3.8 Resources for patients - confidence and authority

'I can't understand it, Mr S. You should have had a colonoscopy before coming in for the operation.'

'Well, here I am. This is the day for my operation, and no-one told me I needed a colonoscopy.'

'Well, I'm very sorry but we'll have to put the operation off. The doctor won't want to go ahead without a colonoscopy.'

Many patients are accustomed to managing much more complicated processes than ensuring that they have a colonoscopy before coming to hospital for an operation, so why not give them the authority to do so?

3.8.1 Lean systems

One of the revolutions introduced by lean thinking, usually called 're-engineering' in healthcare, is the need to reduce the number of steps in any process. The more steps there are, for example, in arranging an x-ray, the greater the cost, the more the delay and the higher the probability of error. Patients should therefore be given the authority and ability to organise more of their care. If thousands of people can arrange complicated holidays in lands where they do not speak the language, surely it is possible for a patient to arrange a chest x-ray, a blood test, or a sequence of visits preparatory to an operation.

2005 Vignette

Mr S is told that he needs a bowel operation. He is asked if he wants to arrange the work-up himself. He says he does because he has a complicated work diary and is travelling in the next few weeks. He is e-mailed the digital care pathway which sets out all the tasks he is required to undertake, and all the contact telephone numbers he needs. He is also given the authority to take whatever action is necessary.

3.8.2 Authority

Being given authority is one thing: having the confidence to exercise it is another. If, however, the patient wishes to accept the authority not only for decision-making but also for arranging those parts of his care that are more efficiently arranged by the individual, the health service, and to be specific, the clinicians the patient encounters, have to treat him with respect. The experience of achievement in a friendly environment will build confidence in a way that exhortation will not.

3.8.3 The symbol of authority

The symbol of a patient's authority should be the ownership of his health records.

Top