In search of the things we do without reason

Nacho Vallejo

In healthcare, there is usually a special appreciation for tradition or antiquity, which does not always translate into better clinical care. The reality is that there are things that we professionals do without the contrast of adequate evidence or, simply, without these actions providing sufficient value.

The Choosing Wisely initiative was launched a few years ago from a private North American institution. It was necessary to suggest to the scientific societies of that country the development of recommendations on clinical practices that both doctors and patients should rethink.

Exponential innovation, or getting ahead

Josep Maria Monguet

The sustainability of health services is associated with rational development. The key element is the generation of knowledge-intensive employment, which can only be the result of innovation.

In general terms, innovation in health must have an exponential dimension and be based on:

• The generation of intelligent demand by health professionals
• The participation of citizens and all social and economic agents
• The promotion of business models based on value for users

Family medicine confined into an individualistic practice

88% of the demand for assistance requires some kind of coordination

If we glimpse at the memories of the primary care centres, we will notice they all attach great importance to the number of visits, especially family doctors, in the sense that the more visits, the less waiting time. Unhappy with this, I have clicked on the primary care document of the AQuAS Results Centre, one of the most advanced evaluation systems in the world, and I have observed that, in addition to efficiency, data on effectiveness, quality, and value practices and information technology development are collected. The indicators of adequacy warrant separate mention since they are the only ones that, although indirectly, give an estimate of the collaborative work of the primary care teams, implying that if the preventable hospitalizations and the number of multi-medicated patients are in low levels, should be an indicator that in that team there is some form of integrated model of clinical work.

The collapse of narratives

Salvador Casado

The systemic crisis that we are experiencing sets the stage for the current collapse of civilization. It is characterized by a globalization of unrest and fear that diminishes thought, reflection and understanding. We find nothing to hold on to, no leaders, no ideas, no narratives, which is allowing power to position itself behind technologies that offer rough substitutes.

Foto: @famani38

This situation of complexity affects all social areas from politics to education, from labour organisation to health. I will focus on the latter, which is the one I know best.

“Always Events” for patient-centred care

Glòria Galvez

What would we like to happen if we, our families or our friends had to be treated in a health centre? The details are important and, although some may seem minor, they will make the difference between having a good or a bad experience. The NHS England, in collaboration with the Picker Institute, the Institute for Healthcare Improvement (IHI) and the NHS Improvement, developed in 2015 a program to identify and ensure the achievement of these details that will be the ones that add value to the patient's experience. The program called Always Events,® as opposed to "never events", aims to translate the principles of attention centred on the person and family into concrete actions.