About the 16th International Conference on Integrated Care

Last week, Barcelona was the host of the 16th International Conference on Integrated Care, a conference that brought together more than one thousand of health and social professionals in order to discuss the integration of services in response to the fragmented practice. Nick Goodwin, President of the International Foundation for Integrated Care (IFIC) in the Conference’s presentation video says that we often think about the integration of services as a mechanism for reducing unnecessary hospitalizations, or even to reduce costs of the waste caused by lack of coordination and inappropriate actions, but Goodwin points out that we should make no mistake: the main objective of this movement is to generate opportunities for care coordination in order to improve the experience and quality of life of patients, especially of those in need of complex health and social care.

Advanced practice nurses: it’s time to strongly support

According to International Council of Nurses, an advanced nursing practitioner is a specialist who has acquired the expert knowledge, the capabilities of making complex decisions and the necessary clinical competencies for expanded practice.

The concept emerged in the US, in the 70s, in the areas of obstetrics and anaesthesia and, thereafter, the development of the nursing profession has focused on what has been renamed Advanced Nursing Practice (ANP). It’s a graduate training that provides an overview for the care of complex patients, for the involvement of people in managing their own diseases and, in short, for everything that regards innovation, evidence and research aimed at improving the care offered to people.

Family doctors: it’s time to strongly support

The number of places for family doctors at the last resident doctors (MIR) call from the Spanish government is of 1,671, only 25% of all specialties convened. The question is: Will this annual promotion of family doctors cover the future needs of an increasingly aging population? If we’d pay attention to a report from British experts, "Securing the future GP workforce" the answer would be clearly negative. This document ensures that to meet the challenges in chronic disease from primary care, half of medical students who now graduate would need to become family doctors. But how to make the profession more attractive if its disrepute is so big that each year, at the MIR call, there are many vacancies left and the dropouts during training reach 15%?

In a survey (“Why doctors flee and shun the family medicine?” by Gonzalez B, Barber P and Ortún V) undertaken with students from the sixth grade of the medical course, a surprising finding stands out: students prefer generalist specialties, including family medicine. The surprise, however, doesn’t last long, because after strenuous preparation for the MIR test, most of, by now graduated doctors, shift in preference and opt for more technical specialties. The same survey warns that, this in this shift, we can detect not only the influence of MIR but also other relevant issues such as working conditions, pay and prestige.

How to involve doctors in transforming the health system

All health systems need to streamline costs while solving a lot of complex problems and  improving health outcomes. We’re dealing then with difficult challenges that are almost impossible without the doctors’ involvement, and for this reason I found this article to be very relevant: "Engaging Doctors in the Health Care Revolution" by Thomas Lee and Toby Cosgrove, from Harvard Business Review, as they are seeking solutions from Max Weber and his 4 fundamental motivations for social actions.

Motivation 1. Look for noble targets

When managers and doctors meet up, they ought to discuss patients, quality and results, and if they really want to change the status quo, they should not wonder away from this script. The conversation, therefore, should never start with contracts and compensations, this topic ought to be reserved, if at all, for the end of the meeting, after the main topics. Managers ought to listen, assess the views and know how to create a process in which all parties should have the opportunity to add their personal touches to the final process. A basic script of 3 points that the authors extracted from Mayo Clinic should be kept in mind: a) at the time of sitting down for the discussion, everyone should be very clear that things can not continue as they are; change is needed, b) the transformative project that arises must be clearly focused on the patient, and c) this is a path on which all involved actors will walk together.

Hospitals and frail elderly patients

Health Service Journal published a report from a committee of experts based on several previous publications, including the British Geriatric Society, Future Hospital Report and King's Fund. From the conclusions of the report I want to highlight some ideas that in my opinion are important:

a) Age should never be a barrier to receiving appropriate, coordinated, safe, efficient and effective care.

b) Integration of social and health services within the community framework is the best approach that can be offered to the group of frail elderly people, although this does not prevent the occurrence of circumstances that may require hospitalization.

c) The emergency departments of hospitals should have the geriatric culture well established in order to make appropriate choices and avoid unnecessary admissions.

d) If the frail person qualifies for hospitalization, the practice of geriatric assessment is imperative as is the practice of developing an individualized treatment plan, because it has been shown that if this methodology is followed through, patients are 30% more likely to survive and go home.

Hospital wards (2): occupation, weekends and safety

In the last Monday’s post, I was referring to the organizational quality, the provision for the medical guard and the coordination of professionals with the clinical safety of patients, and this second part of the same subject of hospitalization wards, I was left with a couple of things to deal with, also related to the quality of care: the stress caused by the large workload and the lack of services during the weekends.

The high occupancy of the wards increases mortality

A group from the University of Cologne, with the collaboration of Cambridge, has conducted a study in 83 German hospitals with more than 80,000 patients with pathologies of risk and have concluded that the tipping point for a hospital ward is 92,5%, occupation, a figure from which, the chaos inherent in the situation created by the excess patients, generates a significant increase in mortality.

"If a hospital regularly works above the tipping point, says professor Stefan Scholte's in the Cambridge University blog, you can bet that it has a structural quality problem, but what we need to be wary of, is those hospitals reaching the tipping point occasionally but repeatedly, generating risk situations for patients who are not normally detected by the aggregate statistics."

Hospital wards (1): nurses and clinical safety

Often, when we talk about clinical safety, we refer to specific activities such as hand washing or surgical checklist, but in this post I will try to explain the repercussions that the methods of working in hospital wards have on the quality of care. When people are admitted to a hospital, they put themselves in the hands of an army of professionals, who follow guidelines and are subject to shifts and medical guards. We must pay attention to all this, because the evidence has been warning us that what we call organizational factors weigh more than we think when it comes to hospitalized people’s health.

The 12-hour shifts are less secure for patients than the 8 hours shifts

A study conducted by the University of Maryland concludes that the probability of error is 3 times higher for nurses who work in 12-hour shifts compared to the one who work on 8 hours shifts. This finding has been corroborated by extensive research (22,000 records) conducted by the School of Nursing at the University of Pennsylvania.