Axioms for improving care for patients

Data from various sources estimate the healthcare deficit at nearly 15% of the budget allocated to healthcare itself by Spain’s autonomous regions, which leads us to a total debt close to € 15,000 million (other sources set the deficit at a more pessimistic 20,000 million euros). The existence of such debt has thus far been treated as an issue purely healthcare in origin, although its recognition and implications are now being seen as more of a general problem.

If the situation is already worrying, it is even more so given the prospect of a more exacerbated scenario in the future, as there will be a growing demand to meet from both patients and pathologies alike, particularly knowing there are likely to be fewer resources at hand. Given such a scenario, the current economic crisis is a great opportunity to introduce programs and projects that reduce costs and improve efficiency, always within a vision of long-term continuity. It is time to carry out measures of a structural nature that involve changes within the chain providing valued health services, as well as ongoing improvements to efficiency that will ease the need for investment and lead to better overall performance of the healthcare system.

These approaches must include strategies aimed at reducing recurrent operating costs and improving patient care. Make more (or at least the same) with less must be the first commandment of healthcare management. Again, we must return to an analysis of what to do and what means should be available to carry this out.

If we examine the objectives of the National Healthcare System Quality Plan, we understand that the three areas having development priority must include evaluating technologies and procedures as a way to support clinical and management decisions, improving the care of patients with diseases that carry a high social and economic burden, and improving clinical practices through the development of information technologies.

Therefore, and as a response to each of the three objectives mentioned above, the bases of the actions to be undertaken rest on improving hospitals, implementing care continuity (such as preventive care), and aiding clinical practices. Any strategic plan that seeks to ensure medical care to its patients should consider these types of initiatives to be its driving force.

Improved hospitals

From a care standpoint, improving the services that hospitals provide comes from increasing patient care and making improvements that allow staff to dedicate more of their time to patient care. We must seek solutions that improve the work healthcare personnel do, as well as those that focus their dedication towards high-value tasks.

Studies in the Department of Health have indicated that nurses in the UK spend only 41% of their time on direct care activity. In Spain, it is estimated that nurses dedicate 30-40% of their time to administrative tasks, which results in a reduced capacity for information analysis, patient care and job satisfaction. This data regarding estimated time dedication has to be evaluated within a broader context related to the lack of health professionals in hospital care. What is more, many of the actions nurses undertake still require manual intervention, which increases the chances of human error whether this is when doling out medical constants such as the medication itself or administering drugs or diets. And let us not forget that the cost of an error in medication is estimated anywhere from 2,500 to 3,500 euros.

Concentrating patient information in hospital computer systems has increased centralization, management and ease of use, but it also taken decision-making tools away from the place most patient interactions occur, the patient's bedside.

It is time to deploy applications that provide flexible access to patient information stored in the hospital information systems, and make it available to caregivers when they interact with the patient. Applications that automatically facilitate the incorporation of vital signs, validation programs for administrating diets or drugs, online queries into patient history, are all valuable aids if we seek to improve the quality of care.

But the improvements in quality should not only be considered from a standpoint of care giving, as the needs of the patients themselves must also be taken into account. Long-term hospital stays and a lack of activity require the existence of leisure facilities available to patients in their surroundings. Today, these services are primarily focused on having access to open television channels. New individual-consumption leisure services such as blockbuster movies, premium television, Internet access or training in hospital services and procedures may be ways to improve patients’ hospital stays.
Companies have done pioneering work in designing applications that can offer these clinical and entertainment services through a single device, thus integrating both benefits. Business models must be drafted that provide subsidies for clinical services through the provision of leisure services.

Implementation of care continuity

Care continuity should be understood as the degree of consistency in the care patients receive over time. This consistency entails:
• Continuity of information: Using information from previous records to provide the appropriate care in the patient's current circumstances
• Continuity Management: Provision of care so as to complement services in a coordinated manner over time
• Continuity of relationship: Monitoring and interaction with the patient wherever they may be

In order for this continuity to be truly possible in the broader sense, there will be a need to have traceable medical care, to apply tele-diagnosis to those situations where the pathology and the patient's condition make it advisable, to encourage long-distance care giving, to have the availability of shared clinical records, to promote the concentration of knowledge that leads to patient referral to specialized centers, and finally, to foster the monitoring and control of chronic patients.

On this last point, it is necessary to develop programs that implement self-care models and patient support, strengthen preventive action, and enable remote private care to the chronically ill. All these measures will help regulate the demand for hospital care (where only 26.8% of the time spent in a visit is dedicated to consultation and examination) and therefore, as hospital must treat those actions that are truly necessary, differentiating chronic treatment from critical treatment.

These actions will facilitate the reduction of hospital costs as 75% of medical costs go to people with chronic illnesses and home care allows for savings of up to 80% of the cost of hospital care.

But not only should financial budgets be the motive for encouraging programs to monitor and control chronic patients. It has currently been proven that telemedicine gets very similar results to traditional diagnostic techniques, treatment and control. Therefore, by using these developments, it is possible to maintain the level of care patients receive at their homes or residences, and even increase the number of medical contacts (and the ensuing attention and care) through remote monitoring.

No one doubts today that a sustainable future of healthcare passes through programs of this nature, ones that combine cost reductions with maintaining of quality care.

Helping clinical practices

Another recurring element in healthcare is the need to foster the communication and collaboration between medical professionals, ensuring that their work is not carried out in isolation and encouraging clinical information is shared, both in diagnosis and the later treatment of cases.

Today, many decisions are still being taken in a manner that is not shared among professionals, where occasionally analyses and medical tests are repeated as the data regarding these cases is not being exchanged.

All this implies increased risks in decision-making, the higher cost of the process, plus increased diagnosis time, especially in the case of multiple pathologies.

What is more, this non-collaborative work model makes it harder to incorporate new medical professionals, because this requires longer training periods, making knowledge transfer more complex.

It is therefore necessary to incorporate collaboration platforms between physicians and healthcare professionals, as well as medical and scientific exchange tools to facilitate knowledge sharing. Web technology makes it easier to use these platforms and speed up their implementation, especially to numerous and highly disperse groups.

The use of these collaboration tools will incur the substantial reduction (and even elimination) of repeated medical tests through the access to a single repository of information. It can also reduce the amount of time needed in the disease diagnosis process and make them more reliable, thus lowering the number of patient referrals. Another benefit is the reduction in the training time for new hires, which increases the number of medical professionals currently available.

All these aforementioned aspects are some of the possible measures to be carried out in this new stage of transformation in healthcare. To truly implement any of these successfully, you need the maximum involvement and conviction from all the agents involved (medical professionals and patients alike), the technological support of private enterprise (and this is where Aventia has the solutions to offer each of the three areas of action that have been thus identified), the existence of sustainable business models, the participation and consulting from industry experts, and obligatorily, political impetus at the highest level.