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“Tribalism is still widespread in the health
service – the different professions are often
separate, almost like the crafts and their guilds
before the industrial revolution. We need the
equivalent of industrialisation.”


Patient-centered care: the case for new ways of delivering healthcare

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Healthcare systems worldwide are increasingly faced with demands such as 'deliver twice as much healthcare for half the cost'. At present, few show signs of measuring up. Could patient-centred care be part of the solution?

Pharmaceutical and medical technology industries, national and local government, healthcare payers, academic research organisations and the third sector came together to discuss the issues at a healthcare roundtable dinner hosted by PA Consulting.

We were delighted to have as guest speakers:

  • Professor Elisabeth Paice, a rheumatologist and former postgraduate dean, who is the Chair of the North West London Integrated Care Pilot, and

  • James Peach from Cancer Research UK, for contributing their excellent thought-provoking insights to the discussions.

Please view the videos of their speeches at the healthcare roundtable.

Professor Elisabeth Paice - Chair of North West London Integrated Care Pilot
James Peach - Cancer Research UK

 Debate at the healthcare roundtable focused on four key themes:

  • The need to innovate around healthcare delivery processes
  • Integrating healthcare around the needs of the patient
  • Rethinking roles and relationships in healthcare
  • The future of healthcare: prevention rather than cure

The need to innovate around healthcare delivery processes

Innovation around delivery processes may be more important than innovation around new drugs, at least in some fields. To improve processes, healthcare systems need shared concepts of value and quality, which may best come from payers. Better processes will also require:

  • better IT (integrated national systems are desirable)

  • provision of the latest tools (particularly diagnostic tools) to doctors

  • clinical leadership – that is, clinicians trained as leaders, who can work effectively with healthcare managers.

Integrating healthcare around the needs of the patient

The North West London Integrated Care Pilot is exploring an important approach to improving processes, with positive results. Consistent, coherent care with technology-enabled information sharing gives patients better care, reduces frustration for clinicians, and saves money.

Integrated healthcare necessitates breaking down the ‘tribalism’ of different professional groups that have traditionally been in competition with one another, so that they can share a vision, protocols, metrics and financial incentives. There is initial resistance, but once the groups start talking they realise that they are all motivated by the interests of the patient.

Collaboration makes it possible to create a shared care plan that pre-empts problems – for example scheduling regular foot examinations for people with diabetes.

Rethinking roles and relationships in healthcare

Changing processes implies changing the role of the professional. Clinicians need to evolve from ‘lonely heroes’ to ‘restless champions for change’ (in Professor Paice's words) who can both lead and follow as circumstances require.

Patients’ role, too, is changing. In future, they will have more rights to make their own healthcare choices and more responsibility for improving their own health and wellbeing.

To perform this more active role, patients need more access to information. They should be given visibility of treatment costs, since they are in a position to decide what constitutes value for money and (in many countries) are footing the bill as taxpayers. Portals can give patients access to this type of information, as well as their own personal data and data to help them choose care providers.

Organising the system to suit patients is more efficient. For example, when GPs spend the first hour of their day on telephone consultations, the number of appointments needed is reduced by around 30%.

Social care and healthcare should perhaps be regarded as a single system though they are structured differently at the moment (e.g. social care is means-tested while healthcare is universal). The two are closely interrelated: for example, health problems create the need for social care such as meals on wheels, and conversely health problems such as obesity arise from social factors such as what is viewed as normal in terms of physique and eating/ lifestyle habits. At present, social care is arguably under-funded compared with healthcare.

The healthcare of the future: prevention rather than cure

There is a growing emphasis on preventative care, which is better both for
patients and for the healthcare budget. But getting people to take responsibility for their own health is challenging.

People are often willing to make lifestyle changes once they have been diagnosed with a condition such as diabetes, but it is harder to persuade them to do so pre-emptively. The chances are better if they feel it’s their choice, rather than something the doctor wants them to do, and if the information is presented in a personalised way that makes the patient really think about it.

Social networking techniques can help, because people follow coaching from their peers more willingly than advice from a professional.

Financial incentives to improve lifestyle are being tried, for example by US employers who “fine” employees who smoke or have high cholesterol by making them contribute to increased insurance costs. These incentives are more likely to work if rewards for behaviour are immediate rather than coming a year later.

Shaping the future of healthcare

The roundtable highlighted many of the challenges and opportunities shaping the future of healthcare and we would like to thank all the attendees for sharing their ideas and views, a selection of which are referenced above.

If you would like to discuss any of the issues raised in PA's Future of Healthcare Roundtable, please contact us now. 

Catharine Berwick
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Chris Steel
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