- Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the Internet, by telephone, and by other means in addition to face-to-face visits.
- Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.
- The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision making.
- Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
- Evidence-based decision making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.
- Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.
- The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.
- Anticipation of needs. The health system should anticipate patient needs, rather than simply reacting to events.
- Continuous decrease in waste. The health system should not waste resources or patient time.
- Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.
Wednesday, September 20, 2006
Dave Pollard in his always excellent innovation blog shows us how interactions between a pharma and its customers and channels can be evolved. At its centre is the idea that the customer needs to be the centre of the information flow and play an active role in their ongoing diagnosis. But also there is the idea that diagnosis and "threat evaluation" is probably better manged within the context of social and information networks, where information has been "cleared" and "approved" to some extent at least. A strong correlation between the trusted source and the perceived trustworthyness of the information shared by that source, means that we will probably pay more attention to the information we get from our sister than from the PA at the doctors surgery. With regards our own "blind spots and biases" active participation in a network should open out some of our blind spots. A new "fitness service" called Traneo gets you to nominate a person to monitor your progress, and to encourage you. Understanding your motivational triggers is key here, as is the ability to "know or predict" when you are cheating. If there is real-time exchange of your shopping list, your weight chart, and your gym entry, then there is a chance you can be monitored (i.e. "I go to the gym all the time", well actually, no you don't"). In this respect we create our own "diet management programme" in a way that nobody else could have managed or perhaps even envisaged. The US health care system sees this and has made moves towards defining some principles that outline the principles upon which all "care based services" could be evaluated. The recommendations of the US National Institute of Medicine's 2001 Crossing the Quality Chasm report which laid out these ten 'rules' to govern effective health care: