Patient-centered care

Patient-centered care

(Video embedded from YouTube on 16 November 2011)

Patient continuity of identity and care

One interesting aspect of healthcare, especially larger hospital settings, is that there is no 'continuity' in teamwork from the moment a patient enters the hospital to the time he has recovered his health. For example, if the patient is scheduled for an operation, no health provider actually admits the patient or care continuously for him all the way through (eg, as a parent would do for a sick child). The surgical team will actually form at around the time the operation is about to start, and it will dismantle as soon as the operation is done. In fact, it may start dismantling as soon as the task is done.

General practitioners or family doctors may be thought as the professionals who provide continuity to a patient's health monitoring, but GPs have little 'role' on what is going on with a patient in hospital, for example (at most, receiving some feedback now and again). Once the patient is in hospital, it is the hospital's patient, let's say. Within a hospital environment, nurses may be the professionals who are closer to providing a longer continuity of care, though. And yet, nurses also work in shifts, in different areas, and on different roles. As the patient moves from one area to the other and from one health state to the next, this continuity of care needs to be handed-over. All-in-all, it is easy for the system to lose the individuality and humanity of patients, even their basic identification, at the level of individual care providers. The only thing that is, at the moment, keeping that continuity in a patient's identity and care is the hospital's 'paperwork' system. It is this paperwork that healthcare providers consult for knowing what to do next. If this system fails (or is not consulted), the patient has much to lose. In fact, this is one of the weaknesses that WHO tries to patch with its surgical safety checklist (see below).

Surgical safety checklist (WHO, 2008)

WHO's surgical safety checklist is usually portrayed as intended to work as a standard operating procedure does in aviation. But it only does so partially. The checklist actually tries to manage some three things at the same time. One of those things is to provide also for a continuity in patient identification that the healthcare system tends to loose at the individual healthcare provider's level.

The elements highlighted in yellow on the image below are those working towards this continuity of patient identity. It makes sure that the surgical team has the right patient, has located the right site to operate and has confirmed the right procedure before moving forward with the operation and dispatching any specimens after it. And it is crucial to understand and fulfill these steps because of the protections it offer to both patient and surgical team. These elements in the checklist provide continuity of identity to a patient which is otherwise quite anonymous (she mostly exists on the system's 'paperwork' but not necessarily on the surgical team's mind) and has no-one to 'protect' her rights, especially if already unconscious. They also provide continuity of care to a patient whose health and safety is also quite anonymous (except for the system's 'paperwork'), and should have the right to have the correct part operated using the correct procedure. And it is the last opportunity for the surgical team to add its 'grain' of healthcare to that particular patient and the last barrier for the surgical team to prevent errors born from the systemic lack of continuity of identity.


Want to know more?

Functional management system Patient as human


Jose D PEREZGONZALEZ (2011). Massey University, New Zealand (JDPerezgonzalezJDPerezgonzalez).

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