PROCESS and tick the boxes DO
For four decades at least and much longer (70 years?) within many health services there has been a preoccupation with process. Patients and carers may then perceive such services and how services are delivered as machine-like. As a whole the experience then constitutes an actual output - an outcome of clinics, appointments, waiting lists, tests and treatments. This is very unfortunate amid ongoing claims for services that are person-centred, individualised, patient oriented and even patient-first.
The patient is left to feel like a diagnosis, or even worse a problem in search of a diagnosis; tossed from one clinical encounter to another. In-between all this activity there are hopefully some compassionate brush strokes that soften the picture and patient experience. If not people notice the impact on values and quality of care ...
One of my pet hates right now is 'process before patients'. It's becoming more prevalent in healthcare and IMO it's wrong.— Clive Blanchard (@blanchyshed) September 28, 2017
Whenever I see the word 'holistic' I wonder if it really is holistic? Yes, you can be holistic by ticking all the boxes, but nursing involves much more.
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'Process' has been delivered at the door of nursing by management and the appeal to theory to inform practice. Nursing itself produced the 'nursing process'.
The nursing process through the stages of assess, plan, implement and evaluate prompted the argument that nurses were processing patients. To nurses of a certain age the nursing kardex, the record filled in every shift mirrored the nursing process. In a way recourse to process is not a problem, it is inevitable. It is to be expected. As we deal with space, time, risks and decisions ... we have to make judgements that are invariably process bound.
The four P's can help to 'balance the books' ...
PURPOSE
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PRACTICE
| POLICY |
We need to remind ourselves of the four P's as they affect us individually and as organisations and collaborative agencies.
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PRACTICE
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Perhaps, patient engagement can be defined as when the tick-boxing is obvious but it is also taking account of the 4Ps (and in a way beyond tokenism). For example, patients, carers and the public involved in policy review? The patient is then more realistically involved in the activity. Anything else, really is a tick-box exercise.
Progress has been made (at least in the four decades of my purview). Government policy is in continuous development but there remains - as ever - much to do. Especially in spanning the various distances that apply from policy, experience, care to be delivered and how; from the individual to the health services and health system as a whole.
('P'rogress! Mm... Is there another way to measure progress?) ;-)
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