others have not fixed, I am not going to fix...

Improving health takes a lot more than exercising, dieting and quitting smoking

Josep Vidal-Alaball

In 2014, Ryan Meili, a Canadian family doctor, wrote a provocative article criticizing the health promotion policies implemented since the 1970s in most developed countries. With the title "Improving our health is about more than diet, smoking and exercise", Meili reviewed the determinants of a population’s health.

As is known, among the elements that determine  population’s health, health care is the least important when compared to the weight of social factors such as, for example, income and distribution, education, housing, employment or the social support available to the individual. Although the importance of these factors is evident, and although study after study has shown the differences in health caused by social inequalities, health policies continue to be largely committed (and budgetary priorities demonstrate this) by allocating available resources to improve health care of the population, often forgetting the other factors that are also determinants.

Who is responsible for providing quality and safe care?

Mª Luisa de la Puente

Chris Ham and Don Berwick argued that the teams of professionals who care for patients are mainly responsible for providing quality care and safety, placing managers and regulators second.

The health managers’ role is to manage the means of communication, training, resources and the time critical requirements to enable the functioning and constant improvement of the care and safety requirements. They cannot achieve this it if they are not focused on what is happening in the front line and making this their main priority.

While managers have the responsibility to add value to clinical teams surrounding them with the resources necessary for continuous efficiency and safety improvement, the clinical leaders must connect with the managers and the professionals and focus on  detecting the organisational factors that may leave room for improvement and work in the reordering them and in innovation to carry these out. According to this view, the new definition of professionalism assumes that those professionals who work in the first line, with the support of others, must accept the responsibility to identify and remove the obstacles that may get in the way of a high quality of care. Similar recommendations have been proposed by others like Bohmer since 2010, but the authors insist on this fact, given the practical difficulty to carry them out. 

Medical Schools: reductionism versus empiricism

Competitive eagerness has reached the medical faculties and now produce batches of new doctors with a higher scientific preparation, priorities arranged by factor of impact, a competitiveness for research funds and, to a lesser extent, clinical practice. Young doctors know that in order to fight for the most coveted places they must show a resume full of publications, while the clinical skills, although present, will not be the differential element. What is observed, then, is that the educational reforms driven by academic success.

The Lean methodology to improve the patient's experience

Glòria Galvez

There are management methods that having proved useful in the industrial sector have now ended up being incorporated into the health sector. For them to be successful, in addition to the methodology used, it’s essential to give the appropriate approach. This is the case of the Lean methodology that tries to eliminate or minimize everything that doesn’t contribute value in the processes. It was initially applied in the automotive sector; hence it is the reason why it was received with some scepticism in the sanitary sector with the argument that "People are not cars". However there are numerous examples in the USA, Canada or Spain of their positive impact on hospitals; such as the case of the Consorci Sanitari del Garraf, which has recently been awarded at the World Hospital Congress 2017 for implementing the Lean Healthcare methodology in its health centres.