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What does quality patient-centred care really mean?

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The RACGP’s third Practice Owners National Conference opened on Saturday, 19 June at the Brisbane Convention Centre, with 440 in-person delegates and more than 100 tuning in online from across the country.
 
It was the largest face-to-face event the college has run in 18 months, and RACGP President Dr Karen Price, a former practice owner herself, opened the event from her home in Melbourne.
 
Next Practice Health founder, Dr Sam Prince and Director and Principal GP at Next Practice Deakin, Dr Paresh Dawda led the first plenary session, with an in-depth conversation on ‘The evolution of a consumer driven primary care clinic’.
 
For Dr Prince, it was the experience of becoming a patient himself that led him to question what quality care means from the patient’s perspective. He was also able to draw from his years as an entrepreneur in hospitality and philanthropy to start thinking about how healthcare could be reimagined going forwards by adopting new technologies.
 
‘Really, best practice is everything that we’ve learnt about when we study, when we practice, and for me, there was an opportunity to think about what will come next,’ he said.
 
‘I was more interested in what was about to happen, now that billions of dollars of infrastructure was in my hand; Apple is putting a lot of work in video and many, many bits of infrastructure that was also going to be in patients’ hands, and if you go back to first principles, you have to then reimagine everything.’
 
The question around what quality care means to patients, and what it could mean in the future, resonated with Dr Dawda when the pair met in 2017.
 
‘It’s a really important question in our current climate,’ Dr Dawda said. ‘Where we started was really looking at the whole patient journey from the word go; the different touchpoints patients have with us in primary care and beyond.’
 
While various meanings can be attributed to patient-centred care, Dr Dawda sums up their model in four key concepts:

• care that is individualised to that person
• care that is enabling, using enabling technologies where possible
• care that is team-based and coordinated
• care that is relational and is delivered in partnership with patients, with an emphasis on maintaining compassion, dignity and respect. 

With chronic disease on the rise, Dr Dawda says it is becoming evident that team-based care will become increasingly important into the future, and that it is vital for practices to think about how they can facilitate that into their layout and setup.
 
‘What [does] the team look like to be fit for purpose for the future of healthcare? And then how do you make that workflow happen in the design of a clinic to be person-centred and how will the communication happen?’ he said.
 
‘Ranging all the way from redesigning the environment and the way the clinic looks, the aesthetics, because that contributes quite a lot to patient experience, to the workflow and the floor layout to make that more conducive to team-based care.
 
‘Then the final thing supporting all of that is purposeful technology. So how do we use digital technologies to really support that journey, whatever touchpoint the patient has with the practice? Be that at the booking point, be that whilst waiting to see the clinician when they’ve come into the practice, be that in the consulting room when consulting with the nurse, with a doctor, whoever may be there, or be that in their own homes.’
 
This has seen Dr Prince and his teams implement a variety of new, innovative ideas that have the patient at the centre, a mission that is maintained by continuing to ask for their feedback.  
 
‘What that means is, rather than having a receptionist, having a patient advocate in the front who is really equipped and trying to do much more than a traditional receptionist,’ he said.
 
‘We have implemented an operation system modelled from what a good practice manager would do, creating a systematic technology about reminders and checklists such that you would be effectively accredited 365 days a year, 24 hours, and so it’s not a mad rush to the end.
 
‘But also patients have the recourse to actually give the patient advocates, people at the front, a mark out of five on how much they feel cared for.
 
‘We look at these things every month, as we do our P and L [profit and loss], to get a sense of how happy our patients are and also how happy our doctors and healthcare professionals are.
 
‘These kinds of things, we think, are lead indicators of what’s about to happen.’
 
Like general practice as a whole, Next Practice has embraced telehealth over the past 18 months, but next month they are taking it one step further with a tele-examination pilot with some of their residential aged care facilities in Canberra.
 
‘We’ve got some equipment [and] we can do 80% of the examination virtually,’ Dr Dawda said.
 
‘We can listen to heart sounds virtually, we can listen to chest sounds virtually, we can look in ears virtually, we can check the temperature virtually, we can do skin examination virtually, we can look in the throat virtually, we can listen to the abdomen virtually, we can do the blood pressure virtually, we can do the oxygen saturation virtually.
 
‘[This] is a really tangible example of reimagining healthcare innovation; bringing the technologies that are already out there, but actually beginning to think about their application and almost being a bit of a living laboratory to do those implementations.’
 
While technology has an undeniable role in the future of healthcare, Dr Prince, who has spent a lot of time in the US observing strides in the sector’s use of technology, says one lesson that has been reinforced time again is that it cannot fulfil the all-important relational aspect of medicine.
 
‘When engineers lead these organisations, they often see us doctors as kind of being in the way or people who just need to be eventually replaced by smart robots,’ he said.
 
‘And so whilst there’s a lot there, I think if you’re not a doctor-centric organisation, which we are, you tend to undervalue things like medical intuition and the importance of empathy and seeing your patients, touching their hand when they’re going through something difficult.’
 
While working out what changes need to be made and how, Dr Dawda says it is equally important, if not more so, that doctors and practice owners work out their ‘why’, and that it be in alignment with their teams.
 
‘Making a positive difference to people’s lives,’ he said.
 
‘That’s what gets me up in the morning, it’s what gives me the bounce in my step, it’s what keeps me going when things get tough. That’s my why.’
 
Recordings of live sessions from the 2021 RACGP Practice Owners National Conference will be made available online by Friday 25 June 2021.
 
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patient-centred care quality care RACGP Practice Owners National Conference technology

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