Essays March 2015

Let's Get Personalized!

Dr. Anne Snowdon and Hugh MacLeod

In the essay that spawned the three part Ghost Busting Essay Series, the Ghost of Healthcare Despair rudely interrupted with this haunting statement…

“Idealist! You waste your time. You should study Saint Machiavelli who wrote: 'It must be remembered that there is nothing more difficult to plan, more doubtful of success nor more dangerous to manage than the creation of a new system. For the initiator is the enemy of all who profit by the preservation of the old institution and merely lukewarm defenders in those who would gain by the new one.' Do you really think you can have any impact on the way things are?  Healthcare delivery is chugging along guided by vested professional interests, political realities, disconnected personal ambitions, economic forces and a host of other factors that make up the real world..

Response…

“Ghost!  I do recognize you. I have seen you before, in myself and my colleagues.  You are a great nuisance.  You keep us quiet when we should ask questions.  You keep us talking when we should listen.  Worst of all, you keep us from acknowledging what is right in front of our noses and doing something about it.”

We reflect on a famous quote by our national hero Tommy Douglas…”Courage, my friends, it is not too late to build a better world.”  Today, we have a rare opportunity to stamp out cynicism by building trust, demonstrating respect and by being open to learning from one another. Changing mindsets is about more than changing minds, it is also about bold and truthful conversation.

The explosion of technology like hand held ultrasounds and mobile eye exam machines, means citizens (the owners) can take health into their own hands. Just think about the impact of embedded sensors on tattoos, and subcutaneous chips that will soon transmit live updated data to the tablets of individuals who take charge of their health and wellness. This disruptive technology will disrupt and change the power balance. It begins to shape a new future that is predictive, preventable and personalized. It’s a shift from a current reactive sickness model to a continuous and proactive value based wellness model.

As leaders in the healthcare system, we know we are not alone in our desire to improve the system. Actively partnering with the people who use our services to make the entire system better is critical. We need to let go of the anxiety that sometimes comes with bringing patients to the table with us. A strategic coming together in a new adult conversation on system alignment using the citizen voice and experience as a focus can offer a humanistic, unifying theme to chase off the ghost of healthcare despair.

We suggest three actions:

Action One: Reframe the conversation from “What is the matter” to “What matters to you.”

The first step to personalization is documenting and framing the conversation around what matters to people as individuals that seeks to identify personal health and wellness goals, which shifts the entire dialogue to focus on the person, not their disease or illness. People judge the experience in healthcare by the way they are treated as a person, not by the way their disease is treated, and not by a provider’s assessment of their “clinical outcome.” In our current healthcare system, conversations focus on the illness or injury (“she is a cancer patient,” “he is bipolar”) which dehumanizes the individual and views them only in terms of their disease.

A personalized health system begins with the person, and focuses on what is meaningful to them. The provider team works with the person to define their health and wellness goals, and then focuses on health services that support the individual to reach their personal goals. The hallmark of a personalized system is the personal connection with the individual – as an individual - that focuses the dialogue on the person and what is meaningful to them, which is the basis for establishing the person’s health and wellness goals, that the provider team strives to achieve by supporting the person to achieve success.

Action Two: Redefine success in terms of health and wellness outcomes that are valued by a population.

Health systems all over the world measure performance in terms of system-focused outcomes rather than person-centric outcomes that are meaningful to people.  Quality, safety, access, and satisfaction indicators are the most common measures of success for health systems.  However, people value health system outcomes in terms, of what is meaningful to them, including quality of life and achieving health and wellness.  Health systems don’t measure person-centric outcomes, they only measure how long people waited for care or the prevalence of adverse events related to care (e.g. errors, readmissions). These measures of quality and safety are important, but they fall short of measures that reflect what matters to people. A personalized health system builds on health system indicators of quality, safety and performance and adds a personalized set of wellness indicators to measure success in terms of person and population health outcomes that matter to people. 

Action Three: Put people in charge - shift the decision-making process from the “Provider as Expert” to the “Person as Expert.”

Putting the person in charge means shifting the power balance in the healthcare system from provider dominated to person centric. A personalized system shifts this imbalance to one that supports individuals, families, or communities in making decisions about their own health, and designs care strategies or approaches that are tailor made to fit with the individual’s personal values, and health and wellness goals. Placing the individual in charge of decision-making allows for discussion to be framed around what the individual wants, and should help narrow the available treatment/or healthcare options to those that best suit the individual’s goals and aspirations for achieving quality of life. This shifts the role of the health provider from decision-maker to facilitator. Once an individual defines what success looks like with and for the health provider, the conversation moves to examining all possible treatment options against how well they achieve the health and wellness goals of the individual, family and community they live in.

Can you hear the whispers below?  If you listen and watch carefully, a movement is afoot.  There is recognition that healthcare is about people.  They are actively shaping and influencing the health system from the outside.  These three actions lay the foundation for health system leaders to create the personalized health systems of tomorrow. 

“Ha!  These three actions require leadership and a shift in culture,” interrupts the Ghost of Despair.

“Have you not been listening to all of the conversations taking place on the balcony of self-reflection?” asks the Ghost of Hope.

My guest next week is Marilyn MacDonald in a conversation about home care personalization.

See essays in this series.

See essays from series 2

See essays from series 1

About the Author

Dr. Anne Snowdon, Academic Chair of the International Centre of Health Innovation at the Ivey Business School, University of Western Ontario.

Hugh MacLeod, engaged and concerned citizen.

References

MacLeod, H. (2012) Forging Complete Questions to Defeat The Ghost of Healthcare Despair. Longwoods Essays.

Snowdon, A., K. Schnarr and C. Alessi (2014). It’s All About Me: The Personalization of Health Systems. The University of Western Ontario.  

 


Comments

Jessie DeSouza wrote:

Posted 2015/09/03 at 12:01 PM EDT

At the Saint Elizabeth Research Centre, the Ghost of Healthcare Hope has been guiding us toward healthcare transformation. We have been exploring and championing a Person-Centred Care Perspective since 2010 and we are thrilled to see it at the top of every healthcare leader’s agenda today. We examined person-centred care, which includes the perspective of the individual receiving care as well as their families and caregivers, within the home and community care context. We identified evidence-informed models of person-centred care and implementation strategies. In addition, we identified barriers and facilitators to implementing and sustaining a person-centred approach. Based on this review, we developed person-centred care workshops for organizational leaders as well as direct-care providers in home care and long-term care settings which we have been piloting across Saint Elizabeth and long-term care sites nationwide.

We are empowering our leaders and providers to build relationships with and to listen to their staff, colleagues, clients, and families. Participants at all levels of the healthcare system are being given a voice in how care is provided and they are working collaboratively toward collective goals.

To the Ghost of Healthcare Despair: We have shown how we have acted on collective wisdom about person-centred care and are bringing it to life. We are building capacity and empowering our leaders to shift the culture.

We invite you to follow along on our journey. Check out our website for information about Saint Elizabeth’s Person Centred Care Initiative and stay tuned for our plans to spread our person-centred care approach.

http://www.saintelizabeth.com/Services-and-Programs/Research/Person-Centred-Care.aspx

Shilpi Majumder, PhD
Lead, Systems Knowledge Translation
Saint Elizabeth Research Centre

 

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