7 Steps to Patient-Centred Care
To change health care for the better, patients and family caregivers need to concentrate on the big picture. Let the experts figure out how to achieve that big picture. It’s really that simple – not easy, just simple.
The following are seven steps that can help us immediately increase the practical patient-centred care we all need and that some people already get. This is not pie-in-the-sky thinking. Some people already get excellent care. Reform means everyone gets that same excellence.
1. Physicians (all of them) need to understand our medical and family histories. They need to take the time (about 20-25 minutes) to do it right, the first time and create an electronic file that we can take with us to other medical appointments. People who take care of us know too little about our medical history.
2. Family caregivers need to keep notes for their loved ones and ask any questions of our health care providers that patients forget to ask. Combine these answers with the patient’s history and you have both the past and present information necessary to make treatment decisions
3. Pain and symptoms must become part of taking vital signs (the others are taking our temperature, blood pressure, respiration and pulse). We know that almost all pain and symptoms can be reduced resulting in people living longer, happier lives.
4. Health care providers need to slow down. Limited staffing, poor systems design and thoughtless policies and procedures demand too much of our health provides. They need to incorporate deep breathing exercises whenever they are with patients. A perfect opportunity is when staff take vital signs. This does three things:
(a) When their breathing slows down, their heart rate (from rushing around) slows down which allows their thoughts to slow down enough to actually be there with the patient instead of imagining themselves down the hall taking care of someone else or picking up milk before heading home.
(b) As they are slowing down, they can help patients and other caregivers learn and use deep breathing to reduce their own anxieties and stresses. Deep breathing can help them all in really practical ways.
(c) Slowing down means that when they touch patients to take a pulse or blood pressure, they are actually acknowledging the physical touch has an incredibly calming and healing effect to the mutual benefit of patient and staff. We have lost that understanding in our need to rush everything.
5. In New Yorker magazine on January 24th of this year, (2011) there was a detailed article on the economic and social benefits of taking care of the sickest patients first. Doctors reduce these patients’ visits to hospital by treating them early on and thoroughly. This saves millions of dollars. More important for patients is that they do not have to become critically ill before they get some attention.
6. Patients and their family caregivers need help to navigate, negotiate and mediate the care they need. Often we don’t know where to go, whom to talk with, what questions to ask, what answers to accept (or not), who is ‘in charge’ of our care, and so much more. Once we get to the right place (if we ever make it there) how do we negotiate the best care possible? Some people in Canada get excellent care. We need to ensure that more people get that same level of existing care.
When we are in the right place receiving the best care possible, there will still likely be times when we need help mediating conflicting priorities. Many of us have had three different specialists see us when we are in hospital and each one offers different opinions of what is needed. They do not, typically, talk to each other. Family caregivers should not have to mediate problems. The health care facility needs to provide that service through a single physician taking full responsibility for a patient’s overall care.
7. There are too many medical errors in hospitals and long-term care facilities. They are costly and, too often, deadly. We need to incorporate checklists similar to what pilots do before, during and after their flights. Checklists are sometimes used for operations but should also be used for visits to a family doctor, for tests, for treatments, for cleanliness of facilities and for infection control. This is not expensive to do. It will save money and lives.
So that’s it. Seven steps. They will allow administrators, politicians, and bureaucrats to meet a patient’s physical, emotional, spiritual and information needs. Again, quite simple – not always easy. But it must be done. We are smart enough to do it. It’s already being done in some places. We need to replicate our successes. There really are no valid excuses.
See related article: "How to Make Sure Changes are Patient-Centered."
Harry van Bommel: Harry van Bommel is the author of over 35 books. You can read many of his publications, for FREE, on his not-for-profit website: www.legacies.ca.