The Concept of Patient Empowerment - Essay Example

?Managing Health Services for Quality I. Productivity, Waste and New Ways to Empower the Patient: a. Nature: Focusing on the comment from Richard Barnes of Windermere, Cumbria, it would seem that actual experience of National Health Service (NHS) clients is far better than the report provided by the National Audit Office (NAO). Perusing the contents of the actual article reveals that the basis of the statement of the NAO is the budget allocation that increased from last year. However, further evaluation indicated that the increase invariably went to the salaries of NHS which markedly improved from last year as well. Nonetheless, a mere increase in the budget without the corresponding increase in the number of personnel does not result in a more efficient and competent service. Efficiency will only be enhanced by a small percentage due to the heightened motivation brought about by the increase in salary. It is emphasized that while the workforce has exhibited noticeable enthusiasm in its performance, this is not reflective of true efficiency since this will plateau after a period of time when effect of the budget or wage increase has lost its appeal or when fatigue sets in. Efficiency should not therefore be measured by the amount of money poured into the NHS as the amount of money does not create more time for the same number of personnel to perform their functions with efficiency and fervour. Efficiency therefore should be computed base on the number of patients handled per NHS personnel. Please note that NHS is not composed solely of medical personnel who actually interact with patients but rather it is also complemented by administrative personnel and other non-essential or semi-essential staff to run efficiently. Efficiency should similarly be equated on the number of essential personnel whose responsibility involves face to face interaction with patients. Focusing on Jo Webber’s letter regarding ambulance response time, Jo was in the opinion that essential to meeting response time for ambulance is also satisfying the actual need of the patient in such time of medical distress. It would not make any sense he averred that the ambulance is at the scene simply to meet the time limit but is inutile in responding to the medical needs of the patient. It cannot be ignored however that measuring response time is the only visible aspect of emergency response that can be considered to quantify efficiency. Other factors such as effectiveness of the team will always rely on the present situation since at most every ambulance is only equipped to respond to certain emergencies but definitely not on all emergencies. Otherwise every ambulance will be considered a moving field hospital travelling in excess of 100kph on the average. Chris Week’s letter regarding patient empowerment elucidated the need for patient to choose the kind of medical care a person would like to have and from whom. Although NHS and some HMO guarantee the best kind of service available to residents, the extent of a patient’s empowerment should not go beyond what is required to fulfil the mandate of medical practitioners to provide medical care. To illustrate: There are patients who cannot decide rationally because of their fear as to the severity of their medical condition. Imposing patient empowerment on the situation would run counter to the interest of the patient and if it remains unabated notwithstanding benign illnesses, patients would demand the performance of unnecessary tests simply to convince them of a non-existent syndrome in the first place to the detriment of those patients who are in dire need treatment. b. Cause: Regarding Richard Barnes comment: NAO’s concern although fiscal competence should also take into consideration the fiscal cost of efficiency. Fiscal cost of efficiency refers to the amount of capital needed to achieve a certain level of efficiency. In this case, it would seem that there is confusion with regards to the efficiency criteria NAO is trying to project to the public. Measuring efficiency based on the amount of money disbursed or spent will not provide a realistic efficiency number. What is needed to resolve the confusion spawned by Richard Barnes’ concern among the stakeholders is to provide an actual efficiency measure. Using time and motion study in the actual process cycle for every type of service will reveal the efficiency of each process. In creating capacity for the NHS, the only data needed would be the efficiency per medical health professional. Increase the number of medical health personnel and accordingly, the number of patient who can be serviced or provided medical care and attention will also increase. Jo Webber’s apprehension regarding the efficiency determination that an ambulance can be gauged with is anchored on the ambulance team’s desire to be an effective responder. Looking at the dynamics of rescue team from receipt of the call to the actual arrival at the scene would reveal the importance to be informed beforehand of the kind of injury or nature of the medical emergency that has been reported. This will ensure that the non-driving ambulance personnel shall be able to prepare what is needed before the ambulance even arrive at the scene. Chris Week’s patient empowerment is rooted from the fact that most patients, even the ambulant ones, lose their objectivity and will power to choose the best kind of medical care they need. The primordial rule in medical care is to make the patient better. A patient is generally not too concerned with the technical terms when it comes to the medical care he needed even his relatives may not be well-informed when it comes to digesting medical information and its implication to the patient. However, they would demand a medical procedure even though they are not showing any of the symptoms indicative of the disease requiring such procedure, test or examination. Empowering patients to go against the recommendation of the doctor that will make him better is counter-productive to the efforts spent to make the patient better. c. Solution: The solution to Richard Barnes concern lies on determining the actual and effective capacity of each medical practitioner. And, what could be done to increase the number of patients who can be handled in a working shift. The medical history should be procured immediately upon admission and other additional tools can be purchased to increase the number of patients or additional test can be performed at the onset to ensure that all available data is on hand when the doctor conducts his one on one examination of the patient so that proper diagnosis can be given. The solution to Jo Webber’s concern starts at the first call. Although gathering information is very tedious and time consuming the twin effect of talking to the caller and getting as much information as possible could both help the state of mind of the caller while the operator would be able to relay as many information needed to help the patient. Chris Week’s patient empowerment solution rely on the commitment agreement of the patient signed or will sign with the hospital. The same commitment agreement can also be signed by his guardians in case of diminished mental capacity on the part of the patient. The commitment agreement shall be binding to both parties and the subsequent conduct of the treatment plan shall be defined within the pages of the commitment agreement. The commitment agreement, among other things, should include the type of care the patient shall receive. It shall also contain the type of decision where the patient’s decision has to be respected. The agreement shall also remove all liabilities from the doctor if in case details of the commitment agreement prevent him from performing his duties and responsibilities as a doctor pursuant to the choice earlier made known by the patient. If in case the patient has been rendered or adjudged not in control of his faculties relatives or those that hold legal responsibility over the patient shall decide for the patient. II. Dentists Routinely Failing Children with Serious Tooth Decay a. Nature: Milk teeth also known as Deciduous Teeth, reborner teeth, baby teeth, temporary teeth or primary teeth have always been considered by parents to be unimportant as far as the development of the child’s oral health is concerned. The logic behind is that “it will eventually detach itself” at a certain age. Wasting financial resources on something that will “eventually fall off” is not a good investment. However, in this modern time, milk teeth is no longer dismissed an inconvenience but rather accorded an equally important attention in oral health care and aesthetic appearance of an individual. Milk teeth are formed during the development stage of the fetus and erupt on the first two years of infancy. Milk teeth are fully functional teeth that can be used the same way permanent teeth are used. Milk teeth will be used from age six months up to the twelfth year of the child. Milk teeth are formed at the sixth week of an embryo’s development it is responsible for the formation of the facial distinctive features of the child. It is also responsible for the formation of the mouth cavity if not the strengthening of the mouth cavern to ensure that all the other parts of the mouth, sinus canal are developed normally. The development of a child’s first word is influenced by the formation of his milk teeth. Since speech dynamics are influenced by all the muscles in the mouth and their effect to static object like the teeth. There are normally a total of twenty milk teeth that starts with the mandibular centrals, while the last to erupt are the second molars. Milk teeth eruption starts at sixth month and then they are completely replaced by permanent teeth at the twelfth year of the child. The roots of milk teeth serve as a guide for the permanent teeth. Permanent teeth generally follow the eruption process of the milk teeth including the way it reacts to the natural germs in the mouth. Formation of carries is generally influenced by the diet and eating habits of the child. Natural bacteria and acids in the mouth react to the food that is ingested by the child especially at night where minute morsels or particles are left in between teeth. Destructive bacteria often get cultured at night when all the environmental factors such as the absence of light and the presence of moisture encourage its growth. Fissures also develop along the face of the teeth but most especially at the business end of the teeth. These fissures, more often than not goes beyond the enamel of the mouth and at times is responsible for the entry of carries deep within the tooth. Fissures are not only developed from chewing and night teeth grinding these are also developed by chemical reaction of the teeth with the bacteria and the food the child is eating. The influence of Milk teeth on the development of the permanent teeth starts even before the Milk teeth erupts. The root of the Milk teeth and the path it creates leading to the surface is the same path that will be followed by the erupting permanent teeth. Both the Milk teeth and the permanent teeth originated from the same tooth bud. Furthermore, due to root re-sorption, the roots of the milk teeth is dissolved and absorbed by the permanent teeth. In cases, where the carries of the milk teeth have already reached the roots of the milk teeth, the carries are also dissolved into the permanent teeth if not the carries already infect the permanent teeth even before it erupts. The onset of carries can be traced from lack of proper diet and nutrition that affect the chemical dynamics in the mouth. Unabated by proper oral hygiene, carries often develop that breaks down the physical structure of the teeth. Carries worsen due to continuous neglect over time. Aside from the continuous throbbing pain experience by dental patients who have neglected their teeth, letting carries develop and eat through the root of the teeth. Puss can develop overtime. The development of abscess often affects the heart and can even poison the blood in some instances. Given these dangers, it is therefore of primary importance for the government to resolve this expanding concern and nip it in the bud so to speak. Prevention is the key to ensuring that problem do not escalate at a level where it will become unmanageable. However, while prevention can be easily administered the resources needed to have the materials available are another challenge. Dental health care concern is a multi-tiered problem. To illustrate: Dental care starts from providing nutritious diet to children. However, this area of concern directly impacts the economic situation of the parents. This particular area of concern can be addressed along with other problems related to the economic condition of the country by the government. The second tier is the direct intervention by the dental healthcare professional which shall be the onus of the solution. b. Cause: The root cause of the problem is economics. Dental care in itself is not that expensive anywhere, a visit to the dentist for a quick check-up and a fluoride rub or bath should not cost too much. However, if the child’s diet is very well taken cared-off and complies with the standard balance diet, a once a year visit to the dentist should be more than enough. Dentists, in general are very much aware of the challenges milk teeth undergo from their first eruption. They are also much aware of how to administer care and how to advise patients the best way to care for milk teeth including permanent teeth. However, their best intention, including their advices may fall on deaf ears. The primary reason for the cheek and bone attitude of parents is the very nature of the dental problem. Milk teeth are generally regarded as a part of the body that undergoes a natural process where it will eventually be shed-off and to waste good money on something that will eventually fall-off is a waste of good money. Dental hygienist or even Dental Doctors are normally powerless in cases where the parents have the right to decide on what to do with their child’s health most especially with the child’s dental health. Dental problem unlike medical problem will not automatically involve social services in cases where there is a clear sign of neglect. In depressed areas, the primary consideration is to put something in the stomach first. However, the quality of food that is being ingested remains much to be desired due to the economic situation of the area. In prioritizing what to spend for dental care is not in one of the top priorities. This attitude can also be reflected in the way government allocate funding for dental care. The result of this long line of neglect is the worsening situation of the dental health of children most especially. The place where the child grew up likewise play an important role in determining the strength and condition of the teeth as when the child originates in an area where mineral deposits are aplenty, where the water source causes discoloration on the teeth or other similar circumstances where oral hygiene is compromised. Unfortunately, dental problem is one of the leading causes of heart ailment, malnutrition and at times in severe cases blood poisoning. There are also instances where common gastro intestinal flu is traced through poor dental hygiene. The proximity of the mouth and possible formation of puss and abscess threatens even the brain. Among children, the ability to verbalize discomfort or even pain exacerbates the situation further. Any display of discomfort is often times regarded as tantrums or the child having difficult fit. Not only are these episodes disregarded, they are often misunderstood. The absence of a clear and visible manifestation of problems is another argument to consider. Only when the situation has gotten worst would the involvement of medical or dental professional are sought. Often times the only solution available to medical or dental practitioner is the extraction of the milk teeth. Being the guide of the permanent teeth in its development and eruption process, an early extraction of milk teeth can present aesthetic problems for the child in adult life. Another area to consider in dental care is the size of the milk teeth, its small size often times makes it difficult for dentist to drill and make room for fillings. The composition and the fragility of milk teeth often discourage dentist to do remedial action such as putting filling in the cavity. Dental Doctors are often torn between exigency and the right solution to a problem. Drilling to provide room for fillings are as painful for the patient as it is difficult for the dental doctor to expertly drill fragile milk teeth that can break at any time when pressure is applied to it. c. Solution: The impetus for parents and dentist to save the milk teeth of children under their ward is to provide good nutrition to these children. Regular visits to the dentist should be done at least once a year. The most common solution to dental problems of children that is in their first 12 years is to save the milk teeth, to enable the milk teeth to guide the permanent teeth as it erupts from the gum. In support of the proposition is to fill the cavity formed by carries to strengthen the structure of the milk teeth and make it survive until it is allowed to naturally fall-off to make way for the permanent teeth’s eruption. To ensure that dental patients are given the proper care. The state should enact a law that will compel the doctors to take charge of the dental health of his patient. The law will ensure that parents are mandated to follow all his written advice and direction to take care of the child’s dental health care needs. The law should likewise provide a limit for toothpaste manufacturers or other similar products to limit the sugar content on toothpaste as the use thereof could trigger the onslaught of carries. The law should equally provide for penalties against parents who fail to follow the direction enunciated by the child’s dental healthcare provider. It shall also be the responsibility of the dental health practitioner to provide the parents enough information that will give them enabling knowledge to take care of their children’s dental health. The parents in turn once informed shall be responsible for the continued care of the child’s dental health at home. Since the child is still in their formative years developing the habit of being conscious of dental care will be to their advantage. To remove the economic problem faced by parents that prevents them from taking care of their child’s dental care. Government subsidy that will provide dental medicines, toothbrush and other medical devices can be made available. A study that will measure the impact of the current cost of resolving dental problems against the cost of preventing dental problems should be taken into consideration. In the same manner that medical neglect of parents can be prosecuted, dental neglect should also fall under the same category. This is to ensure that social services can be informed at once if in case there is a violation. III. A process Issue: inadequate planning and control, an unsuitable process for the task, or poor communication flow. a. Nature: Inadequate planning and control often leads to project failure and wastage. A failed project in health care may have devastating impact to the health of a population that could lead to dire consequences. Failure in project management due to insufficient knowledge of the project leads to the creation of unsuitable process for tasks and confusion in its execution. Project management not only require excellent expertise or command of the project-scope and terms of reference the project manager should also possess other qualities that can be found from experienced managers or leaders. The first order of business for a project manager is to determine the scope or dimension of his project. This would include the expectation and timelines to enable him to determine his milestones that are not only visible to the project team but also to his clients. Second order of business is to determine the correct characteristics or qualification of resources that he would need to complete the project. A good project manager need not have a good command or expertise in all aspect of the project but he should have a general idea of the scope of the project. Next is for a project manager to direct all his resources to provide a task list with expected deliverables and timeline. The input from the resource would then be incorporate to the project plan. Project execution would then include checkpoint meetings and regular meetings to manage the critical path. A clear understanding of what the deliverables are from resources that are not part of the project management team should be communicated intimately. As much as possible during critical path meeting or check point meetings these resources should be included. b. Cause: As indicated the success and failure of a project is the project leadership. He alone shall qualify the requirements and characteristics of his resources. He alone shall formulate and devise the general direction of the project through the project plan while soliciting the help of his resources. The Resources shall basically provide the individual tasks for each segment of the project. The resources shall determine the efficacy of the deliverables with regards to the completion of the task. The project plan is the single most important document that will ensure cohesion in the project team that will provide the impetus to complete the project. c. Solution: Having identified the two most important component of a good project which is the project manager and the project plan, Management for its part should be able to hire the best project manager for the job. The project manage should have a good command of the project scope and dimension including what needs to be done in each milestone. Management should for its part also provide a clear direction or terms of reference for the project that would include timelines and deliverables in a much larger scale. The project manager that is selected should be able to construct or develop a project plant that will provide a common understanding of where the project is headed. The project plan should be able to create the gaps in communication if there is an absence of it coming from the project leadership. Read More