Can PHNs reflect consumer priorities? (Part 2)
Leanne Wells, CEO of the Consumers Health Forum, discusses how Primary Health Networks might measure "success" in consumer engagement.
Primary Health Networks face a number of critical success factors.
Success will depend on whether PHNs have the mandate and adequate resources to be able to commission and purchase health services on a realistic scale in their region.
If they continue to get project-oriented funding of low scale and minimal flexible funding they will inevitably remain little more than a promise in terms of meeting the goal of local solutions and services for local consumer needs.
Success will depend on whether they have the ‘tools of the trade’ to conduct comprehensive needs assessments, identify services priorities and gaps in the system and, most importantly, to do something about those.
That means money, obviously, but it also means access to the right data and information about their regions.
It means access to evidence about models of care that work and the know-how to translate that into real services.
Being equipped with deep insights into community and consumer needs is critical. PHNs must have the consumer stories behind the metrics.
Having the right governance is key.
By that I mean that success will depend on whether PHNs have got consumer and patient perspectives as integral and on the same footing as input from clinicians.
It will depend on their appetite for investing in patient leaders as much as they invest in clinical leaders, and the sophistication with which they involved patients and consumers in all steps of the commissioning cycle.
And of course, the effectiveness and impact of PHNs to act in the direct interests of consumers is going to depend on the quality of their partnerships with LHNs and others, the cooperation of GPs and other primary care providers and the confidence of funders.
PHNs as exemplars in consumer engagement?
Health Minister Sussan Ley has said that patients will have the opportunity to have their say, with community advisory committees to advise PHN boards “from the patient perspective”.
CHF is pressing the Minister to ensure that the consumer and patient voice can systemically influence the direction and design of the PHNs.
But we are concerned that Australia might not take the opportunity for PHNs to be exemplars and followers of world’s best practice in consumer participation and leadership in primary health care.
Such an approach would fail to exploit the growing evidence in Australia and abroad of the value of having active consumer involvement in both design and delivery of health services.
The Australian Commission on Safety and Quality Commission reminds us of the research that demonstrates that patient-centred care improves the patient experience and creates public value for services.
When health professionals, managers, patients, families and carers work in partnership, the quality and safety of health care rises, costs decrease, provider satisfaction increase and patient care experience improves.
However, we all know challenges remain.
But it doesn’t have to be daunting - there are practical things that can be done – it just about mindfulness and always asking the question: how can we get the consumer lens on this?
Dr Karen Luxford and Stephanie Newell, in a paper published in February by the British Medical Journal earlier this year, describe the integrated organisational approach taken by the NSW Clinical Excellence Commission to making patient centred care everyone’s responsibility
Some of the measures they are undertaking include:
- starting each board meeting with patient care story
- spending more than 25 per cent of the board’s meeting time on quality issues
- providing training to senior leaders to promote recognition of their roles as opinion leaders and champions of patient centred care
- appointing patient advisers and involve them in strategic planning
- encouraging staff to view patients as care team members
- using patient feedback from a range of sources
We’ve got opportunities at the policy level too. The Minister’s Primary Health Care Advisory Group – of which I am a member – is an inescapable opportunity to promote the necessity of consumer-guided approaches.
What becomes very clear is that when you start seriously discussing the way health policies and practices come into play in the care of people with chronic and complex illnesses, it’s the impact on the individual patient that helps crystalize the issues that need rethinking.
So, you can have any number of primary care professionals advising each from his or her expertise, but it’s the consumer’s perspective that will likely provide the best cues for coherent policy solutions.
Not just ‘soft stuff’
Patient engagement is not just ‘soft stuff’, nor is the path to consumer-focused services simple.
What this all means is that to reach better health outcomes we require clinical leaders working with consumer leaders: we need powerful patient- doctor alliances, supported by PHN CEOs and their teams.
In their BMJ paper, Luxford and Newell report a comment made to them by a doctor that makes a striking case for the consumer voice:
“The consumer (of health services) tends to see the problem and solution so much more simply and they ask reasonable questions --- whereas the healthcare professional tends to drown in the complexity and what cannot be done.”
And so with PHNs: consumers can offer simple ideas to help overcome what might seem to be wicked problems.