Sunday, November 9, 2014

Revisiting Care systems...


One of the on-going discussions in health care in the West these days is about “Patient Centred Care”. 

What is this Patient Centred care? In simple terms, where patient is at the centre of care, or care personalized with patient preferences and customized to the patients interests and desires.

“The IOM (Institute of Medicine) defines patient-centred care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."

In care homes – the question being asked is “what is important TO the patient” and not what is important FOR the patient. This is an interesting change – change from “professional centred care” to patient centeredness. Professionals know what is good for the patient (at least we think so). But what we don't know is, what is that they want, what is important for them. In the West, this is being done through documenting “One page profiles” of each patient – of what is “Important to “Ms X” or “Mr X” and How best to support Ms or Mr X, and what those who know Ms X and Mr X say they like and admire about him or her. And these one page profiles are used to match care givers to the patient, based on those who will fit into taking care of the needs of the patient. This is supported by communication charts and decision making profiles, based on patient preferences  likes and desires, decision making agreements, and then reviewing systems through patient centred reviews.

How would such a patient centred review look like – in addition to Health out comes, the over all experience out come, the care out comes, and the softer aspects of the stay in the hospital or centre will need to be captured. Definitely this will push systems to a different level and of-course costs too…

In an individualistic culture and society, where individuals desires and preferences are kept at the centre of care, and this is a natural direction to go, if care quality has to improve. In a context like India, where family and community play a major role, if we are to replicate, how could this look like? Can we develop as adapted version of “Patient centred care” supported by “Family Friendly Systems”? Where patient is supported by the family and family are empowered to part of the care system. Where, the systems are family friendly, where by, there are facilities for family to stay with the person, communication and active participation in care are encouraged and supported.

But in the context of a community based culture, even the family friendly systems may not be enough!. We need to move from “Owners run institutions” to Community Engaged or Involved Institutions.

How do we build engagement of the community at large in the institutions we own and run, how can one engage community without losing the primary purpose for which institutions or organizations are set up, are issues one need to think through. Many a institution has lost local relevance, and is of no use to the local community, though it might be providing excellent service to populations away from the local context through referrals. 

If that is the direction how do we build ownership of a care program which functions from their vicinity for a community from out side? Or how do we reposition to be constantly relevant to the local communities needs, unless there are systems to hear and engage with them?

The natural outcome of such repositioning will be an integrated continuum care system. Where the Individual, family , community and institutions become part of a comprehensive care system.

Is it a dream worth pursuing or an utopia….ramblings of the confused mind….!

Stations on the Road to Freedom

Dietrich Bonhoeffer(1906-1945) Discipline If you set out to seek freedom, then learn above all things to govern your soul and your sense...