Healthcare: Quality vs Quantity

December 30, 2008 at 10:40 pm | Posted in Uncategorized | Leave a comment

The NHS is losing its compassion, according to leading health think tank The King’s Fund:

There has been a deterioration in the level of compassion in the NHS in recent years, the head of a leading health think-tank has told the BBC.

The King’s Fund is running a special project to try to get nurses and other staff to focus on being compassionate.

Its chief executive, Niall Dickson, said this was a fundamental issue that should be a top priority for every hospital board.

[…]

Mr Dickson said: “I have very little doubt that we’ve seen a deterioration in the level of compassion that is shown by staff to patients.

“It’s to do with staff facing very difficult situations – because patients are sicker and hospital stays are shorter – rather than them all turning into nasty people.

“If we can’t get compassion into our healthcare, the system is failing. It’s as fundamental as that.

This raises a number of problems. First, as the accompanying discussion on the Today programme pointed out, it’s incredibly difficult to measure compassion, and probably impossible to do so objectively. You could have two patients with the exact same ailments treated in the exact same way by the same nurse or doctor and it’s still likely that their experience of the care they’ve received will be different. An NHS hospital might be blessed with a remarkably caring, selfless and popular nurse, but some patients might still find him/her too fussy or intrusive and prefer to be left alone. Patients are bound to want very different things from their healthcare, and it won’t always be possible to (a) know what those expectations are, and (b) meet those expectations.

Next, assuming you ever get over the hurdle of measuring compassion in the first place, and can somehow identify which parts of the health service are deficient, do we possess the resources to put things right? If this lack of compassion is a failure on the part of staff, you’d think the most obvious remedy would be to increase staffing numbers, introduce kinder working hours and more generous pay and holidays. That way doctors and nurses would have more time to spend with their patients and more energy to deal with the rigours of the working day.

But there’s no money for that under the NHS’ current funding, particularly when PCTs are trying to find efficiency savings across the board. So it’s worth asking, I think, whether ‘compassion’ is necessarily compatible with ‘efficiency’. When healthcare professionals are under pressure to meet local and national targets, there’s naturally going to be an emphasis on quantity of care over quality, and I suspect most people would rather be dealt with in a rather brisk and impersonal manner than be lavished with attention but have to wait a lot longer to be seen. Nurses could devote more time to consoling or reassuring their patients, but that’ll inevitably mean fewer patients being seen or result in administrative/housekeeping tasks not being done.

When you have resources as finite as the NHS there are inevitably going to be trade-offs, and when your main focus is on the volume of care, it seems inevitable that the provision of ‘compassion’, however you choose to define or measure it, will be compromised.

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