6 Proposed new healthcare concept – a patient process that
6.3 Some thoughts on how project models and quality assurance tools
patient process
In a good health and social care process/care planning or healthcare system,
management and personnel work continuously to survey, analyse, discuss and reflect so as to improve their operation. Important areas for improvement are continuity,
competence, access to the right care at the right time, approach and collaboration in order to achieve a flexible process for the patient.
The project model is being used to organise and guide the activities as development work progresses in most industries and social sectors. The project form is very often
units must collaborate to achieve a common objective. Naturally, the principles upon which the project model is based are also used in different healthcare contexts, but not on patient level in direct healthcare work. They might also be adapted to organise healthcare for a patient with complex care needs. In the same way, quality assurance tools such as PGSA and the value compass can be used to draw up objectives, identify opportunities for improvement (in illnesses or conditions) plan measures and follow-up results for the individual patient.
The advantage of project models and quality assurance tools is that they are well known, broadly accepted and widespread. Quality assurance tools are instructional and designed to create participation. They support learning and are easy to take on board. Using quality assurance tools in planning and implementing healthcare efforts should motivate patients and relatives to take a more active role and participate and be involved more. The opposite actually occurs when the profession talks “over the patient’s head”, reinforcing its advantage with incomprehensible technical language. Quality assurance tools also create structure and an overall view which increases involvement and the chances of everyone involved contributing and carrying out their obligations.
Somewhat simplified and adapted, the patient may be regarded as a project. The aim is to create as much value as possible during the lifetime of the “project”. This may take place by remedying problems which have arisen and by preventing them from arising (care prevention).
An operation can then be scoped in order to run a certain number of projects. The operation is responsible for identifying and starting new projects when justified. The project is started when a patient has “qualified” for it, for example when they reach a certain age or when the patient has such comprehensive health and social care needs that it becomes justified to start a project. Patients who might not be in immediate need but who are in the “risk zone” should also be included in the care model. By working proactively, it is possible to generate readiness and avoid being surprised by sudden changes in states of health which can easily turn chaotic. If healthcare cannot then cope with the situation, then the opposite of value creation arises; a common experience when visiting hospital A&E departments.
In their book “Dirigent saknas” [“The Absent Conductor”] [23] Gurner and Thorslund described how shortcomings in collaboration lead to elderly people faring badly. They seek a “conductor” – someone who can act as a project manager. In conjunction with the elderly person and, in the best cases a relative too, the “conductor” can act as “project management” for that case. They plan and determine improvements/objectives to achieve, what efforts should be initiated and who should carry them out.
All this should be managed in the care planning process. It is also crucial that the right efforts are initiated. Our attempts to describe this diagrammatically resulted in the following model. This builds upon results from the Intercare, Sams and MobiSams projects.
The planning needs to be dynamic. It should be possible to reformulate and modify objectives and set new ones. Objectives that are no longer important should be removed. There should always be the opportunity to amend the patient process when events occur that bring about new circumstances for providing health and social care. For this reason, the model should be regarded as part of an iterative process. It may be appropriate to identify the most important areas of need and thereafter get into a more particular objective formulation stage. Input into the objective formulation process comes from assessment and observation, from professional competence and the patient’s value map. This should be interwoven with and influence the dialogue that leads towards objectives. This is where the patient’s value map is important. It gives direction and states what is important and what is less so. By finding out what the patient values and involving them and their relatives in the planning, the “right” problems can be addressed. Naturally, this must be balanced with the professional knowledge which the care coordinator and other key people in the team can bring. Correctly identified objectives lead to improvements. The PGSA method can be used to systematise and structure each objective or improvement measure. When objectives have been properly formulated, it is then a matter of determining what efforts of
patient themselves. The choice of measures can also be influenced here by the patient’s value map but naturally also by what evidence such as knowledge, science and trusted experience can add. The final stage in the model above and in PGSA is to measure and analyse the outcome and results of efforts made. Depending on the outcome, fresh decisions may be taken. Occasionally, the problem may be remedied, but in other cases knowledge may have been gained showing that the problem is actually slightly
different and that a new objective needs formulating and new measures initiating.