Stay focused on the main game – continuous high quality patient-centred care

Published: 14 February 2011

Just before Christmas, the Australian Hospital and Healthcare Association (AHHA) held a Futures Forum on health care in uncertain futures. This scenario-building process drew together a wide range of health executives, clinicians, academics, consumers and health union representatives like me to consider the possible futures for our health care system by 2020. The aim was to explore how the health system needs to change to achieve the best health outcomes for patients and communities.

Given the current political instability at the federal and state levels, we certainly do need to be prepared for possible "alternative futures" for health care. Changes in the political environment will have direct and real impacts on our health and aged care systems. It is essential that nurses and midwives remain focused on our objectives in delivering positive health outcomes for people and communities, and then assess possible futures in this context and plan our strategies accordingly.

However as the current national health reform agenda continues to gather pace, we must also deal with the "here and now" while planning for possible futures. The balance between the reactive and the strategic is a difficult one to achieve at the best of times, but more so with unprecedented disasters like the Queensland Health (QH) pay debacle. Being well prepared and staying focused is the key.

There is a real danger that in our haste to put in place new structures and governance arrangements we can lose sight of what should be the overriding objective of this reform: providing high quality patient/client-centred care across all settings – in acute facilities, in the community, in the home, and in residential services such as aged care facilities.

"Patient/client-centred care" is the mantra of this health reform agenda. We must ensure that the term does not, through excessive or inappropriate use, become an empty catch phrase.

But what does patient/client-centred care look like? It means different things to different people. There are differences in definition for the various players within the health system and the communities who rely on the system. Just because someone states that they are for patient/client-centred care doesn’t mean that they actually deliver on this. The best understanding of our current system is one that is centred on meeting the often-competing needs of multiple players.

It is only when we need to access care that we encounter the fragmentation of our current health and aged care systems. It is hard enough for nurses and midwives, who are insiders in the system, to navigate through the maze. Imagine what it is like for those without insider knowledge, especially given the entrenched power imbalances in health care.

Reaching a shared understanding of what patient/client-centred care means will be critical to successful health reform. Nurses and midwives have a leadership role here as the "insiders" in the health system who are strategically placed to advocate for those in their care. We started the discussion about this issue and advancing a "partnership" approach to optimising health in 2002 when the QNU and Queensland Nursing Council developed the Social Charter for Nursing and Midwifery in Queensland.

This work must be revisited. Other opportunities also exist to significantly revise how health services are provided, such as the QH capital works agenda or improving the continuity of care. Through the continuing "journey" of health reform we must come back to our core values of caring, advocacy, holism and professionalism.

As the recent flood and cyclone crises in Queensland highlighted so well, nurses and midwives are indispensible and creative respondents and advocates in a crisis. We need to keep this firmly in mind when considering potential health futures for our community and the role we can play to improve our health and aged care system.

How can we redesign care so that it is better focused on the needs of patients/clients? How can we assist to redistribute power within the health system so that the community is better equipped to optimise health outcomes?

These are the questions upon which we must focus if we are to make patient/client-centred care more than a catch phrase.

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