Challenges of incentivising patient centred careBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4532 (Published 06 October 2017) Cite this as: BMJ 2017;359:j4532
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Reflecting on the recent experience in England of Rachel Foskett-Tharby and her colleagues on how best to increase the collection and use of patient-reported information, we wish to comment on the importance of one of the dimensions of quality during the process of attention centered on the person: perceived quality.
This dimension should not be forgotten, and some theorists consider it to be one of the fundamental components of the "dichotomous" theme: technical quality - perceived quality. This should be separated only to make theoretical considerations.
Patients, relatives or companions in contact with the health system expect to receive courteous, dignified and respectful treatment by health care providers, so these expectations must be present as premises in the health team. Undoubtedly, the "first contact" marks or leaves an imprint difficult to erase. In most health institutions this first exchange is with the security agent, the porter, the receptionist, the nurse classifier, among others; and is almost never directly with the doctor.
The "second contact" is dependent on the type of health institution, usually the nurse or the doctor. In these two contacts all the personnel of the health system must achieve empathy with the patient, family or companion, show interest for the patient and pay careful attention to the concern that afflicts him, however small the problem. The relationship between health worker and patient is essential to obtain the expected benefits and achieve quality perception.
It is a challenge for staff cohesion, when it comes to health institutions that work uninterrupted 24 hours a day, where kindness depends on the staff on duty. It is necessary to ensure humane and timely treatment, considering the adequate selection of personnel who work directly with patients. That is why our system takes into account continuous training courses, with emphasis on communicational aspects, valid to be taken into account in performance evaluation.
The first contact or gateway to the system is no more important than the moment of returning home, when the consultation with your Family Doctor, when leaving the emergency service, when leaving a patient of the hospital, among others. The "last trace" leaves as many marks and memories as the first contact since it can erase negative memories from the first moment. This has a great practical value, the said footprint, is able to disclose the experience as positive or negative and "modulate the social image" of the health institution.
In addressing the dichotomy between technical and perceived quality in health, it is not necessary to maximize any of the two components, both are important, the technical depends in itself on everything that is done correctly in the scientific order, technical care and the component of personal perception that should not be neglected and which depends not only on courteous and kind treatment, but also on adequate communication with the patient and family at all times, respecting the rights and attending informed consent with all its components, to avoid "non-communication" between the patient and relatives with the healthcare team that gives attention.
The perceived quality must be an important aspect to be considered in order to achieve adequate attention focused on the person.
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Competing interests: No competing interests