Editor's Choice

Through the patients’ eyes

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b588 (Published 12 February 2009) Cite this as: BMJ 2009;338:b588
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

    If we really want to transform the quality and safety of health care, we can’t just do more of what we do now. Even doing it more efficiently won’t be enough. We have to do different things and we have to do things differently. This is the message of two articles in this week’s BMJ.

    Hugh Rogers and colleagues (doi:10.1136/bmj.a2321) tell us that how we deliver and receive care is governed by a set of rules. We may not be aware of these rules, so ingrained are they in how we operate as clinicians and patients, but they represent the design of our healthcare system. Through a series of workshops these authors explored the rules by which patients access secondary care.

    It’s immediately clear that the current system is designed around healthcare professionals rather than patients. Only they can decide about diagnosis, treatment, and recovery. Only they can deliver care and it must be face to face. They control access to services that are structured for their convenience “because clinicians’ time is more valuable than patients’ time, and the demands of patients are limitless.” The result is a system riddled with delays that adversely affect patients’ outcomes and experience.

    A more desirable set of rules that puts patients at the centre of things could substantially reduce these delays, they say. The new rules will already be operating in enlightened parts of our health system. They allow patients to access services and information in a range of ways (phone, email, internet, face to face) at times and places convenient to them “because patients’ time is valued, and most demands of patients are reasonable.”

    It is this shift in attitude that is so radical and important: a shift from thinking that “supply is limited, demand exceeds supply, and both are unpredictable,” to thinking that “demand is finite and predictable, supply is flexible and manageable.” As a way of achieving such new ways of thinking, the authors suggest that clinicians and staff walk through their patients’ journeys and videotape their experiences to see which set of rules—the old or the new—fit best with what they see.

    Jane Feinmann reports on another radical rethink that’s finding its way to hospitals and general practices near you: the Patient Safety First campaign (doi:10.1136/bmj.b420). Trusts that sign up will make a public pledge to make patient safety their top priority. They will adopt one of five interventions to reduce avoidable harm and commit to reporting changes in their standardised mortality ratios. Those already active in the campaign, such as Mark Patten at Luton and Dunstable Hospital, report an attitudinal shift from tolerating harms as inevitable to seeing them as entirely avoidable.

    What binds these two articles is their call on us to look at health care from the patients’ perspective. It has always been part of the clinician’s role to be the patient’s advocate. Now this means standing in their shoes and seeing things through their eyes.


    Cite this as: BMJ 2009;338:b588

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