Dr Azhar Alani, MBChB, MBA 
Healthcare has finally had its eureka moment: put the patient at the centre of everything. Hence the need to look at the industry in a completely different way. If we adapt the patient’s perspective, it will be easier to recognize and manage one of the biggest issues healthcare industry is inflected with today: process waste. In the US healthcare system alone, $1.3 million is being lost every minute in non-value added activities (process waste)(1). Adapting this new perspective - the customer’s viewpoint, will help us understand why the healthcare system needs an overhaul: re-designed to be truly patient-centred. It’s not all about systems and processes, however. At the heart of this journey is changing mindsets.
Without changing mindsets, healthcare industry will remain crippled by its old ways trying desperately to adapt to new realities. One of the approaches to changing mindsets is through a consulting practice called change management: the effort to introduce new ways of doing old things focusing on the behaviour and culture to the effect of changing how people think about their work. However, we need to ask the question: how can we change the mindsets of healthcare managers; those trying to introduce change in the first place?
· compassion, empathy and responsiveness to needs, values and expressed preferences
· co-ordination and integration
· information, communication and education
· physical comfort
· emotional support, relieving fear and anxiety - and
· involvement of family and friends.
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(1) From A Global Village publication, "Enabling E—Health A Revolution for Informatics in Health Care" by Simon Kennedy & Benjamin Berk, The Boston Consulting Group http://aglobalvillage.org/journal/issue4/ihealth/kennedy/
(2) Visit www.patientsknowbest.com/
Healthcare has finally had its eureka moment: put the patient at the centre of everything. Hence the need to look at the industry in a completely different way. If we adapt the patient’s perspective, it will be easier to recognize and manage one of the biggest issues healthcare industry is inflected with today: process waste. In the US healthcare system alone, $1.3 million is being lost every minute in non-value added activities (process waste)(1). Adapting this new perspective - the customer’s viewpoint, will help us understand why the healthcare system needs an overhaul: re-designed to be truly patient-centred. It’s not all about systems and processes, however. At the heart of this journey is changing mindsets.
Without changing mindsets, healthcare industry will remain crippled by its old ways trying desperately to adapt to new realities. One of the approaches to changing mindsets is through a consulting practice called change management: the effort to introduce new ways of doing old things focusing on the behaviour and culture to the effect of changing how people think about their work. However, we need to ask the question: how can we change the mindsets of healthcare managers; those trying to introduce change in the first place?
Changing Delivery Model
Healthcare delivery is structurally changing - archaic ways can no longer cope with the changing environment: cost constraints, patients' expectations and the plethora of new technologies. One analogy that comes to mind is the musical chairs game. This traditional group game illustrates the current situation of healthcare delivery model. By arranging a number of chairs (n), participating players (n+1) are asked to run round the chairs while music is playing. Each time the music stops, players try to sit down on one of the chairs. As there are more players than chairs, one person will be left out each round. Imagine the public healthcare delivery system as the chairs around which patients circling until all resources are exhausted and they would either go private or just endure pain. We are trying to turn this set up inside out: we want to make the healthcare delivery system circle around patients in a truly patient-centred fashion, so that patients themselves empowered with knowledge and ownership of their own medical information will be able to choose the best way to receive the care that would be suitable for their circumstances and life style. It’s the inverse of musical chairs game; if you like.Patient-Centred Care (PCC)
There are several interpretations for PCC. The Institute of Medicine’s (IoM) definition is a well-accepted one: ‘providing care that is respectable of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions’. Add to that the fact we in healthcare can no longer deliver what the patient needs single-handedly in a job-shop fashion as it used to be the case decades ago. Healthcare delivery is a function of organization design – team work plays a vital role in ensuring quality of care; where quality is defined by how closely outcomes meet patient’s expectations. The IoM goes on to offer a list of services and aspects that constitute PPC approach:· compassion, empathy and responsiveness to needs, values and expressed preferences
· co-ordination and integration
· information, communication and education
· physical comfort
· emotional support, relieving fear and anxiety - and
· involvement of family and friends.
Patients Know Best
Disruptive innovation has been talked about and discussed inside and out of business schools around the world. Some large corporates took it to heart and established a creative milieu to foster innovation, and made sure such small satellite units are attached to the corporate head-quarters through a “dotted line” arrangement to give it as much freedom and space as needed for the new ideas to flow. A British company has tried to not only disrupt healthcare industry, but also to adapt the patient-centred care approach by changing the “musical chairs” model. Dr Mohammad Al-Ubaydli, CEO and founder of Patients Know Best(2), has devised a new subscription-based system that revolves around the patient. A medical doctor, software specialist and management consultant, Dr Al-Ubaydli represents the new generation of healthcare professionals daring to cross to the other side to change the industry inside out. “Medicine is basically an information industry. It’s all about knowing the right information of the right person at the right time,” Dr Al-Ubaydli was quoted saying as he was describing the idea behind business. In this new approach to making IT work for healthcare, Dr Al-Ubaydli wants to put patients and clinicians in the driving seat, rather than the technology being introduced. Traditionally and unfortunately now all too familiar, previous attempts to modernize healthcare using IT have failed spectacularly, if Connecting for Health (CfH) programme in the UK is anything to go by.From "Paternalistic" to "Participatory" Medicine
We need to move from the out-dated “paternalistic medicine” model of doctors-know-best model to the innovative and more logical for this day and age: what Dr Al-Ubaydli calls “participatory medicine” where patients are at the centre as well as taking part within the whole delivery team (clinicians, healthcare-givers, IT, others). One of the reasons Dr Al-Ubaydli attributes the failure of CfH programme to is the top-down approach that was followed in architecting the healthcare landscape in the UK. Through Patients Know Best model, individual patients have at their disposal their own information and can give permission to whoever needs access to their information as and when at the point of care. With the participatory medicine model, the focus is the other way round: it’s a bottom-up approach./ --------------------------------------------------
(1) From A Global Village publication, "Enabling E—Health A Revolution for Informatics in Health Care" by Simon Kennedy & Benjamin Berk, The Boston Consulting Group http://aglobalvillage.org/journal/issue4/ihealth/kennedy/
(2) Visit www.patientsknowbest.com/
