Public Hearing 7/5/2552. People Centred Health Care Bi-Regional Forum of Medical Training...

Public Hearing

7/5/2552

People Centred Health CarePeople Centred Health Care

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WHO Bi-Regional Forum of Medical Training InstitutionsBi-Regional Forum of Medical Training Institutions

Manila 1-2 July, 2008Manila 1-2 July, 2008

People Centred Health CarePeople Centred Health Care representsrepresents a major shift in thinking. a major shift in thinking. It has a It has a

long history in research, clinical practice, and long history in research, clinical practice, and

medical education and in recent years, there medical education and in recent years, there

have been efforts to make it a have been efforts to make it a practical realitypractical reality..

However, this has not been satisfactorily and However, this has not been satisfactorily and

collectively enunciated at all of the health collectively enunciated at all of the health

system level, to encapsulate the needs and system level, to encapsulate the needs and

expectations of individuals, families and expectations of individuals, families and

communities, and how health practitioners, communities, and how health practitioners,

health administrators, and bureaucrats could health administrators, and bureaucrats could

respond.respond.

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• “The essence of care is to centre on the patient. This is a shift from traditional,

provider focused practice, and it requires the workforce to develop communication

skills that empower patients through seeing health from the patient’s perspective, and motivating and training patients in health-

related self-management.”

Core Competencies of the Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions (WHO 2005 )

A shift in focus …A shift in focus …

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After the 58th session of the Regional Committee for the Western Pacific held in the Republic of

Korea

September 2007

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TheThe needneed forfor aa paradigmparadigm shiftshift inin healthhealth carecare

1. Health Systems becoming overly

• biomedical-orientedbiomedical-oriented

• technology-driventechnology-driven

• doctor-dominateddoctor-dominated

• market-orientedmarket-oriented

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2. Physician-centered management systems

New knowledge / Research /New knowledge / Research /Advanced TechnologyAdvanced Technology

Disease - focusedDisease - focused

Physician - centredPhysician - centred

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3. Medical Education / Practice

• focus on body systems and disease conditionsfocus on body systems and disease conditions

• less attention to social context, psychosocial and less attention to social context, psychosocial and

cultural issues, ethics, interpersonal communication cultural issues, ethics, interpersonal communication

and relational skillsand relational skills

• specialization and lack of team work leads specialization and lack of team work leads

to fragmented and uncoordinated care to fragmented and uncoordinated care

(hole system)(hole system)

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4. Changing health needs and community expectations

• ageing populationsageing populations

• rising of chronic conditionsrising of chronic conditions

• increased literacy and buying powerincreased literacy and buying power

• better information technology and access better information technology and access

to informationto information

• increasing consumerismincreasing consumerism

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5. Problems in the Health Care System

• QualityQuality

• Financing incentivesFinancing incentives

• Workforce productionWorkforce production

• Distribution and regulationDistribution and regulation

• Weaknesses in primary care and in continuity Weaknesses in primary care and in continuity

of careof care

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6. Health Care Governance

• Few opportunities for consumer input Few opportunities for consumer input

and feedbackand feedback

• Little reporting back to the communityLittle reporting back to the community

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Physician-centred management systemsPhysician-centred management systems

People-centredPeople-centred

ManagementManagement

SystemsSystems

• People

− patient, family, community

− health care provider

• People are served by & are able to participate in trusted health systems that response to their needs in humane and holistic ways

Patient-Centred Health Patient-Centred Health CareCare

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• Health promotion

• Harmony of mind & body, people & systems

• Happiness of people

• health care health care usersusers being informed in being informed in

decision-making participation and decision-making participation and

having choices - empowermenthaving choices - empowerment

• providersproviders showing respect for patients’ showing respect for patients’

privacy and dignity and responding to privacy and dignity and responding to

their needs in a holistic mannertheir needs in a holistic manner

Elements and PrinciplesElements and Principles

1.1. Culture of care and communicationCulture of care and communication

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2.2. Responsible, responsive and accountable Responsible, responsive and accountable

services and institutions: providingservices and institutions: providing

• affordableaffordable

• safesafe

• effectiveeffective

• holistic health careholistic health care

• equitably accessible equitably accessible

• ethicalethical

• evidence-based evidence-based

• putting in place appropriate policies and

interventions

• positive care and work environments

• strong primary care workforce

• mechanisms for stakeholders’ involvement in

health services planning, policy development,

and feedback for quality improvement

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3.3. Supportive health care environments Supportive health care environments

The 4 Action DomainsThe 4 Action Domains

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1. Individuals, families and

communitiesInformed and Informed and

empoweredempowered

2. Health practitioners Competent and Competent and

responsiveresponsive

3. Health care organizations Efficient and Efficient and

effectiveeffective

4. Health systems Supportive and Supportive and

humanitarianhumanitarian

• Increasing health literacy

• Providing communication and negotiation skills

that lead to meaningful participation in

decision-making

• Empowering for self-management and care

• Increasing capacity of the voluntary sector,

community-based organizations and

professional organizations to extend mutual

assistance

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Domain 1: Domain 1: Individuals, Families Individuals, Families and Communitiesand Communities

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Domain 1: Domain 1: Individuals, Families Individuals, Families and Communitiesand Communities

• Promoting social infrastructure that supports

community participation in health services

planning and facilitates greater collaboration

between local governments and communities

• Developing community leaders who advocate

and support community involvement in health

policy

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Domain 2: Domain 2: Health PractitionersHealth Practitioners

• Needs and roles as providers of care

• Needs and roles as people

values expectations preferences capacities overall well-being

• Physicians, Nurses, Paramedical clinical

supporters, Educators, Leaders

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Domain 2: Domain 2: Health PractitionersHealth Practitioners

• Increase capacity for holistic and compassionate care

through better communication, recognition of psychosocial

and cultural issues

• Enhance commitment to standardized, quality, safe and

ethical care

• Equip for patient-centredness as a core competency

3C’s: communicate

coordinate

collaborate

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DomainDomain 3:3: Health Care Health Care OrganizationsOrganizations

• Providing a conducive and comfortable environment

for people receiving and providing health care

• Ensuring efficient and effective coordination of care

• Establishing and strengthening multi-disciplinary

care systems

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DomainDomain 3:3: Health Care Health Care OrganizationsOrganizations

• Strengthening the integration of patient education,

family involvement, self-management and

counselling into health care

• Providing standards and incentives for safe,

quality and ethical services

• Introducing and strengthening models of care

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DomainDomain 4:4: Health Systems Health Systems

• Developing and strengthening primary care and the primary care workforce

• Putting in place financial incentives that induce positive provider behaviour and improve access and financial risk protection for the whole population

• Building a stronger evidence base on ways to improve health care and the health system itself to achieve better health outcomes

• Ensuring rational technology use

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DomainDomain 4:4: Health Systems Health Systems

• Strengthening the monitoring of professional standards

• Instituting public accountability measures for health services organization, delivery and financing

• Monitoring and addressing patient and community concerns about health care quality

• Assisting people who have experienced adverse events in the health system

• Ensuring protection of patient information

• Trying harder will not work.Changing systems will.

IOM, 2001

• Patient-centred care is more than just emphatic interviewing of patients.

It is about re-organising healthcare systems.

Bauman et al, 2003

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SummarySummary

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People-Centred Health CarePeople-Centred Health Care

• Patients do not care how much you know

until they know how much you care

Gerard HealyFormer President Am College of Surgeons

แผนพั�ฒนาสุขภาพัแห่ งชาติ� ฉบั�บัที่�� 10 ในช วงแผนพั�ฒนาเศรษฐกิ�จและสุ�งคมแห่ งชาติ�

ฉบั�บัที่�� 10พั.ศ. 2550-2554

แผนสุ�ขภาพประชาชาติ�เพ��อสุ�ขภาพประชาชน ไทย สุ��ระบบสุ�ขภาพพอเพ�ยงติามแนวปร�ชญาเศรษฐกิ�จพอเพ�ยง

ระบบบร�กิารสุ�ขภาพแบบบ�รณากิาร(Integrated Health Care System)

คุ�ณภาพบร�กิาร

เช��อมโยงไม�ม�ช�องว�างไม�ซ้ำ)*าซ้ำ+อน

ContinuousCare

IntegratedCare

Holistic Care

TertiaryCare3( o Care)

Secondary Care2( o Care)

Primary Care1( o Care)

Excellent Center Tertiary Medical Care

Primary Medical Care General Practice Family Practice Primary Health Care Self-Care

Referral Center Secondary Medical Care Special CareReferral System

Thank you for your attention.

Public Hearing 7/5/2552. People Centred Health Care Bi-Regional Forum of Medical Training...

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