In this brief article by Dr. George B. Isaac MD, we will look at various aspects of
the National Health Service together with the impact of patient involvement; we
will share the usefulness of an approach we have developed for patient
involvement in real-time.
We will also briefly look at some of the challenges facing
the NHS in its goal to actively involve patients; we will detail a particular
approach and look to see what effect it might have on outcomes; we then propose
further research in the area.
Dr. George B. Isaac MD -
NHS Activity & Long-term Conditions
The NHS undertakes a tremendous amount of clinical activity,
with huge amounts of clinical episodes every day in addition to more than one
million scripts being written every day.
It is also worth noting that all interventions in the
Western World are of limited benefit. In fact, only 50% of patients with
long-term conditions might take their medication. We also know that patient
education and their active participation in treatment decisions have an impact
on outcomes too. This is in the context of 80% of the NHS spending being on
long-term conditions.
NHS Challenges
With budgets reducing at a time of financial crisis it is
vitally important that we review how and what we spend, and how effective it
is. In addition, we should take every step we can to measure the effectiveness
of healthcare interventions but more importantly, look to improve the outcome.
There also remains negative feedback to the service that the
NHS might offer, an example being the case of Ian Birrell who summarised his
experiences through articles in The Independent newspaper.
We also have to accept that many of the NHS structures are
bureaucratic and slow. Decisions involve multiple steps in a complex process
and it is not always possible to understand what value is added by these steps
in order to discuss and propagate change.
We are going to share with you a simple tool that has been
developed over a course of many years to look to get real-time patient feedback
and how this has been useful in terms of understanding the patient's point of
view but also helping with team and service development.
A Small Solution by Dr. George B.
Isaac MD
One small solution to the clinical challenges the NHS faces
might be to use real-time patient feedback in addition to patient briefing and
debriefing. This tool is based on the Picker Foundation questionnaire and has
subsequently been simplified to just two questions; in the current guide, it
has several questions, which can be changed over time, but also a free text
area to ask for further suggestions.
The principle of getting the patient's feedback or involving
patients in a different way is not a new phenomenon. Institutions regularly (as
part of the CQC assessment) ask 800 patients for feedback every year. However,
all of these measures tend to be some way removed from the actual clinical
encounters of given patient and a given clinician on a given day.
Dr. George B. Isaac MD
Experience
There are challenges with the real-time patient feedback, or
feedback of any sort, but these are not insurmountable. There are difficulties
of where to start and of sustaining the patient involvement over time.
We would like to share some experience we have gained over
the last few months.
We noticed that there is a need for training, together with
the need to engage and to involve colleagues to demonstrate relevance. There
may sometimes be infrastructure problems in addition to other obstacles, but
critically there may also be fear.
There is a degree of reluctance and hesitancy in looking to
get patient feedback with people being unsure of the objectivity or value of
the patient's feedback. There perhaps maybe even negative consequences.
In the past patient, the feedback has been of a limited
visibility, but this is all changing with the Department of Health, GMC,
patient groups and the patients themselves all agreed on the importance of
feedback to the clinical service.
Current Form
The current form of the systematic self-review was
formulated with the briefing of the team before the start of the clinic pre and
post-consultation questionnaires.
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