Post-Pandemic Population Health
The world has been discussing Patient Quality and Safety for at least 20 years, with few effective results. We continue to massacre the entire multidisciplinary assistance team on the mandatory compliance with policies, guidelines, protocols and tools in the search for better results, but what we achieved with this was a greater bureaucratization of assistance, the patient’s emotional distance and centered care performance and sustainability results only.
It is urgent to break the current paradigms of patient quality and safety by answering a simple question: Why?
In fact, the path chosen to search for results was wrong. The fragmentation of the health system generated over these 20 years ended up worsening, rather than improving, the results of value to the patient.
It is necessary to recognize that the central problem is in the Health System, where the population circulates, and not in the isolated actions of the various organizations that make up the system.
Using a Hospital as a starting point, we can assure with a high level of accuracy, that the poor results come from the lack of understanding of who is the patient that enters the Institution. Obtain accurate information about the patient’s origin in the system, his social situation in terms of vulnerability, what resources and knowledge he has for the promotion and maintenance of his health, his education and ability to understand his role in this promotion and, mainly , his personal history in relation to habits, beliefs, previous illnesses, current comorbidities and genetics is fundamental.
It is not possible to build any care plan for a specific patient by assessing only their current condition or clinical need.
International Accreditation Programs, mainly Canadian, have already brought all these requirements into account since its former Canadian Council on Health Services Accreditation (CCAP-CCHSA) program. But even in Canada, these requirements have not been fully understood and implemented.
Here, a caveat in relation to the language that Quality systems like to establish, full of technical and fuzzy terms, difficult to understand for the population and for the employees involved in providing health care on the front line. It is worth rethinking this jargon so that it has a greater penetration in the construction of a culture of patient quality and safety.
New flows need to be designed, with a focus on greatly strengthening the patient’s admission stage in this structure, comprising a pre-hospital phase (scheduling, relevant clinical information), the initial (administrative) reception and the admission itself in the clinical microsystems ( assistance).
Tools used to prioritize care, such as the various Risk Classification systems, are essential for managing access to demand, but require a subsequent stage of nursing and / or medical assessment for the correct referral of the patient internally.
Understanding where the patient comes from and establishing interfaces with the various organizations that make up primary and secondary care for the safe transfer of information – whether in elective or urgent / emergency care – is essential for the transition of care and proper planning of this stage of the patient’s journey. For this, a robust structure for sharing information among all institutions that make up the health system to which this patient belongs, whether public or private, becomes mandatory.
With this information and the assessment of the current situation of the patient, we will certainly have a full and efficient use of all available tools of patient quality and safety and a substantially greater clinical effectiveness, with less preventable injuries.
And dehospitalization, the patient’s departure from the institution, needs to be equally planned from the time of admission, including patient education, safe information management and the timely and consistent transition of care, with adequate guidance for the rehabilitation and maintenance of your achieved health status.
This was just an exercise in repositioning hospitals within health systems. The strengthening of primary and secondary health care should reduce the demand for hospital structures compared to today, providing a more robust and personalized care to those who need this stage of secondary or tertiary care.
If we expand this redesign to Outpatient Care, Home Care (Primary and Secondary Care) and other support structures or assistance in health systems, we will certainly be taking precise steps to build valuable results for patients, health professionals , institutions and the health systems themselves where they are all inserted.
Dr Elizabeth Reis
IQG Coordinator of ONA and Distinctions methodologies