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Posts Tagged ‘re-engineering’

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.

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In this context “social” means the whole social spectrum: education, health care, social care, police, etc., in short, all those areas that we in Europe have come to believe are citizens’ rights that should be guaranteed by the State.

Cutting social expenses is how most governments are reacting today to the budget deficit problem. And to be honest, this provides quick results. These cuts have another advantage: although they may affect a certain number of voters, why should we care?  Most of those affected are public workers anyway, and we all know that they are not exactly the most cost-effective workers on earth, don´t we? So, the logic follows, the effect on the rest of the population/voters will be minimal or even positive.

But maybe we should consider the medium and long term effect of those cuts. If social care processes remain unchanged, the logic says that, by reducing inputs, the output will be negatively affected. This is true unless, miraculously, the till now inefficient public worker suddenly becomes efficient and maintains the previous output. As I do not believe in miracles of that kind, this reaffirms my conviction:  there will be a reduction of the output.

A reduction of the output is immediately felt in some of those services. Probably that is the reason why we have seldom heard of cutting the police force. But there are other services in the social menu in which the reduction in output will be felt mostly in the medium or long term.  But since we won’t have to worry about that until the next election, who cares?

If we stand by today’s care processes while cutting inputs, the health of the population will be affected in the long run; there will be fewer resources for prevention because acute problems will absorb the remaining resources. The same goes for education; teachers will dedicate their efforts to the brightest of the class, leaving behind those less naturally gifted, thus reducing the average level of
education in the population as a whole. And so forth and so on.

If our leaders could for a moment think about their constituency and not about getting re-elected, then maybe they would realize the obvious: there are no shortcuts. The only way of reducing cost while maintaining the quantity and the quality of the output is by re-engineering the processes in which social services are provided. But then that requires leadership and time!

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How we call or qualify somebody does really matter and shows with more or less subtlety, depending on our stance towards what is now called political correctness, what we think about that person in particular.

Almost everybody will agree that if I address somebody as that person, the implication is that I don’t think very highly of him or her. Shopkeepers will treat people who enter the shop differently if they think about them as buyers –they should come, buy and leave- than if they think about them as clients –they are here to be served and will come back-.

If we assume  the above, why is it that in the health sector we keep insisting on calling people patients? According to the Free Online Dictionary (and I assure you very similar definitions will be found in any other dictionary) the definitions  for “patient” are:

adjective

1. Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.

2. Marked by or exhibiting calm endurance of pain, difficulty, provocation, or annoyance.

3. Tolerant; understanding: an unfailingly patient leader and guide.

4. Persevering; constant. “With patient industry, she revived the failing business and made it thrive”.

5. Capable of calmly awaiting an outcome or result; not hasty or impulsive.

6. Capable of bearing or enduring pain, difficulty, provocation, or annoyance: «My uncle Toby was a man patient of injurie» (Laurence Sterne).

noun

1. One who receives medical attention, care, or treatment.

2. Linguistics: A noun or noun phrase identifying one that is acted upon or undergoes an action. Also called goal.

3. Archaic: One who suffers.

A neutral reader will see that most of the definitions refer to suffering or calmly enduring something. Does this not say a lot about how the health sector regards what should be, and are, its clients?

Unless health professionals start thinking about people in need of health advice as clients, and calling them clients, I think there is little hope for an effective re-engineering of the heath processes that will result in the necessary sustainable health and social system. Anything less is just plugging holes in an antiquated social and health provision system.

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