Creating a People-Centered Healthcare Environment
Maria Fatima Garcia-Lorenzo
Co-founder and Executive Director, Kythe Foundation
President, Philippine Alliance of Patients’ Organizations
Creating a people-centered healthcare environment encompasses four domains; 1) individuals, families and communities, 2) health care practitioners, 3) healthcare organizations, 4) health systems (WHO Technical Papers on People-Centered Health Care, November 2007).
Let us focus on individual, families and communities. The goals for engaging individuals, families and communities are to improve self-care, treatment decisions, health literacy and responsiveness (WHO Technical Papers on People-Centered Health Care, November 2007). Currently, most patient-doctor relationships can be described as patients being overly dependent on the doctor. In the wards, especially in government hospitals, patients are still afraid to ask their doctors for a full explanation about their illness and treatment plans. One strategy which has worked for us in Kythe, in order to empower patients and their families at Philippine Children’s Medical Center, is to gather parents of children with cancer, to regular focus group discussions. The goal of these FGD’s is to surface issues, which may be causing some confusion or stress in relation to their child’s treatment. Once we are able to identify the issues, we facilitate a dialogue with the pediatric oncologist, to foster deeper understanding regarding treatment protocols and the hospital system. This process has established an open communication between the medical team, and carers of pediatric cancer patients.
Another result of th FGD’s was a creation of a handbook called “Gabay Magulang” (Parent’s Guide). With the help of volunteer medical students from the Ateneo School of Medicine and Public Health, we were able to synthesize the parent’s experiences, and organize these in a handbook. Seasoned parents use this handbook to orient parents, whose children were newly diagnosed with cancer, on how to navigate through the whole pediatric cancer treatment process. In the ward, you see parents helping other parents.
Let us focus on the next domain-health care practitioners. I believe empathy can be taught in medical schools. I wish you can allow your students to “waste time” with patients in the ward. The goal is to get to know the patient more as a person. At the end of the day, the medical students must know the patients dreams and failures, what makes him laugh and cry. During one of the focus group discussions, one volunteer medical student asked the parents what was their message for them as future doctors. One parent responded “ituring ninyo an aming mga anak parang isang kapamilya, sigurado na gagawin ninyo ang lahat para sila ay gumaling at hindi sila masasaktan.” In English, treat our children as if they were a member of your family, for sure you will treat them with utmost care and do them no harm.
The healthcare practitioners’ willingness and openness to involve patients and carers in treatment decisions, is one important factor in shifting the mind-set towards a people-centered health care environment. Patients and carers have access to information through the internet. The patients also gather information from friends, and even co-patients. It is ideal if the medical team, the patient and carers sit down to discuss the gathered information, to examine these thoroughly, in order to arrive at the best treatment option. I hope the healthcare practitioners will not underestimate the capacity of patients to discuss treatment options. This is the patient’s right. This process deepens the trust between patients, carers and the healthcare practitioners, and more importantly, it increases patient’s compliance which hopefully leads to cure.
The third domain is healthcare organizations. As the representative of patient groups, I sit in the technical working group in crafting the National Policy on Patient Safety. The TWG agreed that we should emphasize patient safety as a shared responsibility by all stakeholders. We, are therefore, calling it the National Policy on the Culture of Safety. This means, top management up to the janitor and security guards must be conscious about safety, and the patient and their carers also have shared responsibilities.
Focus on healthcare organizations also means how the members of the organizations are cared for in terms of just compensation, professional development and even how each one communicates to another. Is the culture in the healthcare organization stiff or warm? How are the leaders of the organization, caring for the members of the team, so they can care for their patients more?
And lastly, let us focus on healthcare systems. Some of the key characteristics of people-centered health care were described as; 1) financing arrangements for health organizations that support partnership between health practitioners and people accessing health care, 2) investment in health professional education that promotes multidisciplinary teamwork, good communication skills and an orientation towards prevention, 3) integrates evidence about psychosocial dimensions of health care, 4) commitment to a process of ongoing evaluation and improvement, and 5) involvement of communities and other stakeholders in health governance and policy development (WHO Technical Papers on People-Centered Health Care, November 200).
Well-designed healthcare policies, including health insurance programme, could help reduce health inequity by improving access to health care (WHO Technical Papers on People-Centered Health Care, November 2007). PAPO is quite happy Philhealth has created several case rates which eases the financial burden of Filipino patients. We in PAPO, appreciate how Philhealth listens to the needs of the patients through public consultations. It is unfortunate though that the patient groups are not represented in the Philhealth Board. The senior citizens, overseas Filipino workers, employers sectors are represented in the Philhealth board, but not disease-specific patient groups. We have discussed this issue with Congresswoman Helen Tan, Chairman of the Health Committee of the House of Representatives, and she has agreed to support our advocacy to amend the law on the composition of the Philhealth Board.
Let me focus on the commitment to a process of ongoing evaluation and improvement. I believe the most important value of engaging patients is providing health care providers honest feedback. If we are to create a people-centered healthcare environment, then there must be a systematic and functioning feedback mechanism in place. PAPO was as a member of the TWG in creating the DOH Hospital Scorecard. The plan was to relate the amount of Hospital Facility Enhancement Funds to the results of the Hospital Scorecard. The plan of rewarding good performance was ideal. The Hospital Scorecard has not been fully implemented, but I am still hopeful a more systematic and effective feedback mechanism will be institutionalized.
In summary, creating a people-centered healthcare environment requires a collaborative effort from each one of us. Kythe has flourished for nearly 25 years because we facilitate open communication between patients, their families and the medical community. This has resulted to higher patient compliance and issues are settled through amicable resolutions. There is great work yet great value in pursuing people-centered healthcare environment.
Let me end by para-phrasing the parent’s message to the future doctors, “let us treat each other as if we are family, so we could take care of each other, and treat each other well.”
“People-Centered Health Care Technical Papers. International Symposium on People-Centered Health Care: Reorienting Health Systems in the 21st Century, The Tokyo International Forum, November 25, 2007. World Health Organization (Western Pacific Region).