When I was starting out my career in medicine, patient-centred care was the new ideology.
Although now it seems like somewhat of an overused phrase, it was in its time a pioneering concept which challenged the prevalent notion that the clinician was at the heart of healthcare. It articulated the imperative to share power more effectively with service users and to think about the patient first and foremost in what we do as individual clinicians and as a design principle for the service.
It truly challenged a lot of healthcare thinking at the time, from the style of consultations to access routes and service design. Clearly, we are still on that journey and the heroic work of Kate Granger and the #hellomynameis campaign is a great example of what can be achieved when someone simply holds a mirror up to what we are doing and measures us against that core design principle.
Limitations to patient-centred care?
Arguably, patient-centred care could only go so far in a broader system that is fundamentally designed around the effective running of organisations. There is only so much that can be changed if the money merely follows activity and regulation focuses on organisations rather than populations and outcomes.
But now, a powerful voice in care reform is attempting to address this – place-based care. It is the population equivalent of patient-centred care, with the premise being that healthcare is designed with the population being served at the core, rather than planned around the organisations delivering services.
Place-based care has the triple aim of better population health, better patient experience and improved cost-effectiveness as primary objectives. It has been powerfully articulated since the publication in October 2014 of the Five Year Forward View.
Population health management and personalised healthcare
Putting the population at the centre of our plans is core to the Sustainability and Transformation Plans (STPs) and the emerging thinking around accountable care.
However, we will be unable to realise this vision of population health management unless it is underpinned by digital capability. This has recently been reinforced by Matthew Swindells in his blog on the NHS IT strategy.
The opportunities include not only ways digital can support clinicians in delivering direct patient care, but also allowing us to design care systems around a whole population backed up by effective business intelligence systems that focus on those triple aims. The prospect of giving patients more influence over the care they receive and the digital capabilities that support that has shifted from a noble intention to a strategic imperative.
To be effective, this will need to become far more personal, more individual than ever before, with targeted interventions to groups in our populations, capturing outcomes that are meaningful and using this to drive the organisational and clinical behaviours we all want to see.
In time, the prospect of genomics will help individualised care become even more targeted and we are on the cusp of that impacting every day clinical practice.
HIMSS UK is supporting through its Executive Leadership Summit in London on 18 October and Health Insights in November the theme of ‘place-based care’.
What are the digital capabilities that make population health management possible and how do we link our digitally enabled organisations in partnership with our citizens? Expect all of this at the HIMSS UK events this autumn.
