Human Centred Healthcare: A Manifesto for Change

"We can't solve problems by using the same kind of thinking we used when we created them."

Albert Einstein

There's no doubt we're at a pivotal moment in healthcare - where transformative change is not just desired but essential. We all know the problem space well - aging population, rising levels of chronic disease and a shrinking healthcare workforce etc. I contend this needs new thinking. You may have seen my entreaties to adopt a 'human centred' approach to healthcare before but what is it?

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This blog seeks to answer that question, weaving together human-centric values, an understanding of the limitations of cost-centric strategies, and the importance of human speed, scale and 'being'. I want to offer some holistic considerations for healthcare leaders striving for sustainable and effective change but I don't claim 'human centred healthcare' as my own. It's a shared idea - which others have already embraced (thanks to my friend, Hassan Chaudhury especially for championing this idea) and I hope more will do so in time.

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This piece is written partly as a manifesto for change.

Human-Centric Transformation: Prioritising People by Embracing Empathy and Experience

I'm not at all suggesting that we're losing our humanity in healthcare but it certainly sometimes feels like it. We have patients waiting hours to be triaged in ED. Once they're triaged, they can spend hours waiting on a trolley . In the UK, we recently had a case of a patient who starved to death . The NEJM Group recently reported that 1 in 4 patients admitted to hospital in the USA, will experience harm .? While the Royal College of Emergency Medicine calculated that there were 23,003 excess patient deaths in England in 2022 associated with long waits in the Emergency Department .

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Being human centred (or 'centered' for my American readers!) isn't just about patients. As UK charity Doctors in Distress is at pains to remind us, a nurse takes their life every week and a doctor every three weeks. This isn't just a UK phenomenon either. It's also a problem in the USA . Let's not forget being a clinician is dangerous too .

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We must not forget carers. A frightening 88% of carers report that they do not take care of their own health and welfare . Unpaid carers in England and Wales contribute ￡162 billion per year (Petrillo and Bennett, 2023) to the UK economy. For comparison, the entire UK Department for Health and Social budget in 2022/23, was ￡182bn.

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We might be forgiven for believing that healthcare managers and administrators don't matter. After all, they're just bureaucrats and pen pushers aren't they? Yet they fulfil vital roles - for example, booking patient interventions, ensuring that follow-ups happen, pathology requests are made and results logged and that transformation initiatives achieve their intended impact. Yet, 78% of GP receptionists have experienced threatening, racist or sexist behaviour. It's probably never been a worse time to be a healthcare manager or member of support staff.

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At the The King's Fund Annual Conference last November (2023), Amanda Pritchard spoke about the need for the NHS to be more 'people centred' - which I'd like to think is the same as being 'human centred'. That acknowledgement says to me that the need to become more human centred is recognised by those running the NHS. But is it truly understood?

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In my view, human-centric healthcare puts patients, clinicians, caregivers, carers and administrators at the forefront of how we establish systems, institutions, care pathways and achieve transformation. It involves understanding uniquely human perspectives and challenges and creating empathetic, human-focused solutions. However, it also means asking people to be human centred themselves. That means ensuring that in everything we do, we consider the human element. For example, we frequently make the transformation of healthcare about cost or efficiency. Yet these initiatives often fail. My contention is that if your starting point is a financial target, rather than a human focused outcome, you are bound to fail.

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Let's also emphasise responsibilities as well as rights. In the new world we find ourselves in, where healthcare systems are under greater and greater pressure, if we're taking a human centred approach, is there anything wrong with asking people to take more care of themselves if we give them the tools, education and support to do so?

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The Manifesto

Healthcare has become entangled in the complexities of technology and bureaucracy. We therefore need to prioritise the human element at the core of healthcare delivery. This manifesto advocates for a healthcare system that is compassionate, patient-focused, and equitable. I hope this manifesto is a thoughtful provocation for healthcare systems, providers, policymakers, and communities worldwide.

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I think it's a mistake to believe that technology is going to revolutionise healthcare in the way we think it could. Yes - technology is going to radically change how some services in healthcare are delivered, but at the end of the day, healthcare will remain fundamentally, a human-to-human activity, at least for some time to come.

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Drawing on a number of writings, I'm putting forward the following principles as a conribution towards a manifesto for a more 'human centred' approach to healthcare.

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1. Deepening Compassionate Care: Building on the foundations laid by "Compassionomics" (a concept introduced by by Stephen Trzeciak and Dr. Anthony Mazzarelli), I call for a healthcare culture that nurtures empathy and compassion at all levels, recognising their transformative impact on both patient outcomes as well as clinical and carer well-being.
2. Empowering and Engaging Patients: In line with Eric Topol's and Mark Britnell's emphasis on patient-centricity, I advocate for systems that empower patients (‘no decision about me, without me) with knowledge and recommend involvement in their healthcare decisions, fostering a partnership model between patients and providers and ultimately drive towards patient activation.
3. Enhancing Relationship-Centred Care: Echoing Mary Catherine Beach (Relationship-centered Care. A Constructive Reframing) et al., I stress the importance of meaningful relationships in healthcare - between patients, families, and healthcare teams - as the foundation for effective and humane care delivery.
4. Continuous Professional and Ethical Development: Drawing from the work of Monrouxe and Rees, I believe it's vital to promote ongoing education and reflective practice among healthcare professionals, emphasising the importance of personal growth.
5. Championing Equity and Inclusivity: Informed by Paula Braveman’s research my approach advocates for taking health disparities seriously and ensuring access to quality healthcare for all, regardless of socio-economic, racial, or geographic factors.
6. Integrating Technology Thoughtfully: Following Robert Wachter's cautionary guidance and Mark Britnell’s optimistic views, I endorse the use of technology to enhance human-centric care, ensuring that technological solutions support, rather than supplant the human touch in healthcare and that technology is deployed at a human scale and at a human speed.
7. Prioritising Mental Health: Recognising the integral role of mental health in overall well-being, I advocate for its equal importance in healthcare provision, ensuring accessible and high-quality mental health services[cs1]? for patients, caregivers, carers, clinicians and administrators.? This should include tackling mental health as a symptom of physical health conditions.
8. Valuing the Wellbeing of the Formal and Informal Healthcare Workforce: I call for policies and practices that support the health and well-being of healthcare workers and carers, recognising that their well-being is fundamental to patient care quality.
9. Promoting Holistic and Integrated Care: I support a holistic approach to health, considering the physical, mental, social, and environmental factors that contribute to well-being and advocate for integrated care models that address these multifaceted needs for patients, staff and carers.
10. Fostering Community, System and Global Collaboration: I call for collaborative efforts at community (including the third sector), system and global levels, sharing knowledge and best practices to innovate and improve healthcare systems worldwide. I also advocate for diverse, multidisciplinary teams that transcend professional boundaries.

Conclusion

This manifesto is a suggested blueprint for a future where healthcare is fundamentally human centred – a world where compassion, empathy, and respect are not just ideals but the practiced reality.

Agree? Disagree? Have something to add?

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References

1. Britnell, M., 2019. Human: Solving the Global Workforce Crisis in Healthcare. Oxford University Press.
2. Trzeciak, S. and Mazzarelli, A., 2019. Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. Studer Group.
3. Topol, E., 2015. The Patient Will See You Now: The Future of Medicine is in Your Hands. Basic Books.
4. Beach, M.C., Inui, T. and the Relationship-Centered Care Research Network, 2006. Relationship-centered care. A constructive reframing. Journal of General Internal Medicine, 21(S1), pp.S3-S8.
5. Monrouxe, L.V. and Rees, C.E., 2017. Healthcare Professionalism: Improving Practice through Reflections on Workplace Dilemmas. Wiley Blackwell.
6. Braveman, P., 2014. Achieving equity in health. Journal of Health Disparities Research and Practice, 7(2), pp.1-8.
7. Wilkinson, R. and Marmot, M., 2003. Social Determinants of Health: The Solid Facts. 2nd ed. World Health Organization.
8. Wachter, R., 2015. The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. McGraw Hill.