10.1 Hospitals or prevention?


    Ultimately, it is much better if we ensure that fewer people get sick, and more people grow old healthy. “Prevention is better than the cure,” is that not the saying? In ancient China, doctors were paid as long as their patients were not sick. We have become alienated from our roots; we are fixated on the treatment, and hardly on the causes. Our food chain can be organized to be a lot healthier, with smaller production units, local or regional production, no hormones or other stimulants, and no “saccharification” of products. We need a cleaner living environment, re-using instead of dumping in the ocean. That is how we can stay healthy.

    I got to know Lucien van Engelen through Twitter. His username is @Zorg20 (Healthcare 2.0). Lucien is the Zorg 2.0 ambassador/innovation change agent at the Radboud University Nijmegen Medical Center. Of course, he is a great advocate of new media, and he started an in-house Seats2meet.com co-work location called the REshape center, open for everybody involved in healthcare to come in, work, and meet other people.

    Lucien sees huge changes starting to take place, especially in the area of transparency and communication. He relates:

    “Six months after I started at Radboud, I was confronted with fragmented information in emergency care. After some research and advice, I took the initiative to form a community for professionals around this issue, where a scientific library can be found as well as current developments: AcuteZorg.nl (Emergency Care). During the preparation and implementation of this platform I discovered how strong the role of the Internet is and the relative absence of it in healthcare. In particular, I saw possibilities for social media and communities in a sector which I believe will move more from a point of functionality instead of functionaries. Position this in a world that, in itself, is changing, a world where Generation Y will surpass the Baby Boomers in population size. It is a world where over 80% of people will first surf to Doctor Google before going to their own physician. If you consider that an average consult takes ten minutes and that people do not remember over 50% of what was said, then you will understand that there needs to be different ways for a doctor to communicate with a patient. And that way has been found because 60% of patients share their experiences in one way or another on the Internet. The Internet is being used increasingly more to determine which hospital or which doctor to visit. This is widely accepted in the US: based on ranking and rating sites, a physician may be chosen. If this is done on the basis of objective, verifiable and transparent criteria, there is no problem. It becomes an issue if there is talk of blunt criticism without retort. I think and hope that this will become a self-regulating process, based on social control.”

    Marcel van Marrewijk has done a lot of research into patient experiences as manager and owner of the agency Research to Improve. I asked him to share his vision with us. Marcel emphasized the particular role of healthcare as an institute, and the unusual role of the patient:

    “Healthcare organizations are special companies. They distinguish themselves in one essential aspect compared to regular industrial organizations: the patient – the person who requires care – is, as it happen,s a very unusual customer. The patient has a very strong dependent relationship with the healthcare professional(s): he can be seriously ill, be in chronic pain, or experience existential fears which will result in feelings of vulnerability and insecurity. Dealing with these issues as a healthcare professional is a completely different kettle of fish than providing a service to a customer. This is what makes healthcare institutions, like hospitals and nursing homes, so different to other organizations.”
    “The emotional and psychological dependence that many patients have in relation to their healthcare professionals, make great demands on the quality on the mutual relationship. That requires specific competencies from the professionals; and, in particular, the willingness to treat patients with sympathy and courtesy – and to show mercy and compassion when the situation (and the patient) asks for it. In healthcare, unlike with service organizations, the patient – often a vulnerable and insecure person – has a strong need for empathy. The healthcare professional must have the capacity to open oneself up without prejudice unconditionally, and to connect on an emotional level. Only then can compassion and mercy come into being. And it is these qualities that are crucial to win the loyalty of the patient. Even if healthcare professionals are mostly recruited on the basis of availability and expertise, in reality, many individuals, in particular in nursing, poses these essential values, motives, and competencies to realize the personal rapport with the patient time after time again. It is usually not the healthcare employee; the healthcare system is the restricting factor most often – leading to great frustration and eventually cynicism and dropouts. Recent experiences with Presentatie (presentation), developed by professor Andries Baart, connect to the personal directed approach. Baart says: ‘Healthcare is not fixing. Healthcare is caring for somebody.’ His Presentatie theory is all about getting very close to somebody, opening your self up to that person, and, in that relationship, trying to figure out what their needs are. You enter into a relationship with that person, and you are there for her or him, unconditionally. Good healthcare should be the basic principle, not the residue – the unintentional effect – of a self-referring system that is optimized by efficiency and market forces.”

    I care for all this! Don’t you?