Dr Hawking asks an important question, namely, "how to decrease the burden?". Once the problem is recognised the obvious next step is to operationalize solutions. I would suggest a good starting place is to revisit the final question in our editorial. If that question were considered when looking at how to improve patient pathways or before any new service is rolled out then that would be a reasonable place to begin.
Currently, the focus often seems to be more about improving overall efficiency and the smooth running of systems and the implications for patients and their supporters receives scant, if any, attention. A good example is a recent change to systems at the health centre at which I work. We have a treatment room, run by the health board, to which GPs can send patients for blood tests or minor procedures. The health board recently changed the way our associated treatment room operated so that patients could no longer go straight to the treatment room and be treated, instead they had to book an appointment and return at a later date. This means that patients now have to attend the health centre twice rather than once to get problems sorted. A clear "burden" was added to patients, who now have to arrange transportation twice and/or get time off work twice, in order to get relatively minor problems addressed. The rationale for the change was: "to bring our health centre in line with the rest of the health board area and improve efficiency."
If the question, "Can you really do what I am asking you to do" was asked before that change was enacted then I strongly suspect the change would never have happened. There are numerous examples of how we can lessen burden. For example, one stop diagnostic services/clinics where patients can get numerous investigations and see the appropriate specialist in one visit rather than three or four.
We also need to move from disease centred services to more patient centred services.....so an example might be a move from one stop heart failure services to one stop breathlessness clinics. .
We need to transform our approach to health care delivery but this could begin right away through burden checking every new initiative while at the same time considering how current systems can be made maximally supportive.
Competing interests:
I supervise a PhD studentship funded by the Chief Scientist’s Office, Scotland, that addresses the subject of treatment burden in stroke and co-lead the International Workgroup for Minimally Disruptive Medicine with Victor Montori.
Rapid Response:
Dr Hawking asks an important question, namely, "how to decrease the burden?". Once the problem is recognised the obvious next step is to operationalize solutions. I would suggest a good starting place is to revisit the final question in our editorial. If that question were considered when looking at how to improve patient pathways or before any new service is rolled out then that would be a reasonable place to begin.
Currently, the focus often seems to be more about improving overall efficiency and the smooth running of systems and the implications for patients and their supporters receives scant, if any, attention. A good example is a recent change to systems at the health centre at which I work. We have a treatment room, run by the health board, to which GPs can send patients for blood tests or minor procedures. The health board recently changed the way our associated treatment room operated so that patients could no longer go straight to the treatment room and be treated, instead they had to book an appointment and return at a later date. This means that patients now have to attend the health centre twice rather than once to get problems sorted. A clear "burden" was added to patients, who now have to arrange transportation twice and/or get time off work twice, in order to get relatively minor problems addressed. The rationale for the change was: "to bring our health centre in line with the rest of the health board area and improve efficiency."
If the question, "Can you really do what I am asking you to do" was asked before that change was enacted then I strongly suspect the change would never have happened. There are numerous examples of how we can lessen burden. For example, one stop diagnostic services/clinics where patients can get numerous investigations and see the appropriate specialist in one visit rather than three or four.
We also need to move from disease centred services to more patient centred services.....so an example might be a move from one stop heart failure services to one stop breathlessness clinics. .
We need to transform our approach to health care delivery but this could begin right away through burden checking every new initiative while at the same time considering how current systems can be made maximally supportive.
Competing interests: I supervise a PhD studentship funded by the Chief Scientist’s Office, Scotland, that addresses the subject of treatment burden in stroke and co-lead the International Workgroup for Minimally Disruptive Medicine with Victor Montori.