Re. Charles Leadbeater's State of Loneliness, The Guardian, Society, 01.07.09
The cover of this weeks Society Guardian immediately caught my eye with its picture (I wonder which corner of which care domain this lady is sat in?):
The text initially passed me by; then yesterday I caught up, it seems the business model quest in one sector is having a domino effect with new models needed elsewhere including health and social care.
Leadbeater's piece reminded me of Lean thinking the improvement process with its drive to identify value, reduce waste and repetition. ... His text points out that:
More efficient services quickly move in and out of people's lives, but they don't really change how people live. That is one reason why we have not made deep inroads into the most deprived communities, the most troubled families, the most intractable social problems. Services manage and process people and problems, but only rarely allow people to change their lives. Service solutions are ill-suited to the emerging challenges of the rise of long-term health conditions, diseases linked to lifestyle and diet, ageing or climate change. You cannot deliver a solution to an epidemic of diabetes the way that DHL delivers a parcel.So any model, method that is primarily process centered may find itself compromised - providing just one cylinder's worth of power in a four cylinder engine. In Hodges' model I have identified the 4Ps. PROCESS, PURPOSE, POLICY, and PURPOSE (to which we must now add PROBITY). It will be interesting to see how value is defined across service forms of engagement, intervention (including signposting) and the new set of outcome measures to follow whether local, national, service-reported or patient reported outcome measures. Leadbeater continues:
The key will be to redesign services to enable more mutual self-help, so that people can create and sustain their own solutions. The best way to do more with less is to enable people to do more for themselves and not need an expensive, professionalised public service. Enabling people to come together to find their own, local solutions should become one of the main goals of public services. Services do a better job when they leave behind stronger, supportive relationships for people to draw on and so not need a service.So Jo(e) Public needs to reflect, compare, evaluate, learn, collaborate and make informed decisions in order to stay well amongst many other things. They need to be engaged holistically.
Where is the model for this...?
The Wall Street Journal has something to add here The Doctor Will Text You Now and relating to my earlier posts on 'Beware Reflex Moves'. Relationships matter, but if nurses are out there assessing, assessing, assessing who is doing the education, dividend added therapy outcome focused?
If e-health is going to make a real contribution in augmenting and freeing high value care resources then this in turn depends on the value invested in relationships.
Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family’s doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. “I can get into his virtual office anytime,” says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members’ regular health complaints.If older adults move home and need new primary care services, what are most probably(?) well established patient - doctor (patient - primary care team!) relationships are not just undermined they are undone! A person's sense of community is fractured. ...
Do read the two articles mentioned - excellent.
Image source: Guardian
Mathews, A.W., The Doctor Will Text You Now, JULY 1, 2009, The Wall Street Journal Interactive Edition