Public Hearing 7/5/2552

People Centred Health Care Bi-Regional Forum of Medical Training Institutions Manila 1-2 July, 2008 People Centred Health Care WHO Bi-Regional Forum of Medical Training Institutions Manila 1-2 July, 2008

People Centred Health Care represents a major shift in thinking. It has a long history in research, clinical practice, and medical education and in recent years, there have been efforts to make it a practical reality. However, this has not been satisfactorily and collectively enunciated at all of the health system level, to encapsulate the needs and expectations of individuals, families and communities, and how health practitioners, health administrators, and bureaucrats could respond. 3

4 “The essence of care is to centre on the patient. This is a shift from traditional, provider focused practice, and it requires the workforce to develop communication skills that empower patients through seeing health from the patient’s perspective, and motivating and training patients in health- related self-management.” Core Competencies of the Health Care Workforce for the 21 st Century: The Challenge of Chronic Conditions (WHO 2005 ) A shift in focus …

5 After the 58 th session of the Regional Committee for the Western Pacific held in the Republic of Korea September 2007

6 The need for a paradigm shift in health care 1.Health Systems becoming overly biomedical-orientedbiomedical-oriented technology-driventechnology-driven doctor-dominateddoctor-dominated market-orientedmarket-oriented

7 The need for a paradigm shift in health care 2.Physician-centered management systems New knowledge / Research / Advanced Technology Disease - focused Physician - centred

8 The need for a paradigm shift in health care 3.Medical Education / Practice focus on body systems and disease conditionsfocus on body systems and disease conditions less attention to social context, psychosocial and cultural issues, ethics, interpersonal communication and relational skillsless attention to social context, psychosocial and cultural issues, ethics, interpersonal communication and relational skills specialization and lack of team work leads to fragmented and uncoordinated care (hole system)specialization and lack of team work leads to fragmented and uncoordinated care (hole system)

9 The need for a paradigm shift in health care 4.Changing health needs and community expectations ageing populationsageing populations rising of chronic conditionsrising of chronic conditions increased literacy and buying powerincreased literacy and buying power better information technology and access to informationbetter information technology and access to information increasing consumerismincreasing consumerism

10 The need for a paradigm shift in health care 5.Problems in the Health Care System QualityQuality Financing incentivesFinancing incentives Workforce productionWorkforce production Distribution and regulationDistribution and regulation Weaknesses in primary care and in continuity of careWeaknesses in primary care and in continuity of care

11 The need for a paradigm shift in health care 6.Health Care Governance Few opportunities for consumer input and feedbackFew opportunities for consumer input and feedback Little reporting back to the communityLittle reporting back to the community

12 Physician-centred management systems People-centredManagementSystems

People − patient, family, community − health care provider People are served by & are able to participate in trusted health systems that response to their needs in humane and holistic ways Patient-Centred Health Care 13 Health promotion Harmony of mind & body, people & systems Happiness of people

health care users being informed in decision-making participation and having choices - empowermenthealth care users being informed in decision-making participation and having choices - empowerment providers showing respect for patients’ privacy and dignity and responding to their needs in a holistic mannerproviders showing respect for patients’ privacy and dignity and responding to their needs in a holistic manner Elements and Principles 1.Culture of care and communication 14

15 Elements and Principles 2.Responsible, responsive and accountable services and institutions: providing affordableaffordable safesafe effectiveeffective holistic health careholistic health care equitably accessibleequitably accessible ethicalethical evidence-basedevidence-based

putting in place appropriate policies and interventions positive care and work environments strong primary care workforce mechanisms for stakeholders’ involvement in health services planning, policy development, and feedback for quality improvement 16 Elements and Principles 3.Supportive health care environments

The 4 Action Domains 17 1.Individuals, families and communities Informed and empowered 2.Health practitioners Competent and responsive 3.Health care organizations Efficient and effective 4.Health systems Supportive and humanitarian

Increasing health literacy Providing communication and negotiation skills that lead to meaningful participation in decision-making Empowering for self-management and care Increasing capacity of the voluntary sector, community-based organizations and professional organizations to extend mutual assistance 18 Domain 1: Individuals, Families and Communities

19 Domain 1: Individuals, Families and Communities Promoting social infrastructure that supports community participation in health services planning and facilitates greater collaboration between local governments and communities Developing community leaders who advocate and support community involvement in health policy

20 Domain 2: Health Practitioners Needs and roles as providers of care Needs and roles as people values expectations preferences capacities overall well-being Physicians, Nurses, Paramedical clinical supporters, Educators, Leaders

21 Domain 2: Health Practitioners Increase capacity for holistic and compassionate care through better communication, recognition of psychosocial and cultural issues Enhance commitment to standardized, quality, safe and ethical care Equip for patient-centredness as a core competency 3C’s:communicate coordinate collaborate

22 Domain 3: Health Care Organizations Providing a conducive and comfortable environment for people receiving and providing health care Ensuring efficient and effective coordination of care Establishing and strengthening multi-disciplinary care systems

23 Domain 3: Health Care Organizations Strengthening the integration of patient education, family involvement, self-management and counselling into health care Providing standards and incentives for safe, quality and ethical services Introducing and strengthening models of care

24 Domain 4: Health Systems Developing and strengthening primary care and the primary care workforce Putting in place financial incentives that induce positive provider behaviour and improve access and financial risk protection for the whole population Building a stronger evidence base on ways to improve health care and the health system itself to achieve better health outcomes Ensuring rational technology use

25 Domain 4: Health Systems Strengthening the monitoring of professional standards Instituting public accountability measures for health services organization, delivery and financing Monitoring and addressing patient and community concerns about health care quality Assisting people who have experienced adverse events in the health system Ensuring protection of patient information

Trying harder will not work. Changing systems will. IOM, 2001 Patient-centred care is more than just emphatic interviewing of patients. It is about re-organising healthcare systems. Bauman et al, Summary

27 People-Centred Health Care Patients do not care how much you know until they know how much you care Gerard Healy Former President Am College of Surgeons

แผนพัฒนาสุขภาพแห่งชาติ ฉบับที่ 10 ในช่วงแผนพัฒนาเศรษฐกิจและสังคมแห่งชาติ ฉบับที่ 10 พ.ศ แผนสุขภาพประชาชาติเพื่อสุขภาพ ประชาชนไทย สู่ระบบ สุขภาพพอเพียงตามแนวปรัชญา เศรษฐกิจพอเพียง

ระบบบริการสุขภาพแบบบูรณาการ (Integrated Health Care System) คุณภาพ บริการ เชื่อมโยงไม่มีช่องว่างไม่ซ้ำซ้อน Continuous Care Integrated Care Holistic Care Tertiary Care (3 o Care) Secondary Care (2 o Care) Primary Care (1 o Care) Excellent Center Tertiary Medical Care Primary Medical Care General Practice Family Practice Primary Health Care Self-Care Referral Center Secondary Medical Care Special Care Referral System

Thank you for your attention.