What practical obstacles stand in the way of real patient power? Examples from Sahlgrenska University Hospital/Östra in Gothenburg, where research findings are quickly implemented, indicate that person-centred care can shorten hospital stays, and patients are more satisfied.
In late June, the Patient Power Inquiry submitted its final report to the Swedish government. The University of Gothenburg Centre for Person-Centred Care (GPCC) at Sahlgrenska Academy is at the forefront of this field of research. GPCC has shown in studies that a partnership with the patient shortens waiting lists, reduces patients’ pain and can cut healthcare costs by 40 per cent.
GPCC, in collaboration with Sahlgrenska University Hospital/Östra, has created a national test environment, where the internal medicine department has adopted person-centred care into its everyday practice.
Shortened hospital stay by twelve per cent
At a seminar during Almedal week, representatives from the department related how they had succeeded in shortening length of stay by twelve per cent after just six months.
“Specifically, providing person-centred care means that we now ask each patient three questions: Why are you here? How do you perceive your problems? What are your goals for this hospital stay? Within 24 hours we prepare a treatment plan, discuss healthcare interventions and, together with the patient, we then set a provisional discharge date,” says Elin Hultgren, specialty registrar at the internal medicine department.
She continues:
“Dialogue is important: Now you have pneumonia and will receive antibiotics. We’ll do a chest x-ray, you will need oxygen but you’ll be able to manage without it after a few days. Although you won’t be fully recovered, I think you can go home on Tuesday – how does that feel? Can you handle it, or would you like us to contact the municipality?”
Elin Hultgren thinks it’s a fun way to work.
“The challenge is that the patients get involved – older patients in particular sometimes have the idea that the doctor knows best…”
More satisfied patients
Studies at Östra show that patients have also become more satisfied since the introduction of the person-centred approach – something that nurses Lena-Carin Nilsson and Mahboubeh Goudarzi notice:
“It’s all about how we see and listen to the patient’s real needs and also see their resources, how their daily lives are affected and how families are affected.”
“No one wants to go back to the old way of working. Our teamwork is much better when we work together with the patient, pulling towards the same goal.”
Östra plans to implement person-centred care at all levels – and there is great interest throughout the region.
Patient power in practice
One person who has experienced what it means to be a patient is journalist and author Elisabeth Höglund, who was recently treated for serious form of cancer.
Höglund was also moderator of another GPCC seminar that was based on the question: What does patient power mean in practice?
“When I became ill, I was admitted to a ward where the doctor didn’t know anything about cancer, didn’t understand that I had peritonitis. If my husband hadn’t hunted up doctors, fed and taken care of me round the clock I wouldn’t have survived,” says Elisabeth Höglund.
Does patient power mean that relatives have to take over providing care to the patient?
Inger Ekman, director of GPCC:
“We prefer to talk about partnership, person-centred care is an attitude, an ethos to be integrated into everyday health care. Many departments have a philosophy of care in their vision, but it must be reflected in concrete actions – always. Healthcare personnel want to provide, and do provide, good care, but not always and not systematically.”
Eliminate inequalities
The common goal, as summed up by the panel, is equality in health care, eliminating the current “post code lottery” that can result in differences of years of survival depending on the county where you are treated. But the panel also concluded that the healthcare sector has a strong hierarchical culture that will require considerable effort to change it.
Panelists included Bengt Kristensson Uggla, professor of Philosophy Culture and Management at the Swedish-speaking university in Finland, Åbo Academy, as well as assistant professor of world views and ideology at the University of Uppsala; Olle Larkö, dean and professor of dermatology and venereology, Sahlgrenska Academy, University of Gothenburg; Inger Ekman, professor and centre director, Centre for Person-centred Care, University of Gothenburg; Johan Assarsson, inquiry chair, patient power inquiry; Elisabet hHöglund, journalist and author.
