Established services that need radical reshaping to deliver coordinated care are services that patients are relying on, day-in and day-out. Given that the goal of all this disruption to the status quo is to improve patient care, it is important that the patients themselves support service change.
Opposition from patient groups can emerge for all sorts of reasons, including protecting much loved local services, aversion to closing physical facilities for notional ‘quality gains’ and for changes that have been poorly communicated. Regardless, such resistance can significantly undermine the case for service transformation.
One lesson from across several countries when communicating major service changes is to try and offer benefits in the most tangible way possible. Demonstrating improved outcome measures that new arrangements are likely to have may be convincing to a clinical audience, but it is often hard for non-professionals to feel impassioned to fight for changes when articulated in an abstract way.
By far the most successful strategy, is to make sure that patients and caregivers are actively involved in the development of service changes from the start. Preferably, with participation at multiple levels including representation on the key project and decision making groups, as well as broader consultation methods. This often requires some investment in patients’ capacity and knowledge. Some organizations even develop and hire ‘patient consultants’ to represent local people’s views in a more substantial, remunerated basis.
See KPMG International’s report, Creating, new value with patients, carers and communities to fully realize the value inherent in better patient involvement and communities to improve care.1
In the UK, major patient representative organizations have formed themselves into a separate coalition to argue for coordinated care – the Richmond Group.
The Richmond Group provides practical support for those parts of the health and social care system that are trying to move towards better coordinated care. This is not an abstract argument for a change in policy but provides real patient support for these changes in practice.
In its report From Vision to Action the Richmond Group states that: “Coordinated care is as important for patients following a stroke as it is for someone with diabetes. An older person, a patient with cancer, or a patient with a mental illness will all want to be involved in decisions about their care. Self-management works for patients with heart conditions and for patients with asthma. Being encouraged and supported to live healthy lives is important for everyone and this requires a flexible and responsive system that can diagnose and intervene early. Emotional, psychological and practical support is crucial to better health outcomes for patients with chronic lung disease as is better physical healthcare for patients with severe mental illness. And of course as we age many of us will not only have one condition but several” 2
The Richmond Group is adding capacity and capability to patient groups and providers through better service models that address the real priorities of the local population and ensure those changes gain a wide base of support to make them happen.
2The Richmond Group, From Vision to Action, 2012