Jan 1, 1970 - Jan 1, 1970,

Truly Patient-Centred Healthcare Systems Require Real Focus

eyeforpharma speaks with Dr. Vaughan Glover, CEO of the Canadian Association for People-Centred Health (CAPCH), about the need for healthcare systems around the world to change their focus, and why calling yourself ‘patient-centric’ isn’t enough anymore.



How do we move from a provider-centric, illness-focused healthcare system to a truly people-centred model?  According to Vaughan, “although virtually every stakeholder group says they are people or patient-centred, at the moment we don’t have a people-centred health system in Canada or elsewhere.  Being people-centred is  about accepting the reality that nothing in health is universal. There are 35 million unique individuals in Canada and thus – 35 million  health systems in the country, one for each person. People are at the centre of their care, and there is nothing a doctor or any other health stakeholder  can do that will overcome what a person will not do for themselves.”

Being people-centred is about accepting the reality that nothing in health is universal

Vaughan explains that “at the moment we have an illness-focussed system; it is episodic and focussed on treating illness, not the overall health of the individual. Being people-centred is about treating people as human beings, not as an illness, a number, or a particular demographic. Each person, when we take the time to develop a relationship with them, wants to be treated as a special human being – people are, after all, very different. I have asked thousands of people the question ‘what is health?’, and have never got the same answer. If you happen to have a car-crash tomorrow, your definition of health will be very different to what it is today. If you talk to a ninety-year-old, their definition will be very different from that of a twenty-one year old. This exemplifies another aspect of what we have to understand about people-centred – the need to go from population healthcare to individual healthcare.”

This is important because, as Vaughan points out, without the person’s understanding and complicity, treatments  will be less effective, if not a total failure: “there are so many issues with compliance in drugs because people don’t understand why they are taking them. As healthcare professionals we are trained to fix things, rather than getting to know the person and helping them to understand why they have a problem and what their options are. If they don’t know why they are being given a medication, they aren’t going to value it and will most likely be part of the less than 50% compliance statistic . This leads to massive waste in the system. We are continuing to fund the most expensive way to support the health of the people, which is an illness-focused system – we are so caught up in day-to-day crisis management and  illness care, that there is nothing left to invest in preventing people getting to that situation. There needs to be a conscious decision by leaders to acknowledge that public funding can’t be all things to all people and we have to invest wisely. We should be making a greater effort to inform and empower people, and helping them in early life to accept their role as the nucleus for their lifetime of health and care.”

Vaughan sees putting more information in the hands of the patient as the first step towards a people-centred healthcare system, and believes that EHRs targeted at healthcare professionals do not go far enough. “For each person to manage and take better responsibility for their own health, they need access to all the relevant information and records. EHR’s as we know them are either doctor-centred, or institutionally-centred, instead of being person-centred. The first generation of people-centred technology, takes all of the hospital and physician-centred records and puts them on a platform for the person to manage and share wherever, whenever and with whomever they choose.  The best examples of platforms of this kind are found in banking and insurance, which is where the idea for using this technology came from. Wherever you are in the world, you can put in your pin number to get all your banking information – and this is what we want to see in healthcare. There is no reason this can’t be achieved in a secure fashion.”

People make choices all day long that effect their health and well-being in life. Health is a twenty-four hour job.

Giving people access to their health information is a vital move towards putting the person at the centre of their healthcare. Another is realizing that healthcare decisions take place not just in the clinician’s office but twenty four hours a day. Vaughan describes how “one of the things I did in my book was to research what percentage of a person’s lifetime is spent being supported by a primary care provider. If you work out the numbers, the average person spends less than 0.24 of 1% of their lifetime in primary care and primary care is the only time people view themselves as patients.  This is another reason why “patient-centric” is not an adequate term for the system we should be aiming for. I am not a patient the other 99.96% of my life. I am not a patient when I am working with a nutritionist, in a grocery store shopping for food, in an exercise class, playing sports or when I attend a pharmacy to pick up my prescription and yet these all have a huge impact on my lifetime of health. People make choices all day long that effect their health and well-being in life. Health is a twenty-four hour job. Pharma companies and pharmacies both have the potential to influence people outside of a primary care setting.”

Vaughan states that moving to a people-centred paradigm is about behavioural change for all stakeholders. He related a project that CAPCH has been involved in which incorporates people-centred principles in order to improve healthcare. “The researchers at York University started by asking how they could use people-centred technology, health coaching and care systems to influence behavioural change for type-2 diabetic patients? The goal was to better manage their health and care and to reduce stress on the healthcare system. We took a people-centred approach."

Vaughan continues, "The focus was not on doctors, or hospitals, but rather on each person having access to relevant information and being coached and supported in ways that can help them manage their diabetes. We gave each person a Blackberry (through RIM’s involvement with the project) with a platform technology (developed by NexJ Systems) installed on each hand held device, and this was all connected with a health coach. The health coach met with, and personally reviewed each  individual’s case, and helped them to understand issues around nutrition and diabetes. Traditionally people with diabetes might keep a written record, or try to remember what they’ve eaten, reporting this information back to the clinician at a later date. With a people-centred system, the information is on their platform.  The coach and the person develop a personalized program. Together, they program when the person has agreed to eat, discussed diet and portions. The Blackberry then vibrates at the time they said they were going to eat and asks them to take a picture of their meal which is then available in real time to their coach. An hour later, it vibrates again and asks them how they feel. The difference is instead of waiting weeks to discuss their diet the person gets immediate feedback which is one of the keys to behavioural change. The coach can then get back to the individual and discuss what they see, their portion sizes, content and relate this to how they feel. There have been some very positive results on this project that are impacting all of the metrics in treating diabetes.”

"This is just one example of the types of apps and virtual support systems that are evolving as innovative technology, provider support models, and all stakeholders begin to develop support systems that truly put the person in the centre of their health and care. Ultimately, each person wants to be treated as a human being. It is time for all health stakeholders to explore innovative ways to move from the illness focussed insurance support plan we have now, to helping each person to be all they are capable of being throughout their whole lifetime."



Jan 1, 1970 - Jan 1, 1970,