Archive for 25 febrero 2015

This is a real story of a real person in a real country that, I am afraid, can be replicated across many other countries in Europe. It is a story about cuts in healthcare services and its real influences in overall expending for the Government and for the people.

Mr. XXX is a manual worker whose job implies using his arms to move thing around. After several months of feeling that his right arm was hurting, he went to visit the primary care doctor. The diagnosis was clear: a strong tendinitis that prevents him from performing  his duties until he is properly treated. So the primary care physician sent him to the traumatologist for consultation and further treatment.

And here the nightmare starts. Due to cuts in healthcare personnel, the waiting list for traumatology is such that Mr. XXX receives an appointment for 90 days from now. What are the implications? First, Mr XXX cannot work and he will be on sick leave for at least the next three months. He will be paid  by the social security a percentage of his salary, with a complement by his employer to make up for the basic 100% of his salary. Secondly, his employer will have to employ another person to fulfil Mr. XXX duties.

So the outcome is that, by cutting back on personnel disregarding the actual demand, the health service has prompted an increase on the social security budget and at the employer’sexpense, while Mr. XXX lies in bed weighing to be taken care of!

Are these the savings that we are aiming for? I certainly doubt it.


Read Full Post »

If demographers are correct, an ageing population is coming and will put mounting pressure on social and health services. The pressure is already here and the response of most governments has been to make it more difficult to access them, reducing the population covered, or to cut the provision of services, reducing the coverage offered, or any combination of both. In other words, look for a quick fix and postpone the problem.

So much talking about structural changes and all our governments are coming out with is cutbacks in the services they provide, without looking at the way they are provided.

Social and health services have to be redesigned. This is so obvious that I am not going to talk about this aspect of the redesigning effort. The only thing that is needed is a political push in that direction. A political push that needs to interiorize that a certain investment has to be made before reaping the benefits.

I will focus on another aspect of the redesigning effort; namely the need to redesign keeping in mind the primary end-user i.e. the patient.

We may have achieved the most efficient work flow, with the possibility of reaching a level of efficacy not known till now, yet despite all our efforts neither that level of efficacy nor the expected efficiency is reached. The problem, I think, lies in the interface between the user and the system. Have we taken care of the lay-out of the system? Have we made it user-friendly not only for the ICT literate but also for those ICT illiterate so that no one feels bored or stressed? Have we considered the cultural differences not only among nations but also within a nation? A carefully designed process needs a carefully designed interface that allows the primary end-user to feel comfortable and at ease when using the service, from the screen in his or her smart-phone to the colour of the walls or the seating arrangement in the care centre. Not reaching that level of integrated design is at the root of so many good ideas gone to waste.

We all have experienced communication problems between process designers and ICT developers, but to that we have to add a third group of professionals, those in charge of making everything look amiable and user-friendly. If we tackle this problem from the beginning, we will have working towards the same objective the expertise of the socio-health professionals, the use of the latest ICT technology providing more efficient care processes, and the end user vision of their real socio-health demands.

Read Full Post »