Making the case for changing relationships

In the last five years Health Foundation programmes have produced evidence pointing to how changes in the way people interact with healthcare providers can lead to better care.

The current economic climate and healthcare reforms make this work more relevant than ever, but we recognise that there is still much to do to understand the issues and challenges, to convince people about why it really matters and what it really means.

We will be taking forward a range of work in 2012 to bring alive our vision, surface the issues, share the evidence and create debate. We will also continue to test what works in practice and  share good practice with those who are ready to try new approaches.

Three key relationships

Too often healthcare providers operate service models centred around their operational needs rather than the needs of their users. But our programmes demonstrate that improved satisfaction and outcomes can be achieved through changes in three key relationships:

1. local communities and the wider healthcare system: bridging gaps between services provided and what communities really need, by understanding expectations and preferences and recognising the contributions they can make to improving health
2. people using services and the wider healthcare system: making services more integrated, personalised and responsive through embracing new technologies and joining up
3. clinicians and service users: helping them to work together as equal partners, sharing expertise, understanding and purpose.

Health Foundation Director of Improvement Programmes, Jo Bibby, says: ‘Sustainable services will require a shift in expectations and responsibilities. People need to take more responsibility for their own health and services need to facilitate this.’

Equipping patients to play a more active role

The Health Foundation advocates a radical transformation of relationships between people and services so that patients are equipped to play a much more active role in their own healthcare. When people are empowered in this way they tend to be more committed to a course of treatment and more satisfied with the outcomes.

Jo says that when clinicians are unable to engage effectively with service users it can lead  to substantial waste through, for example, medicines prescribed and not taken and courses of treatment not followed through. She also cites slow take up of new technologies and the maintenance of a dependency culture as areas we need to address.

‘People need to be enabled through better interaction with their healthcare providers and new ways to take responsibility, such as being able to see results of tests and making entries in their own records,’ says Jo. ‘These things would be taken for granted in other areas of our lives.’

Changing relationships is essential for effective shared decision making and supported self management – both tried and tested approaches in which building motivation and confidence are critical.

‘It’s about clinicians conducting consultations in different ways,’ says Jo. ‘We know people want to be healthier but they often find it difficult. We’ve done a lot of work looking at how to develop people’s motivation, including training clinicians in motivational interviewing skills to help them provide support by building the confidence needed to change lifestyles.’

Jo says that having access to their health records enables people to think in advance about what they want to ask their clinicians, and helps to avoid them leaving the consultation room with more questions than answers. Access to records also contributes to safer care because individuals can spot mistakes and correct them.

On the topic of harnessing technology, Jo says: ‘We’re testing web-based records that can feed through personalised information – such as the information women need at particular stages of pregnancy. If Facebook can use this kind of technology, healthcare services can too.’

Sometimes people think that changing relationships and shared decision making devalue clinical expertise. Jo doesn’t accept this and says: ‘Clinical skills and knowledge are the foundation of high quality healthcare, but unless people fully understand the choices and benefits and are motivated to follow treatment advice, then those skills and knowledge are going to waste. Our knowledge is of limited value unless we help people to make better use of it.’

Focusing on the bigger picture, Jo says that we need a national, macro level debate about what the public can and should expect from their healthcare services. ‘We need to talk about how service providers can’t meet all society’s healthcare needs and define what service users need to do to help themselves.’

Health Foundation improvement programmes

Co-creating Health is embedding self management support within mainstream health services to improve the quality of life for people with long-term conditions.

Magic: Making good decisions in collaboration is exploring how shared decision making can become part of everyday clinical practice.

Closing the Gap through Changing Relationships involves seven partnership teams exploring a range of innovative approaches, including access to health records and redesigning antenatal services.