Introduction
Is patient-doctor relationship important in the effort to ensure adequate treatment and control of disease? This question could sound simple and irrelevant in the ears of a person who has not given enough consideration to the topic of the patient-doctor relationship. However, for one who understands the dynamics of medical care, his perception would be completely different. As a health care manager, this is one of the areas that need attention in order to come up with an appropriate quality improvement intervention. In this assignment, I intend to analyze how the patient-doctor relationship can be used as a tool in the improvement of quality in a Hospital. Specifically, the paper intends to base on the role of communication as an integral part of relationship building between a doctor and his patients. As a result, this paper will explore and discuss the role of communication facilitation and how this can implicate the patient-doctor relationship. Finally, the paper will conclude by pointing out how health care quality improvement intervention can be developed by improving the communication considerations to facilitate the patient-doctor relationship.
Definition of Quality in Health Care
Definition of quality in health care does not take any other form different from quality in other organizations. Equally, quality involves ways by which resources are managed within a given organization, in this case, the hospital, the level with which goals are set and achieved and how the organization has placed itself in relation to the competitors. As a result, quality in health care has one bottom line; it must promote life over premature death. However, there are other factors that must be considered in order to define quality in health care. To begin with, a good hospital must offer programs that are affordable to the public. When strategizing for a health care for a given society, one of the key elements to be considered is the affordability to an average person. As a result, a quality health care should allow most of the members of the society to be able to seek for medical attention from a doctor comfortably, be able to access laboratory tests for common ailments and also be able to get the prescribed drugs without too much strain. If most of the members cannot afford this, then quality will have been compromised. Equally, a hospital, as an organization must base its operations on this standard. Its services must be affordable to all members of society (Walshe & Smith 2006).
Another very important aspect of health that should be considered when defining quality in health care is the degree of reduction of premature deaths and those deaths that could have been controlled. This marks the baseline of health care. It is therefore important that health care programs measure their quality by considering how each aspect of medical care has been addressed. With an appropriate medical care strategy, mortality will, without a doubt, be affected positively. To further reduce mortality, good hospital policies should hand in hand with good health care. The policies must promote factors that lead to the reduction of premature death, deaths that occur from accidents, and other infections that are acquired from the hospital.
Good health care must be founded on financial stability. It is therefore important that the amount of money spent must be less than the amount generated any contrary effort could result in a botched endeavor. This means that health care programs must be financially viable. If the expenditure exceeds the money generated, the quality will be questionable as most patients will be dying prematurely. In addition, the standards of health care will remain low without enough money to promote attainment of the state of the art facilities. Also, good management is completely dependent on funding in order to come up with good results. With funds, the relevant changes that are appropriate for a given society can be undertaken and hence develop quality health care. To a hospital institution, funds are an integral part. As mentioned above, all operations within the hospital rely on finances to succeed (Donabedian 2003).
Considering the different aspects of quality in health care, two major factors are evident for quality health care. One is the health of the general public and the second is the financial capability for both the hospital and the general public. Quality health care must therefore put the general public in consideration. This begins from the way through which lives of the public must be prolonged by reducing mortality and controllable deaths. Furthermore, the public, as a stakeholder has been considered through the use of appropriate health care that is affordable to all members of the society. In addition, the policies that are made by hospitals concerning health care must be aimed at promoting lives of the public.
The second stake holder whose interests are catered for by the definitions of quality in health care are the service providers. According to the definitions, a good quality health care plan must be able to have more money generated than the expenditure. This helps to keep the organization afloat so that it can develop good facilities and also promote management. The policies also try to promote the interests of the organizations. They have to be policies that allow the physicians work without strain and exhaustion. Therefore, quality in health care is designed to promote, at most, the interests of the general public. However, quality must also put in consideration the organizations involved in providing this care. When both aspects are put in consideration with policies promoting both interests of the stake holders, the health care will be considered to be quality. When any of the two is not put in consideration while developing a health care plan, the whole endeavor will be termed a failure (Walshe & Smith 2006).
Considering the factors that contribute to a quality health care, is there a way through which a hospital can ensure quality services? The answer to this question is yes. There are several ways through which quality can be achieved in health care. One of the most appropriate ways to ensure quality is through the development of an appropriate patient-doctor relationship. By employing this method, quality in health care will be achieved as the service provision will put into consideration both the doctor and the patient. This part of the paper will point out the importance of patient-doctor relationship and how this can be used as a tool by which hospitals can ensure quality.
Importance of Patient-Doctor Relationship
Patient-doctor relationship was and remains an integral factor in the management of a hospital (Walshe & Smith 2006). This importance is cemented on the fact that the relationship defines the way through which the data is collected. It also dictates, to a large extend, the way by which diagnoses are made and the plans of controlling the conditions. It is also through an effective patient-doctor relationship that compliance can be achieved and also, patient activation and support can be facilitated through a well developed patient-doctor relationship. As a health care manager, it is also important to understand that people’s decision to seek services from a given hospital is highly dictated by the characteristic outfit of the degree of patient-doctor relationship in the organization (Goold & Lipkin 1997).
Without doubt, there is no other medium of communication within a hospital that is more important than interview. However, interview as a medium of exchange can only be successful if the relationship between the patient and the doctor is well developed. This is attributed to the role of interviews in health care provision. According to Goold and Lipkin (1997), interviews are the main tools used for information gathering. Secondly, therapeutic relationship is strongly dependent on interview for its efficiency. Finally, the practitioner must communicate certain information to the patient. This forms the third role of interview in health care provision. Considering the functions of interview, a poor relationship between a practitioner and a patient is very likely to lead to failure to disclose certain essential information if the patient has no trust for the practitioner. On the other hand, anxiety on the part of the patient can make him fail to understand the information being passed to him. Given these three roles and the fact that interviewing is completely a patient-doctor relationship affair, it is evident that every health care provider must ensure that good patient-doctor relationships are developed within their institutions. This means that the relationship between the doctor and patient greatly determines the completeness and quality of information being passed from doctor to patient and vice versa.
Research data further points out that by maintaining a good patient-doctor relationship allows the patient to ask questions concerning their treatment and care. According to studies carried out, it has been ascertained that patients who have the chance to ask questions and hence who engage in a participatory treatment in their care usually have a better record in biological terms. This is to say, they exhibit better quality of life and their satisfaction is comparatively greater in relation to those patients that have no chance of participating in their care provision.
In their analysis of patient-doctor relationship, Goold and Lipkin (1997) further point out that interview, whose success wholly depends on the effectiveness of the relationship, has several structural elements that have great implications on the therapeutic relationship of the two. When put into strategic use, the elements of medical interview are the major determinants of medical outcomes and other psychosocial factors like life quality and satisfaction. The structural elements of a medical interview as pointed by Goold and Lipkin (2006) include a good preparation of the environment prior to the interview and also making oneself ready. This is followed by observing the patient before giving him warm greetings. After this, the interview can be commenced, during the interview, the practitioner should be quick to identify the possible barriers to communication and design a strategy of overcoming them. Next, identify the problem and negotiate the priorities. From this point, the practitioner can construct a narrative thread before constructing the life context of the interviewee. This then leads to the establishment of a net of safety before the findings are tabled together with the viable options. Finally, the interviewer must come up with the way forward through negotiation with the patient before closing the interview. This marks the structural elements of a medical interview by which the practitioner can come up with an effective health care plan for a patient if well put in use.
Wong and Lee (2006) equally identify the role of patient-doctor relationship in the effort of coming up with a reliable health care provision program. In their argument, they point out that good communication skills by doctors will greatly improve their relationship with their patients. In fact, they term communication skills as a core requirement for any effective health care program. The importance of communication skills in doctors is an invaluable contribution to the field of health care. To begin with, the level of emotional distress in patients is reduced greatly with effective communication skills. The outcome of an effective health program is dependent on good patient doctor relationship that facilitates good communication which eventually facilitates history taking and management plan, two factors that are essential in an appropriate health outcome. As a result of this, health care programs where patients and doctors had a good relationship tended to exhibit better emotional and physical health. Furthermore, the same assisted in higher symptom resolution and also facilitated the treatment and containing of chronic diseases. This resulted in an effective control of glucose in the blood, blood pressure and reduction of pain. Finally, the patients’ perception that their visit to the physician was characterized by patient centered approach tended to receive diagnostic tests that are comparatively fewer than their counterparts whose physicians had an approach that was more of physician centered.
A good patient doctor relationship implicates positively on the patient’s compliance to treatment. Without compliance, the hospitals have to be faced with increased admissions which translate to higher costs and also subjects hospitals to endless frustrations. This, therefore, calls for an effective way of managing the patient’s compliance to treatment. One way of addressing this issue is through the use of an effective patient-doctor relationship. The attitude of the doctor towards his clients can affect the patient’s compliance to medicine. In addition, listening and acting to patients’ concern also determines the chances of compliance of a patient. Finally, a patient’s compliance is also greatly determined by the physician’s ability to offer appropriate information and also develop a favorable trustworthy relationship with the patient. Considering these factors that affect the rate of compliance, it is evident that they are directly related to an appropriate patient-doctor relationship (Wong and Lee 2006).
Another factor that implicates negatively or positively on the patient-doctor relationship is how accessible and courteous both the management and the clinical officials are to the general public. This is specifically created by the organization policies which could either make them easily accessible or completely inaccessible. In addition, the patients feel cared for and that the organization cares for them when educational materials that are easily understood are employed during trainings. This, coupled up with a culture that promotes patient interests as opposed to a physician/profit centered culture also implicates greatly on the relationship between a patient and his doctor. When a patient feels that the culture in a given organization is centered upon him, he becomes more attached to the physicians and hence develops a good relationship with the doctor (Reason 2003).
The Health Care Quality Intervention Plan
As identified above, the patient-doctor relationship can have detrimental or positive effects to the quality of health care depending on the way the organization treats the subject. If an organization is characterized by poor patient-doctor relationship, there is very limited chance of it being competitive in the market. Equally, lack of competitive advantage makes it run into losses that eventually incapacitate it from acquiring state of the art facilities that eventually leads to dissatisfaction of patients and hence poor quality services. However, a good strategy must put into consideration the fact that time comes with changes. Therefore, it should be continuously restructuring itself so that it puts the changes in the environment into consideration. Consequently, this puts the Continuous Policy Improvement Model into a more advantageous position. This model offers a simple pattern which allows the policy maker to plan an action then implement the action. Later, the action is checked before it is acted upon to straighten out all the possible loopholes and hence meet the challenges that are present during that point of time (Walshe & Broaden 2005).
Considering the above mentioned factors that influence patient-doctor relationship, one thing becomes indispensable; communication. This paper intends to come up with a communication strategy that can be employed within the health care programs to ensure that the patient-doctor relationship is developed.
The Plan
This plan borrows heavily from the shared communication model. In this format of communication, each side of the communication participates actively in the decision making. The whole process of treatment is developed from a participatory method that sees both the patient and doctor giving their views and preferences. Equally, the doctor shares information based on his diagnosis while the patient shares his symptoms before they both come up with the best way through which they can develop the treatment method. After discussions on treatment preferences from both, the doctor and patient comes up with the most appropriate treatment method (Charles et al 1999). However, this method is very tricky owing to the fact that communication skills are needed in order to facilitate the two way communication. Many doctors could have the skills of diagnosis but fail to have the relevant interview and communication skills. It is from this weakness that this paper tries to develop strategies by which this doctor-patient communication model can be facilitated for better results.
Charles and colleagues further point out that the way the begin of a doctor-patient relationship greatly affects the outcome of the treatment. In addition to the onset of the relationship, they further argue that the knowledge of the analytical requirements in communication and conversation are very essential in the determination of the outcome. Finally, they advocate for flexibility when developing the treatment model. Equally, this plan calls upon doctor and patient abilities in communication, flexibility and the use of relevant structures of interviewing in order to have a maximum possible positive outcome. On the other hand, Gravelle et al (2008) point out on the effects of pay under a pay for performance strategy within a hospital. Considering their argument, it is possible that good pay on performance basis can improve on the doctor’s performance and patient outcome. However, these strategies can also be detrimental for it can lead to fraudulent ways of getting results so that one can earn more money. This means that this is not the best approach that can satisfy the patient and the doctor at the same time. As a result, communication strategies seem to be the most appropriate methods by which the patient can be satisfied and the doctor also feel satisfied.
The first issue to be addressed in patient-doctor relationship is the development of skills for the promotion of patient-doctor relationship for the physicians and the patients. It has been identified that many physicians have a problem when delivering news that might not be favorable to the patient. In addition, there are no strategies developed to critically and intensively examine doctors when undertaking the mentioned activities (Walshe & Broaden 2005). However, the skills that are necessary for communication knowledge and attitude formation towards patient-doctor relationship are factors that can be learned. The first action that can be taken is ensuring that all practitioners are subjected to a thorough education program that will impart communication skills in them. With adequate communication skills and knowledge, the physicians will be in position to appropriately use the structural elements of a medical interview to come up with favorable outcomes that promote patient-doctor relationship.
The second action should entail ensuring of continuity. The hospitals must ensure that each individual patient is linked to a given physician with whom their relationship has to be continuous. Change of physicians time to time gives a patient a hard time of coming to understand and love the new doctor. However, if a patient is subjected to a single doctor for a long period of time, the most important aspect of a relationship is developed; trust. With a long history, a relationship that is marked by reliability and characterized by advocacy can lead to trust. In addition, the patient can develop a personal relationship with a doctor that has been attending to him for a period of time. This means that mergers and acquisitions should not be given great priorities by health care managers. These break the relationships that had been developed between the patient and the doctor who might not be continuing with the health care program for the patient. However, if the organization must merge or acquire another one, the management should try to ensure that the patients within the merged organizations continue with the previous physicians who were attending to them. With trust, communication will be facilitated and the patient will be able to offer adequate information on the virtue of personal relationship between him and the physician (Goold & Lipkin 1997).
According to the Continuous Quality Improvement Model, the Plan has to be implemented. This means that doctors will have to be subjected to training for the acquisition of communication skills. This will be the first action. The second action will ensure changing of policies so that continuity is implemented within the programs. The model then points out that the actions have to be checked. Having understood that the system has no provisions that monitor the doctor’s capabilities during interviews, checking will involve coming up with a way through which interviews by doctors will be recorded randomly so that loopholes can be sealed. Finally actions to seal the loopholes will be carried out. This involves identifying the weaknesses by use of the recorded conversations so that relevant skills are identified and incorporated within the training program (Walshe & Smith 2006).
This program is important because it involves giving communication skills to the doctor while at the same time promoting a culture that builds trust on the side of the patient. This means that the program is not one sided. It tries to capture the requirements of both sides in order to promote doctor-patient relationship. The only weakness of this program is that it might be difficult for the organizations to stay afloat without mergers and acquisitions. This is especially evident given the current economic crunch that is sending many organizations into serious financial crises. It forces the hospitals to merge and be acquired in order to keep afloat.
Conclusion
It is therefore evident that patient-doctor relationship is essential for a quality health care program. This is especially important as it promotes communication between the patient and the doctor which leads to improved health, compliance to medication, patient satisfaction and also doctor satisfaction and less burn out. Considering this, it is therefore important that patient-doctor relationships are fostered by hospitals. This calls for training on communication skills to doctors and also a change of policies so that continuity is achieved. This is very important because it develops trust which is essential for an effective communication. Although this might not be easy due to economic and social factors, it can greatly improve on the patient doctor relationship which will in turn improve the quality of health care.
List of References
Charles, C., Gafni, A. & Whelan, T., 1999. Decision-Making in patient-doctor encounter: Revising the shared treatment decision making model. Social Science and Medicine, 49: pp, 651-661
Donabedian, A., 2003. An introduction to quality assurance in healthcare. Oxford: Oxford University Press
Goold, S. and Lipkin, M., 1997. The doctor-patient relationship: Challenges, opportunities and strategies. Journal of General Internal Medicine, 14(1): pp, 26-33.
Gravelle, H., Sutton, M. & Ma, A., 2008. Doctor behavior under a pay for performance contract: Further evidence from the quality and outcomes framework. Center for Health Economics Research Paper 34. University of York.
Reason, J., 2003. Human Error. London: Cambridge University Press
Walshe, K. and Broaden, R., 2005. Patient safety: Research into practice. London: Open University Press
Walshe, K. and Smith, J., 2006. Healthcare Management. London: Open University Press
Wong, S. and Lee, A., 2006. Communication skills and doctor patient relationship. Hong Kong Medical Diary; Medical Bulletin. 11(3): pp,7-9