People-centred health systems

Social, economic and political changes have shown the need for an evolution in the management of health systems.

The strategies and resources in the health system often occur from top to bottom duet to the centralization in the administration and, consequently, in the professionals’ management. This has produced a less efficient model where strategies and resources are hardly applicable.

Ill people are the focus of the entire health system and to whom all the efforts must concentrate. Despite being obvious, this "patient-centred" approach the "patient safety" and "patient empowerment" encounters many difficulties in its practical implementation. Some of these problems are resistance to change by some groups, isolation of different professional groups during the training time, poor incentives for professionals who need to carry it out and, sometimes, lack of training programs for patients or representatives thereof.

The concept of quality and patient safety as the heart of the health system and its extension to the concept of citizens as owners of their own health, is and has been led by institutions such as the European Community, the World Health Organization (WHO) and, especially, the Agency for Healthcare Research and Quality's (AHRQ). They have prioritized strategies toward patient safety, demonstrated the impact on people and spending, as well as the results about quality.

Although works published by these institutions have shown an increase in the efficiency of the health system, its application is not always easy. Local factors (such as the diversity of management health systems or political, economic and social circumstances) impact on its final implementation and, nowadays, the results are very heterogeneous.

Today, there is a gap between groups of decision of these strategy health policies and professionals and environments where they have been carried out. The little dedication to motivate these professionals and the involvement of patients and patient groups when designing the functional plans –and especially operatives– of these strategies, involves that the adherence of all these people is much lower than expected. Therefore, the answer is worse than initially calculated.

The training and preparation of all participants to these new strategies is essential. It must be useful, real and non-theoretical. Firstly, in an interdisciplinary environment, considering all the professionals involved and always focused on patients and caregivers, who also need training in the same learning plan. This serves for motivation and reinforcement of both professionals and patients with regards to the return that is obtained.

All stakeholders need to be involved in the design of the training for professionals and patients: from the academic field (such as universities or vocational schools), to different health services where these actions will be developed: hospitals, primary care centers, home care, community care, street emergencies, association of patients, etc. All of them should be involved in shaping the preparation of people and environments where new strategies will be carried out. The combination of a suitable design with an appropriate monitoring will allow the capacitation of the people involved and, therefore, of the whole system.

The extension of the concept of health includes the social area and the citizen strengthening as the heart of the health system. It is a more ambitious challenge than patient safety. The integration of different systems of public service requires much more cross-cutting policies, open and, especially, people-centred, with the professionals and the administration at its service. The training of citizens in these policies and their participation individually or through associations or representatives would increase population and professionals adherence to new ideas, making the system much more efficient.

Strategies in the health field should take into account the knowledge as an added value for all the people involved. Sharing this knowledge allows the definition of a planning that not only includes the latest technology, but also and especially the human factors related to them and the non-technical skills (such as the empathy, the assertiveness, the professionalism, the ethics and the teamwork) as core values of the job of professionals and its relationship with patients and people in general.