Value based healthcare: Go and see your patient for yourself

Value based healthcare: Go and see your patient for yourself

Never waste a good crisis

A growing demand for care, ever-rising costs and fewer and fewer people to provide that care. The social crisis is looming. In particular, the increase in the number of people with complex and multiple chronic conditions is at odds with the current fragmented organisation of care. Critical voices about the 'accountability industry' in health care are calling for new, decompartmentalized organizations of care. In other words, value-based healthcare or value-driven care. An approach in which the value experienced by the patient is central.

The patient or the human being?

The mantra of 'patient centricity' is seen as the key to decompartmentalisation. A beautiful promise, but in practice it is often far from reality. Logical, because the word patient already indicates it: someone in a dependent position with limited options. After all, for years caregivers have known what is right for someone in need. And that is just as well, because in a life-threatening situation you do not want a joint decision-making process. However, from the perspective of someone with a chronic condition, this is different. People with a chronic illness have to fit their condition into their daily lives themselves. And that's exactly what tomorrow's crisis will be. This calls for a different perspective, one that focuses on health and the perceived value of the care process rather than disease. In this context, I speak of person-centred care in which somatic, cognitive, emotional, behavioural, spiritual, social and economic factors are considered in conjunction. This approach is also central to positive health by Machteld Huber. Despite the fact that we have known for a long time that a human being is not made up of pieces, we have still organised our care provision at the level of disorders. A people-oriented approach requires an integrated care offer across the entire chain of prevention, care and welfare.

Except for the differences, every patient is the same

This requires different competencies of the policy makers, administrators and care providers involved. These include the ability to reason from a health perspective, to take a preventive approach and to work together across disciplinary and institutional boundaries. But the biggest challenge lies in being able to deal with differences. The underlying idea of an integrated approach is that health care should be considered as a complex adaptive system that adapts to local circumstances. This is at odds with the current (disease-specific) accountability industry in which we assume that we can organize care like a machine. Unfortunately, current guidelines and protocols are mostly based on this Porterian thinking. And let's face it: we're all prone to this linear thinking. After all, it implies predictability and control. But this approach is inadequate in practice because it reduces health problems to biomedical factors, without addressing the underlying economic and psychosocial issues. And it is precisely these underlying problems that require the ability to deal with variation. Because the patient does not exist. It means not only assessing (cost) effectiveness, but also assessing whether a treatment really adds something for the person in question. This requires a radically different mind-set from the researchers, policy makers, administrators and healthcare providers involved. It means that one should not dare to put the average at the centre of research, policy and practice, but rather the variation. And that's pretty scary, because it means acknowledging that we are on the edge of chaos and that outcomes are unpredictable. In short, together they learn how an intervention can really add something to a person's life. Perhaps this is the time to start the discussion with all stakeholders (including the patient) about the accountability industry and the false security of their own linear standards and protocols, before responsibilities are shifted?

What do patients really find important?

In essence, it's about whether the patient actually experiences added value from a particular treatment, intervention or medicine. The Triple Aim does not indicate for nothing that we must start with the 'patient experience of care'.patient experience of carewhat he or she really values and what not? In other words, the PROMs and PREMs of this world. So this means looking beyond our current clinical and financial parameters. How do you apply this tomorrow in your practice or organization? By not asking your patient: What are your symptoms?, but what do you think is important? In short, go and see your patient!

The Connected Care Explorer

In recent years Essenburgh Training & Consulting has developed the Connected Care Explorer based on international scientific research in 19 countries. The Connected Care Explorer can map the patient's or client's journey through the entire care system based on the Rainbow Model. This tool gives you direct insight into how you can improve collaboration and efficiently organize processes based on what the patient really finds important.

Want to know more?

Would you like to get started with the Connected Care Explorer? We'll be happy to tell you how we can help.