Dr. Asif Imam’s name is synonymous with SINA Health, Education and Welfare Trust which he founded in 2007. An immunologist and and an allergist by profession, Dr. Asif moved back to Pakistan after 20 years of clinical practice in USA and since then been actively working towards creating quality healthcare solutions for the poor. He shared his views and insights about Patient Centric Healthcare with Dr. Tayaba Khan.
Q – What are the key attributes of patient centric care?
Ans – The name itself implies that it should center on the patient’s needs and to assess them via a proper communication channel. First and foremost we must change our mindset of placing the patient first rather than treating him as a recipient. Nowadays healthcare is centered on the doctor, the nurse and the pharmacist. The doctors are empathetic but the problem is constraint of time. You have empathy but if you don’t know what your patient’s needs are then you can’t really address them. This communication is not taking place because the doctor is spending only five to ten minutes with the patient with multiple interruptions and problems. Within ten minutes it is not possible to attain patient centric care outcomes.
Q – What are the most important factors that contribute to patient centric care?
Ans – The healthcare providers that are the key contributors, whereas understanding the needs of the patient is where it starts. For example in the US where Obama care is being rolled out, they have developed a healthcare team approach with an important member called the healthcare coordinator. The healthcare coordinator communicates with the patient, assesses their needs and coordinates the healthcare services. These can include physician visits, prescriptions, nursing services, pharmacy and patient education.
We really cannot expect the doctor to give all this in ten minutes period. We must move towards adding a tier to the healthcare providers who are trained to assess and provide the patient’s healthcare needs effectively.
We must come up with a standard model for patient centric care. This model should be applicable to both the private and public sector otherwise the entire exercise will be futile.
Q – Are there differences in these factors for inpatient and ambulatory care settings.
Ans – You see in the hospital setting it might be easier to provide patient centric care because the patient is physically there. The hospital can provide the needed team; they have the dietitian, the physiotherapist, educational needs or all whatever is required within the same space.
The problem is the outpatient and ambulatory healthcare in which basically you don’t have the team available right there. We need to address it and we need someone who can focus on patient centric care model creation.
Q – Can the lady healthcare worker model be used perhaps for this purpose?
Ans – Yes but we must remember that the lady health worker program is very focused and small. What we need to do is to improve their skills and make them broader based. The training has to be very thorough. Again, it all depends on how the training is devised and delivered. Lady health workers were mostly trained to provide maternity health but we need to expand their function for this particular role.
Q – What are the major barriers that stand in the way of achieving patient centered care?
Ans – As I said, the current healthcare model is not really adequate to deliver this concept due to both lack of training and time. So at SINA health care we are thinking of actually expanding this team of doctors, nurses and physicians to a health counsellor or the coordinator. This person will provide the crucial assessment of the patient and ensure smooth care delivery.
Q – What will be the qualification of this person?
Ans – We can start with a matric or an intermediate in science or even persons in psychology or social worker fields. In the US model this person could be a social worker or a nurse. However, in particular context of Pakistan we should start thinking this model as a community based model.
We can recruit people from the community and train them to become what we call patient educators, counsellors and coordinators.
Q – So we can say that the patient centric healthcare model is not confined to a hospital, rather it is a community project?
Ans – I think ambulatory care is more effective as hospital care is very limited in a particular limited time frame. Over 90 percent care is given in ambulatory settings, and therefore that is where the real impact will be felt.
Q – Have you been able to implement this role at SINA?
Ans – We are very tempted to do so but the problem is that we need to create this position in the healthcare provider tier. There should be a very well thought out curriculum and training program, and then comparing outcomes after placing the trained person in the team. We are seeking partners to join us to create this role.
Q – Do you think there will be resistance on the development of this role among doctors?
Ans – Yes we can expect resistance. One of the reasons is financial costs. Second, there will be a lot of cynicism with doctors and nurses stating they are well equipped to provide the required services. But the reality is they are neither they nor the system is equipped to carry the services out. Therefore, there is need for education, advocacy and awareness among the professionals.
Q – Do you have any success stories where you implemented the concept successfully?
Ans – We started SINA about 15 years ago with a mission to build a healthcare system which catered to the patient’s needs. In the beginning some patients would require specialty care for whom we used to write a referral form for a public hospital as majority of the patients were poor. However, we found that the patient would go to these public hospitals and effectively get lost without obtaining the required treatment. They would not know what to do and no guidance.
Q – What is it going to take to achieve widespread implementation of patient centric care?
Ans – Awareness among the medical community is the need of the hour. The healthcare leaders should come together and pilot this project and see what the outcomes are and if it is successful then make it an integral project. The project at SINA is a start although presently it is restricted to referring to a specialist. But we are going further in that.
Q – Where will the leadership and/or leverage come from to drive this transformation?
Ans – The heads of organizations, private hospitals and others should do a brain storming session to see how we are going to develop this program. It will require funding in terms of time and money.
Once the curriculum is developed and pilot training conducted, it should be piloted in the real world looking at the outcomes of patient satisfaction and disease modification.
We can compare one group of patient outcomes with no coordinator in terms of satisfaction and disease modification with the second group having a coordinator. In this way, scientifically we have to prove that his person is making a difference. Once proven we need to advocate it being a part and parcel of health care team. This is not going to be easy. It is another tier and person added to the health care system requiring time, effort, costs, training and experience.
In the developed countries such as the USA much emphasis is now being shifted towards what we call nondoctor healthcare system. In this system the education and coordination of care makes a huge difference in patient satisfaction and health outcomes.
Q – Any final words or message that you would like to give to the readers?
Ans – I would thank Dr. Zaki for starting this initiative. I believe once we get some people interested in the project we should come together and do a brainstorming meeting on how to move forwards and create true change in the healthcare system in Pakistan.