Sunday, 19 November 2017

Imagine a hospital without beds – please have mercy on us!

Consideration of how and why we communicate featured in my thinking last week. My interest was first sparked by the story published in the Independent about a computer hacking group with the improbable name of Di5s3nSiON. They had been hacking into the Isis terror organisations online site. Their aim was to disrupt and if possible, close down the extremist propaganda site – as they say #stopthewords. Isis responded by putting in place what they described as ‘stringent security measures’ – boasting their web site could no longer be hacked.  It took Di5s3nSiON just 3 hours to once again break through these new security measures and reveal some 1800 email addresses of those subscribing to the Isis site. The digital battle of words continues.

Later in the week I was also involved in a ‘battle of words’ – or rather a battle ‘over’ words. As I described in last week’s blog, I’m doing some work with the NMC on the development of educational proficiencies for future nurses. Last week’s work focused on the skills nurses will need to demonstrate at the point of registration, and procedures they will need to be able to undertake from day one as a qualified nurse. It is an iterative process. Drawing on wide consultation and with the benefit of access to expert knowledge, propositions have been created which as a group we challenge. We do this remotely through teleconferencing, with each teleconference lasting 2 hours. Now I like to look into the eyes of whoever it is I am speaking with, and teleconferencing doesn’t allow you to do this. Even Skype and Facetime have their limitations in this regard. Ironically, last week’s teleconference focus was on the skills of communication and on the context and media used. Given that we were looking at what the graduate nurse in 2030 might require in terms of such skills, it was difficult to move our thinking from the here and now.

As can be seen from the Isis example, social media can be an extremely powerful way to communicate and influence others. However it is not the only way. Last week I was able to catch a glimpse of something very different in how health care might be provided in the future using digital technology, and communication media in particular. My glimpse came from a report about the work of the Mercy Virtual Care (MVC) Centre, in St Louis, US. It has a great deal that is similar to most UK hospitals - it has nurses, doctors, and other allied health care professionals. What it doesn’t have are beds.

The doctors, nurses and other staff do all the things you would expect them to do in looking after their patients, monitoring vital signs, and looking at the results of diagnostic tests. Their patients are elsewhere. Many of them are in their own homes, others are in specialised units distant from the MVC centre. Like the UK, the US health policy see's health care providers moving services closer to people’s homes. Unlike the UK, the US system is more explicitly linked to payments at the point of care. The move in the US is towards paying hospitals to keep people healthy and away from entering their front doors.

In the UK we have a health care system that waits for patients to pitch up at the hospital, an approach that increasingly causes problems – just think about the A&E crisis we are currently experiencing. The effective use of new digital technology allows health care professionals at the MVC centre to monitor those with complex and long term conditions to such an extent that they can advise on early interventions and reduce un-necessary hospital admissions and lengthy stays. The MVC centre also works closely with other hospitals. Yes we will still need some provision for those involved in trauma, needing an operation, delivering a baby, receive intensive care and so on, but increasingly care will move towards those with long term health problems such as diabetes, heart failure and potentially life shortening diseases such as cancers. In the future I don’t think we will have the huge hospitals we have today. In the future health care will be provided from small units, with speciality health care services provided centrally. 

The MVC centre’s approach could provide the ‘organisational glue’ to ensure that patient deterioration is picked up more quickly and accurately, allowing those working in close contact with patients more time to provide person centred care. There is a paradox in this approach however. The health care professionals at MVC report a very close (almost intimate) relationship is possible with the patients they have contact with. But the one thing they miss is being able to put their hand on the patient and say ‘my name is…’ – and in our NMC teleconference last week the group put ‘touch’ alongside listening and speaking as important aspects of skilled communication in developing effective therapeutic relationships.