Hospitals and the paradigm shift to a person- centred model


In 2005 I published my book ‘Journey to Wellness – Designing a people-centred health system for Canadians’ and launched the Canadian Association for People-Centred Health.

The same year, Paul Wallace of Kaiser Permanente predicted we were in the midst of the greatest paradigm shift in health information and power, in the history of mankind — this being the shift in power from the provider to the people. He also predicted this shift would affect virtually every stakeholder in healthcare. Thus far the majority of hospitals and health care institutions around the world have essentially maintained the status quo of the provider and institutionally-centred paradigm, but this is beginning to change at a rapid pace.

It is time to advance our thinking, with urgency, to an understanding of the role these vital institutions will play as people assume greater control of their own health. Putting the needs of the people first in healthcare is happening whether we like it or not, and it is the right thing to do. Failure to do so is jeopardizing the efficiency of our institutions, outcomes they achieve, and quality of care.

It is time to take off our institutionally-centred hats, move out of a silo mentality, and put some critical thinking to work with the single objective of determining how we can make this happen with the least amount of stress and upheaval.

Using my 40 years of health care experience, designing a person-centric care model, and 20 years of writing, speaking and advocating for person-centric system transformation, the following is a list of where I see an increasingly informed and empowered people driving our health systems and hospitals in particular. As I travel around the globe, there is growing consensus that each of these statements is no longer a dream. Each of these things is happening now in innovative centres around the world. This is what the people are demanding and asking for more of, and I think we should listen.
• People want the care back in healthcare. With access to information and technology, healthcare is becoming totally transparent. People will know their options and choose to be supported where they have a trusting relationship and feel understood. The Doctor as God model is disappearing.
• There will be a conscious and rapid shift of care delivery from within institutions to home and community, for many financial and system design reasons. When people bear a greater financial role in their healthcare as is happening increasingly in Canada, and are able to access information seamlessly, they will realize what an expensive ($2500 – $5000 per day) but valuable and cherished resource hospitals are. They will then begin to respect them more and understand that these are specialized support units, not a catch all for all health issues. If we don’t use them respectfully, they will not be available for those who truly need them.  It must be stated that the primary force driving people out of hospitals and back to home and the community is that this is where people feel safe and want to be.
• Virtually all hospital design and new construction based on the hospitals as the centre of care should be stopped and rethought. As is happening in the UK, and elsewhere, all design should be based on major hospitals as specialized acute and emergency care centres with community-based poly-centres to serve the people closer to home. Decisions must be based on where things are going in future, and what is best for the people, rather than where things have been and what was perceived to be best for the institutions.
• Emergency Care: As much as 80 per cent of the emergency visits that are now done in hospitals, will be managed outside the hospital by primary health care teams, including Physician Assistants, Nurse Practitioners, Nurses, health coaches and allied health professionals. These teams will be located in malls, pharmacies, community centres and locations where parking is free and people actually want to go for many reasons. This is already happening around the world and it is time to catch up. We see Loblaw in Canada, Walgreens in the US, and other retailers announcing major investments to serve their customers in terms of healthcare.
• Chronic care is driving system design and care models and moving it out of institutions and into home and community. Over 70 per cent of health expenditures are for chronic care and most chronic care does not have to be done in a hospital or even a primary care centre. Technology enabling home monitoring, communications, etc. are enabling rapid shifts in this context.
• Driven by system reform and legislation in various parts of the world, person centric cloud-based technology is making it possible to bring all provider and institutionally-centred, electronic health records together, putting it in the hands of the people so they can access and share their health information. This will enable teams in the community to provide care and support that in the past could only have been done in a single hospital/ institution, for the primary reason that the hospital and doctors office was where the information was stored.
• Very exciting health system apps and technology managed on mobile devices and supported by health coaches and cloud-based technology is drastically reducing the need for physical visits to the hospitals for tests like, ECG, Doppler’s, Blood Pressure, etc
• In addition to these myriad of devices and Apps and a key theme in Dr. Topol’s book ‘The Creative Destruction of Medicine’, genomics and proteomics are enabling dramatic changes to how we diagnose and treat illness and disease at a personal level, fundamentally changing the way care is administered and funded, and the design of the hospital. Truly personalized care based on genetic factors is becoming a reality.

When viewed in aggregate,  I think you would have to agree that a person centric approach to care, enabled by proper utilization of the technology that is already available with realignment of the providers’ role to their full scope of practice, and delivering care where the people most want to be cared for,  is dramatically changing the role of hospitals.

The hospital and system leaders must be innovative in managing the journey from where we are now to a truly person-centred model for care and support.