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Archive for 12 diciembre 2011

“The problems that exist in the world today cannot be solved by the same level of thinking that created them.”—Albert Einstein

So far, we are witness to how society has approached the challenges posed by an ageing XXI century society with care processes designed in the XIX Century. All we have done is to provide the expert with tools, technological and pharmaceutical, to help in certain tasks of the care process. Very little has been done in the field of re-engineering the care process itself.

I see three main reasons for this sorry state of affairs. First, our focus is on caring for acute problems, not on preventing their occurrence. It is like the person who, seeing a banana peel on the sidewalk, is ready to help anybody who trips but is not capable of picking the peel off the ground. Even though different expertise is needed for each of the processes, anybody can see that it is cheaper to remove the banana peel than to heal the injured. As is often the case, the expertise for the solution of the problem, a street sweeper, is cheaper than the healing of the problem, a health care professional.

A second reason is that we are treating the human being as a sum of parts: health, social, economic, cultural, etc, with each “expert” dealing exclusively with his or her part, disregarding the interrelation with the other aspects of the person. The approach to the care process should be holistic. A human being is not a sum of parts; it is a whole in which whatever happens in one part greatly influences what happens to the other parts and to the whole. None of the parts should be treated separately. If my elder brother dies, I may fall into a depression, but most likely, the help of friends will be a lot more effective than Prozac.

And thirdly, and by no means lastly, we will not solve the issue of the well-being of an ageing society with processes based mainly on person-hours and equipment. We have to adopt the principles of modern management to re-engineering the care processes. We could learn from the, today not very popular, banking sector. Some ten years ago the process of sending a bank transfer followed a pattern designed in the XIX century. We would go to the bank and ask a teller to fill out a form by hand with the required information, then we would sign it, the teller would verify the signature in a card and, countersigning it, deposit the slip in an out-going tray. From there, a very complicated mechanism of human intervention and notations would end with a coded wire sent to the recipient´s bank. The reverse process would then be followed at the other end, finishing with a posted letter informing the recipient of the transfer. This process was first improved with the help of technological tools. Hand-written forms were substituted by machine formats. This is where the care sector is today. But then banks introduced a complete re-engineering of the transfer process. Today the customer, from home, sets in motion a completely automatic process to transfer money from account nº1 into account nº2, and in real time!

The banking system has re-engineered the transfer process by empowering their customers, allowing them to be in charge of managing their accounts. Today bank tellers have almost disappeared.

And, underlying all the previous reasons for our failure is the fact that the care sector treats people as cattle, not as human beings. Most caregivers treat their customers as property; they talk of “my patient”, “my client”, etc. This tendency to relate to people as if they were their personal property is in the basis of how they deal with them. Going back to the banking system, could you imagine if we had to go through a burdensome process to get a statement from our banks?   Well, this is what happens in most instances if we dare to ask for our health record. What’s more, they will produce an edited copy of it, never a full version with all the notations. There are two reasons for this. First, despite all public pronouncements to the contrary, professionals still think that my health record belongs to them. Secondly, they think that I am too stupid to understand anything, so what is the use of giving me information that I am incapable of comprehending?

If, on the contrary, care professionals started thinking about people as people, capable of understanding things if provided with the right information, things would change.

Let´s look at two “recent” examples of how care professionals should behave. There is a shoe repair shop in Madrid, established in 1948. There is a big sign in the workshop that reads “What is a client? The client is the most important person in this shop, no matter how he gets in contact with us, whether in person, in writing or by phone. The client does not depend on us, we depend on him”.

I have an even “more recent” example. It relates to a certain Rufus of Ephesus living in Ephesus (today Turkey) in the late 1st century. His teachings emphasized the importance of anatomy, and sought pragmatic approaches to diagnosis and treatment. He wrote, “The patient must be interviewed. By means of these questions, it is possible to learn a great deal concerning the illness, which enables a better treatment. The time that an illness began is also important. In addition, one should inquire as to patient’s attitude toward life and general mental state. In this way, the patient’s mental health can be assessed.” I would like to emphasize the part that reads “one should enquire as to patient’s attitude towards life”; no comments.

My point is that we need to re-engineer the care process and move beyond today’s focus, which only means wasting more person-hours and more gadgets on an obsolete process. We really need to think about the people we are serving. We need to empower them by realizing that they are able, intelligent people, capable of taking their own decisions if only they have the right information.

If we could keep in mind those three + one paradigms we may be able to move away from the pilot trap towards efficient processes. Then we would have achieved: preventive actions, with a holistic vision; care processes designed for today’s economic and demographic environment, and which empower people to have complete control of their lives.

Focusing now on active and healthy ageing or AAL, there are a couple more things that we have to take into consideration before plunging into re-engineering the care processes.

First, let´s consider lifestyle. Overweight and obesity, social exclusion, lack of physical exercise, bad eating habits, etc. are all cause for future medical conditions that will jeopardise our well- being as years accumulate. I want to emphasise future because things rarely happen overnight. It is through years of stuffing ourselves with spaghetti a la carbonara that we easily become overweight and most likely will develop some cardio-vascular disease.

So, what is the chance of having any success with a target population that has not been aware for years of the need for controlling its habits? Of convincing them that the time has come to change? Do we really believe that a person in his or her seventies will suddenly introduce radical lifestyle changes, learning how to eat more healthily or how to use a new gadget? Can’t we recognise the fact that what we are subtly transmitting to that seventy-year-old is: now, now, you are really old and frail; the time has come to surround you with machinery that will make sure you are not going to do anything stupid.

Let’s look at who exactly is our real target population. Consider that from the time somebody has an idea to the time that the product gets to the market, seven to ten years can pass. One or two years for inception, three to five  years for research, and three years, more or  less, for production.

With this time frame, we should be designing for people like myself. I am almost sixty years old and I will probably need something in ten years time. Whatever we design should build on the lifestyle of today’s average 60-year-old, so that I don’t suddenly feel that I am old. What’s more, my needs will evolve over time. I really don’t want to keep adding changes to my lifestyle or gadgets to my house that require a new learning process; I would like to have a simple ubiquitous interface with whatever I need.

There are two clear candidates for taking up the role of interfaces.

My first candidate is the mobile phone. The figures from Eurostat reflect the use of the mobile phone among persons in the 55-74 age range. In most countries, more than 60% of the population in the 55-64 age range uses the mobile phone.

The other gadget which a large proportion of the population is familiar with is the PC, laptop or tablet, whatever you prefer. Taking advantage of one of their many features, the internet, let’s see how popular it is according again to Eurostat. Obviously internet  is not as popular as the mobile phone, but among the big EU countries, only Poland is under the 10% threshold in everyday use of the internet for the similar age range.

Summing up, we should aim at re-engineering the care process by developing an information management system, which would serve as the sole interface between the citizen and the rest of the world. It should allow access to all health, social, family, financial, and any other information the citizen needs for his or her decision-making. It should also be the interface for command and control of equipments that are meant to assist in activities of daily life and independent living. It should be modular so that every person can choose which modules better adapt to his or her particular needs, facilitating a smooth transition from middle age to old and to older. It should empower people by refocusing the care process on the person and not on the professional.

Let me finish the way I started:  with a quote. This time it is from the well-known American radical feminist activist, writer and poet Ms. Robin Morgan:

“Knowledge is power. Information is power. The secreting or hoarding of knowledge or information may be an act of tyranny camouflaged as humility.” Robin Morgan.

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