The importance of change; how through perspective and communication we can improve care

Having discussed the importance of perspective and communication in my previous articles, it seems only fitting that I now comment on the role of these factors in improving healthcare. Namely, where an understanding of the patient's perspective gleaned through open communication can lead to new innovations in improving NHS systems.

There is a growing drive for quality improvement within the NHS, where 'quality improvement projects' are designed by frontline clinical staff through a process of identifying opportunities for improvement within existing healthcare pathways. The NHS model for quality improvement requires 'evidence-based change', where success is measured on the degree to which cost is reduced and patient care maintained and improved. It is the responsibility of the clinician, in the context of a healthcare system under budgetary stress, to maintain or improve patient care whilst reducing cost.

There is great potential for junior doctors in quality improvement. Fresh out of medical school, these young doctors are in the prime position to identify potential changes in the established processes that the more experienced staff may have grown accustomed to. One such example is the early need for multidisciplinary team input in patient care, a process which has been shown to be wildly successful in reducing inpatient stay in a number of fields.

In my role as a junior doctor I spend most of my time face-to-face with patients and have the privilege of understanding their experience. I have previously mentioned the importance of understanding the patient's relationship to their disease, and how through good communication we can reach a shared understanding of the care pathway. I argue that his process is of paramount importance in tailoring patient-centred healthcare plans, but also lends itself to the earlier identification of problems in a patient's experience.

Through constant and mindful communication with an open perspective, we are able to maintain a wide scope through which we can see the patient's place within the NHS as whole, from clerking to discharge. By understanding the patient's experience of the 'machinery' of healthcare, we can identify where 'shortcomings' such as delayed discharge, delayed referral and others are often missed. This is not to say that current processes are poor, but simply that an imperative to improve a system is inherently important within evolving healthcare.

The identification of these 'shortcomings' and the design of 'changes' leads to the 'quality improvement' projects that I mentioned before. It is open communication with patients that allows us to see shortcomings, and a shared perspective that allows us to design changes that are both subjectively superior in the eyes of those in our care, and objectively superior in the eyes of the NHS. The frontline, day-to-day experience of the junior doctors allows us a more holistic perspective of the overall patient experience, allowing us to notice shortcomings that others may miss.

So where are we heading? The overall goal is to improve care standards for reduced cost. By designing successful quality improvement projects, we are able to streamline the current processes within the NHS. In a growing population with an increasing demand for excellent, and accountable, care, such change is not only beneficial, but necessary. It is in the best of interests of the NHS and our patients to push for change. This can be accomplished at a number of levels, but at the lowest, in the hands of the frontline juniors who can offer a fresh perspective.

So what can you do? Talk to the junior, you might just get us thinking. It is up to us to work together to keep improving the NHS, and it is through quality improvement projects that we can make the change. It is up to doctors and patients to work together to improve healthcare.

The opinions expressed in this article are those of the author and may not represent those of SDHCT. No patient identifiable information is included.


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