Is it possible to humanize health organizations?

Jordi Varela
Editor

Today, more than ever, the human part of the contact between patients and clinicians is taking centre stage, from health centres to critical care units and, therefore, the former must strive to be more accessible, while the latter has to demonstrate that the services they go beyond sophisticated clinical practice. Right now, we are at a point where the technical preparation and dedication of clinical professionals cause admiration, but it must be recognized that, with few exceptions, the warmth in human treatment has a lot of room for improvement.

Improve the safety of your patients… share your ideas!

José Joaquín Mira

"But, if you don't know how this goes...!" "What are you in for?" "Shut up, you're better!" Expressions like these are common. They modulate the culture of our organizations and, although we do not give them excessive significance, they condition our behaviour. I don't know if it has happened to you, but sometimes we have the feeling that it is better to remain silent than to speak. Sometimes, the fear of being disliked, receiving a bad response, or receiving a reprimand causes us to keep quiet. In the workplace, there are hierarchies, unwritten rules, customs, and group dynamics that determine when and how things are done and what should and should not be said. But this way, the quality of care will never improve and patients will have a higher risk of suffering an adverse event. The culture of the organization contributes to speaking up or shutting up. Individual differences do the rest.

A new recipe for teamwork in primary care

Jordi Varela
Editor

 

Primary care teams in Spain are under pressure from the schedules of daily visits, which sends multidisciplinary teamwork to the background. To understand each other, the sessions are held whenever possible and the level of attendance and participation is often irregular, given that nothing encourages them. The core aspect of a primary care centre today is that each doctor and each nurse is assigned a contingent of citizens -presumed to be patients-, who, when requested, must be attended to as soon as possible.

Five-point plan to increase the value of clinical practice

Jordi Varela
Editor

In an article recently published in Clinical Medicine, Five recommendations to increase the value of clinical practice, I proposed a plan with a view to a more valuable clinical practice and, given the timely topic, I allow myself to partly reproduce in this post. You should note that this plan does not support pilot tests or halftones, but should be implemented with a perspective of in-depth organizational change, aiming to generate an institutional profile of value and excellence.

Hospital outpatient department, the great mess

Jordi Varela
Editor

 

Hospital day services don’t stop growing to the detriment of traditional hospitalizations, to the extent that the NHS has estimated that, in England, patient movements to hospitals generate 5% of road traffic throughout the country. Many of these services, such as surgery without admission, chemotherapy, anticoagulants or endoscopies, have been very well outlined since their origin, external consultations in general, on the other hand, are multipurpose devices where each speciality has accumulated outpatient services of very different characteristics until they become overflowing spaces that are difficult to manage, precisely because they have not defined what is expected of each of their activities. To give an example, a rheumatologist told me that it was unfortunate that they were evaluated due to the relationship between first and subsequent visits, when it’s known that his patients are complex forever, and he suggested that it would be convenient to be able to assess their service based on the quality of life their patients get, about the costs of prescribed treatments.

Surgery and the elderly

@varelalaf

More and more elderly people are being seen in the operating room, especially for large joint replacement interventions, for colorectal cancer resections or for vascular pathologies, to cite the most frequent casuistry. Many of these actions are aggressive and generate risks of postoperative complications, which often require catheters, serum, transfusions, intubations, etc. Therefore, a lot of clinical circumstances are generated that induce immobilization, a situation that adds a new chain of risks, especially thromboembolism, bedsores, infections, disorientation, delusions, malnutrition and dehydration.

COPD: can patients’ quality of life be improved?

Chronic Obstructive Pulmonary Disease, as the name suggests, is characterized by a chronic airflow obstruction in the bronchi and in contrast to asthma, this limitation is poorly reversible and progressively worsens. The diagnosis of COPD is based on spirometry, a test available to primary care and nurses trained in the technique. According to an EPI-SCAN study of 2006-2007, the prevalence of COPD in the Spanish population aged 40 to 80 years is 10.2% (95% CI 9.2-11.1), with a stronger presence in men than in women (Soriano, 2010).

To better understand how you can relieve the daily lives of patients with this chronic disease, I have chosen a systematic review, not a meta-analysis, published in the Archives of Internal Medicine in 2007.

Can unnecessary hospitalizations be avoided?

It is said that the best savings in health is in avoidable hospitalisation that doesn’t occur, especially since the use of a hospital bed is the most expensive health resource of all the health offers, but also because if one person, let’s imagine an elderly one with several chronic conditions, can avoid being admitted in hospital, his/her health will suffer less compromising situations. For this reason, all health systems are very active in trying to launch all kinds of measures to reduce the admission of chronic and frail patients.

Dr. Sara Purdy, family physician and Senior Consultant at the University of Bristol, published under the auspices of the King’s Fund, in late 2010, an analysis of what actions reduce the unnecessary hospital admissions and which ones do not. The work of Dr. Purdy is focused only on organisational actions such as home hospitalisation or case management, and, in contrast, does not include strictly clinical factors such as the impact of a new drug for asthma conditions.

See below what actions have been proven to reduce unnecessary hospitalisations (for the source of evidence, consult the King’s Fund paper):