Put Patient-centred Care At The Core Of Health System

Friday, 21 April 2023, 7:01 pm
Opinion: Ian Powell

In January this year my political opposite Heather Roy and I jointly published a paper under the title Te Whatu Ora: Achieving Patient Centred Care and Wellbeing: Achieving Patient-Centred Care and Wellbeing.

What is patient-centred care

We explained what putting patient-centred care at the core of Aotearoa New Zealand’s health system in the following way:

Our starting point for Te Whatu Ora should be patient-centred care, which is broader than, but includes, patient outcomes. The extent to which care is enabled to be patient-centred, the better the outcomes for patients.

Patient-centred care means treating a patient with dignity and respect and involving them in all decisions about their health. It is linked to patient’s rights to timely access to quality healthcare. The principles include:

• treating patients with dignity, respect and compassion;
• communicating, coordinating and, where applicable, sharing patients’ care between appointments and different services over time, including between primary and secondary care;
• tailoring care to suit patients’ needs and what they want to achieve;
• supporting patients to better understand and learn about their health;
• empowering patients find ways to get better, look after themselves and stay independent; and
• involving patients in their healthcare decisions at all times.

To achieve patient-centred care requires sufficient workforce capacity and capabilities to work in an integrated manner. But it is more than just how patients are treated by health professionals. It is also about how community care providers, hospitals, and the government create and support policies to put patients, rather than organisations, at the centre of care.

In our concluding comments we gave the following advice:

We firmly believe patient-centred care must be the central pillar of Aotearoa New Zealand’s health system. Those responsible for providing this care, the health workforce, should be empowered to deliver quality healthcare and innovate as necessary to ensure constant improvement as treatments, techniques, and technology advances.

Depending on the approach it takes, Te Whatu Ora can enable or hinder. It must take all reasonable steps to understand and address the needs of the population, especially the needs of defined local populations. Achieving healthcare that is equitable, comprehensive, available, accessible and cost effective depends on it.

Then Chair of Health New Zealand (Te Whatu Ora) Rob Campbell responded quickly and positively by forwarding it on to his board. This was an encouraging start. But there was no reaction on the political front.

That is, not until former Minister of Health Andrew Little was in effect sacked and demoted.

Quite a different health minister

His replacement, Dr Ayesha Verrall, is quite a different minister – for the better. Her office quickly contacted us to organise a meeting with her to discuss our paper. The meeting was held on the morning of 28 February; it proved to be an ominous day for another unconnected reason.

When working for the Association of Salaried Medical Specialists for over three decades I had many meetings with health ministers. The meeting with Dr Verrall was one of the better and more constructive ones. This was despite the fact that the news was dominated by whether Rob Campbell would be sacked or not.

It was clear that the Minister took our paper seriously. She had both read (and reread) and understood it. Her final words to us were to encourage us to write more (this is work in progress).

Apart from her constructive attitude and good preparation, what struck me the most was her first question.

Grasping the key issue

It quickly became clear that she had grasped the key issue of our paper. Dr Verrall observed noted as a medical specialist (infectious diseases) she was familiar with patient-centred care but saw in the context of an individual patient’s treatment.

Consequently she was interested in our advocacy of patient-centred care in a health system context. She had not previously thought of this in that light. The co-authors of the paper could not have asked for a better start to the meeting.

Our response was that we were advocating taking individual focussed patient-centred care to a collective application level. That is, applying it as the baseline when considering any systemic change to the health system.

This application could be, for example, a service within a hospital, hospital-wide, community healthcare provision, and integrated care between community and hospital. The first question to consider should be can a proposed systems change enhance patient-centred care.

Ensuring patient-centred care

Ensuring patient-centred care requires that the design, configuration and delivery of health services is health professional led. Relevant health professionals are in the engine room of decision-making. Management’s role is one of support and enabling.

This requires a significant cultural shift to recognising that the biggest intellectual capital resides within this workforce rather than in hierarchical leadership structures or business consultants. In other words, empower this workforce.

Empowerment requires the right health professional workforce capacity and capabilities. Systemic patient centred-care can’t be provided in an environment of severe workforce shortages which have been allowed to stymie New Zealand’s health system.

It even extends to collective bargaining between Te Whatu Ora and the health unions. Each negotiation and settlement for each health professional group should, in the first instance, focus on the extent to which it better enables the ability of these groups to enhance patient-centred care.

Composure

It proved to be a very constructive discussion lasting for around 40 minutes and ending with the health minister encouraging us to keep jointly writing about our shared thoughts (we are working on this). It confirmed the wisdom of her appointment to the health portfolio.

While one swallow doesn’t make a summer, if the ideas of our joint paper gradually seep into health system decision-making that would be an encouraging spring.

As an aside, before Heather Roy and I entered her office we were pondering whether the meeting might be canned because of the controversy over the future of Rob Campbell as Te Whatu Ora Chair which was swirling around.

What we then did not know was that 20 minutes after our meeting ended was the deadline for him to either resign or be sacked. And yet there was no sign of a health minister being worried. There were no signs at all of distraction.

Instead there was complete composure. Putting the sacking to one side, composure and presence of mind are promising traits for a health minister.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Salaried Medical Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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