The crisis as an accelerator of latent changes

Cristina Adroher
 

It has been said by active and passive: a different society will emerge from this crisis, with profound changes in its values and practices. As for the healthcare system, there will be a time to analyze it, once the storm subsides but those of us in the backstage can go paving the way. Here are three proposals for aspects that I think could begin to be amended.

First, the role of primary and community care. it’s explained by a team of doctors from the Papa Giovanni XXIII Hospital in Bergamo, the focus of the virus in Italy, in an article published in NEJM. Western healthcare systems have been built around the mantra of patient-centred care, but in a state of the pandemic, this approach has to be replaced by a community-centred model (see an interesting initiative to introduce community health workers put into a march on the NHS). In our context, the primary care teams have reacted to this situation by reorganizing themselves with changes in the work teams, adapting their services and assuming new functions such as support for the end of life process, among other actions. Even so, could the first level of care be more protagonists in the management of the current crisis?

This situation seems to suggest the need to rethink its orientation by emphasizing the community essence: the management of health problems through comprehensive care (holistic vision), the approach to the broader determinants of health, that is, knowing the context of the person through bonds of trust with the professional, and promoting the autonomy of people in their daily environment, hence the importance of home care. In addition to the list of proposals discussed in this blog, the role of primary care in supporting nursing homes and social centres (critical point in the management of COVID-19) should be reformulated and the incorporation of instruments and incentives to retain patients in the first level of care as is the case in other European countries. Open the thunder box of the contracting model and the payment system!

Second, the hospital model we want. Hospitals are organizations in which highly specialized knowledge is concentrated, with access to high-tech equipment and a high capacity for innovation. These days are being the epicentre of treatment for infected citizens, highlighting the specificity of their resources and their professionals to respond to the critical situation they have to face. They are reinventing themselves at full speed, adapting the way they provide their activity, treating an exceptional volume of patients, increasing the number of critical beds, maximizing the versatility of professionals or attending home, among other measures.

In the return to normality, it could be approached what concept of the hospital we want (dimension and casuistry to be treated), rationalize the use of hospital beds and reformulate its structure moving towards centres focused on treating more complex cases (high technology procedures, advanced therapies, etc.). The activity that isn’t strictly necessary to develop in a hospital, it’s better to carry it out in another less technical centre or at the patient's home. The adaptability that hospital organizations are showing to the current situation shows that, under normal circumstances, they have room for improvement in network performance with other devices and to be more "liquid", leaving their walls and adapting to needs of the new citizenship.

Third, we have the extension of the use of non face-to-face care resources. Confinement has shown that some expendable travel can be avoided - a perfect opportunity for telemedicine. Miracle! Tools that allow you to continue serving citizens and avoid contagion: face-to-face consultations converted into remote ones, both in primary care and hospital outpatient consultations, or procedures that in 2020 are still mostly carried out in person, such as discharge management, medication update, etc. Furthermore, this situation has been a catalyst for digital patient portals, as demonstrated by the extraordinary promotion of the use of La Meva Salut.

We have finally reached the 21st century. In terms of technology, society is much more advanced than the healthcare system. We must take advantage of the change in habits these days - of the system as a whole, both professionals and users - to evaluate the tools used and promote those that are effective. Under normal circumstances, that is, in the absence of pandemics, some studies suggest that digital health tools lead to social savings, as well as environmental ones.

These days, health sector professionals show a great capacity for resilience and teamwork based on shared leadership. It remains to be seen whether from this we will emerge with a more strengthened society, with stronger social ties and capacity for cooperation. In  Robert Putnam’s, with greater “social capital”: “If we want prosperity, we must begin to rebuild the structure of the community.” If we want a prosperous healthcare system, we must begin to promote latent changes with community vision, changes that those in the front line are already undertaking.