Engaging the public in healthcare policy: Why do it? And what are the challenges?

“….The development of evidence-informed healthcare policies relies heavily on the hierarchies of research and the technical know-how of experts. However, the experiences, opinions, and value preferences of patients, the general public and consumer advocates also play a legitimate and useful role, especially when difficult, value-laden decisions must be made."

A new paper from the Canadian Health Services Research Foundation highlights how engaging users in health policy decisions increases the public’s trust and confidence in their healthcare system.

If one accepts that "the public holds important health knowledge, but this knowledge should be applied carefully and appropriately", all working in health will be interested to think about how best to capture, analyse and understand such knowledge.

How do you do it? How does your organisation do it?

Teaching "strong relationships"

It is almost a cliche (but like most cliches, based on fact) that medical schools take varied, bright, positive, caring, students, fill them full of science and facts (with a bit of communication skills tacked on the side) and turn them into efficient machines for managing hospitals stays of patients. There is no evidence to suggest that the bad effects of this process have been addressed by recent changes in medical training.

Perhaps as a result of this, people have become increasingly disenchanted with their relationships with their doctors with complaints increasing, whilst many doctors move out of the profession or take early retirement - not finding the passion and fulfillment that they went into the profession for. But a few pioneering medical schools in the States are attempting to rewrite medical education and produce doctors who love their jobs and patients who love their doctors. (Seems like rather a sensible goal).

A study released in January's Academic Medicine profiles a program at Indiana University as well as four other U.S. medical schools that sought to teach faculty members a different way of instructing medical students. The curriculum highlights the human dimensions of care, such as the need to communicate effectively, show compassion and build strong relationships.

As covered before on "Experience Matters", such "human dimensions" predict great clinical outcomes, happy patients and satisfied doctors. Not only should they be a major part of all medical school training, but such education and support should be part of lifelong professional development for all healthcare professionals. Most doctors know this is essential and embrace it, the others might do well to question why it was that they went into medicine.

Poor communication predicts complaints against doctors

But more importantly, predicts unhappy patients not getting the care they need.

An excellent patient experience (as measured by quality of communication from their physician) not only predicts quality clinical outcomes, but is important in protecting the doctor (and her organisation) from complaints and reduces the risk of litigation.

Of course all good doctors already know this and make monitoring and continually improving their communication skills a priority. It is interesting to see "early-adopters" amongst doctors now embracing web-based feedback from their patients as another tool to ensure excellence.

This JAMA paper from 2007 (JAMA. 2007;298(9):993-1001) describes a detailed, ten-year prospective study of complaints against doctors, and then performs regression analysis against their exam results in clinical communication skills. Final line of the conclusion is clear and powerful support to all who understand that an excellent patient experience is an integral part of excellent care, and not just a "nice to have":
"...the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints."

Whilst communication skills are now an integral part of most medical schools' curricula, patient satisfaction scores are not increasing - is it time to make communication skills a core part of regular, re-training for all doctors?