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| Interdisciplinary team to evaluate patient experience |
Directly or indirectly, I experienced three innovations in the provision of services during the 1990s. I am referring to major outpatient surgery, hospital at home, and home mechanical ventilation. In all three settings the characteristics are the same:
a) These innovations had been developed throughout the world for years and with good results.
b) Practically no new technological requirements were needed to put them into practice since ambulatory anaesthesia was well known and portable ventilators too, for example.
c) They were implemented due to a change in mentality promoted by professionals. In the first phase, there was no financial incentive for health care organizations to promote this alternative.
Of the first two innovations, I have direct references from two good friends, Dr. Jordi Colomer(4) and Dr. Francesc Rosell (e. p. d.)(5). In the case of home mechanical ventilation, I was directly involved in the process at the Hospital Universitari de Bellvitge(6). It would be difficult for me to understand a large part of my work caring for people with chronic respiratory insufficiency without reference to the "Vida als Anys" (Life to Years) Program (1986). Some projects dazzle, but stimulating, rooted, and fruitful projects are the ones that constantly enlighten. The "Vida als Anys" Program would be a clear example of these successful innovations in the provision of services, both in the field of elderly care and in an intermediate care or the palliative care(7).
The Dutch experience with the Buurtzorg model (small teams led by nurses who care for groups of elderly people in the community) is a disruptive option and it seems that with good results(8), a good model of success.
At the other extreme, we find the disruption in the provision of services based on access twenty-four hours a day, seven days a week, with technological support. The Chinese insurer Ping A Good Doctor(9) offers online consultations with a good experience in most cases (except for acute respiratory infections or dermatological problems). JAMA magazine has recently published an opinion on virtual visits(10). A North American insurer has offered cheaper care programs if they include virtual visits 24 hours a day, seven days a week, as the first option for contact with primary care. It can be argued that these last two examples could be labeled as technological innovations, but the truth is that the technology they use has been around for a long time. What is innovative is using it differently, using existing technology in such a different way that it profoundly changes how the service is delivered.
It would also be necessary to analyse whether a priori disruptive, convenient and sustainable conceptual frameworks have been properly used. I am referring to the entire conceptual framework of integrated care. Hughes et al.(11) wonder why integrated care does not work: there are no significant changes in the patient experience and no reduction in admissions. The conclusion of the study is this: "However, integrated care structures were only part of the complex network of resources that patients used to manage their pathologies in the long term. For integrated care to work (for structures affect the material and concrete results), patients must be able to resort to relevant and timely resources". Perhaps the key is to define what are the "relevant and timely" resources and, perhaps, there are more "relevant and timely" resources in the social field than in the health care field. Without discussing the need for and how to achieve social and health care integration, it would perhaps be interesting to learn more about the experience of Barcelona's "social superilles" (inspired by the Buurtzorg model), a community home help service, and proximity.
Regina E. Herzlinger(12) says that three main types of innovations stand out: those that focus on the "consumer", those based on technology, and those based on changes in the financing system. All three forms of innovation have to face resistance and barriers. In the case that concerns us in this article, innovations focused on the "consumer" (on the person receiving the service) generate resistance because they are seen as a direct threat to the status quo. Overcoming the barriers implies considering all the professional sectors involved, the legislation, the payment system, technology, and accountability. But in the case of consumer-focused innovations, the active role of the person receiving the service is key. In our case, it is clear that it is the patients and the caregivers.
The patient experience is now the driving lever of innovation in the provision of health services. At the Hospital Clínic de Barcelona we have systematically introduced the patient experience to improve the provision of services globally at the Clinical Institute of Nephrology and Urology, in a project promoted by Dr. Beatriu Bayés and the Hospital's living lab, with relevant short-term results: start-up of new assistance devices ("Hotel-Health" to welcome patients undergoing study or recovery, through "protected early discharge"), improvements in information for patients and caregivers (videos, electronic bulletins, and live seminars), new functions for volunteers (hosting) or reinforcing various professional roles (psychological support or nutritionists) and promotion of alternatives to face-to-face visits (peritoneal dialysis). All these projects share a common denominator: taking into account the perspective of the person receiving the service. The tool is simple: just ask.
Ask with meaning, with intention. Edgar Morin has written on Twitter: "If we knew how to understand before condemning, we would be on the way to humanizing human relations." We could substitute "condemn" for "assume" or for "it has always been done this way" or "this is not possible in our environment" and, perhaps, in this way "we would be on the way to humanizing human relations". Asking to understand is the key to make innovative proposals in the provision of health care services based on who receives the service.
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