Educating for consumer engagement in health care

Professor Peter Brooks AM is Professorial Fellow of the Centre for Health Policy School of Population and Global Health at the University of Melbourne. At the recent Global Access Partners Summit on Education he addressed some of the major challenges for our health system.

ISSUES

Health education and -literacy is one of the important issues of our time – how do we cope with the tsunami of health care we need to deliver to an ageing and chronically ill population? If we are going to allow patients to engage with health professionals in a meaningful way about shared decision making for their own health then we need to educate them appropriately. We need to include health education as part of a general education of our children and we need to ensure continuing education (lifelong learning) on health issues for all.

It is quite unacceptable to have the current level of health literacy where less than 50% of Australians can read and understand the label on medications. Are we not surprised that we have such difficulty in getting patients to take their treatments long term or suffer side effects of the medications because they take them inappropriately!

FACTS

In most developed nations health is the largest budget item that governments deal with. Australia spends around 10% of GDP on health – $139 billion in 2013-14 and the out of pocket expenses – some $23 billion – are the fastest growing part of the health budget. The health and wellness industry is now one of the largest employers of workers in Australia and that workforce is like all of us, ageing. According to the Productivity Commission Report on Health Workforce (2006) it is also working at only about 80% productivity – particularity in the public sector. Think what a productivity gain of even 10% would do for the national balance sheet –about $15 billion every year – not just a one off!

The major challenges for the health system are around ageing and chronic disease. It is about deciding what services we are going to provide and then working together to deliver the right care, at the right time, in the right place, by an appropriately trained professional – at the right price.

So the issues I want to address are

• How do we train health professionals to work as a team
• How do we increase health literacy

Training health professionals is ‘team care‘ , not rocket science – but it does require a commitment by training institutions, teachers, the clinical placement providers and regulatory bodies to ensure it happens. We know that team skills – working together, role delineation, leadership, followership, task delegation and communication deliver better quality and safer care. These principles are used in many other industries – why not in health?

It’s because we have learned in silos – we work in silos, and we really don’t acknowledge the importance of a patient focus. I often think that the health (although it is really an ‘illth’ system) exists to maintain the health professionals in the manner they are accustomed to rather than anything else.

So if inter-professional training is really important – and it is – why can we not do it? It is hard (but not impossible) to align curricula, to organise nursing, medical and allied health students to be in the same place at the same time. It takes leadership on the part of Deans and Heads of curriculum development, but it can be done. It could also be driven by the regulatory authorities such as the Australian Medical Council and the Australian Nursing Council and the Deans – most of whom currently give lip service to inter-professional learning.

One way to train health professionals together is to us simulation techniques – the same way that pilots learn or relearn their skills. Simulated learning environments are good for training health professionals together in a simulated operating theatre, casualty or in fact any environment you wish to create. Students can feel safe, but will have all the physiologic experiences – sweat, increase their pulse, breathe a sigh of relief even, but do it without actually harming a patient. Training by simulation is faster and information imparted retained longer. Recent studies of the National nursing curriculum in the USA have shown that 50% of the current clinical training can be substituted by simulation while achieving similar student outcomes in the examinations and in the workplace.

Anyone interested in seeing the power of simulation in a child learning environment is encouraged to ‘google’ ‘Kidzania’. The way we learn is also changing – we forget that around 30% of learning is peer learning – things we learn from each other, so let’s be mindful not to pollute the minds of those who hold our future in their hands! Teachers are no longer the ‘sage on the stage’ but rather the ‘guide on the side‘, helping students in problem solving.

The other issue I wanted to touch on is patient education. Many in the community don’t understand basic anatomy – where their heart or liver is and what it does. Many don’t understand why they have a health condition or how they can treat themselves.

Health literacy is poor with less than 50% of Australian adults can read and adequately interpret a label on a medicine bottle. However, we do know that patients who are informed about their condition have better health outcomes. That means they survive for longer and use fewer health resources (hospitalisations, health professional visits etc). So there is a reason to educate them. In an ideal world one might think of providing an incentive to encourage patients to learn about their condition. If we accept that education reduces the call on services then you would surmise in this best of all possible worlds that this could be done, and health Insurance companies could provide these education programs to their clients with chronic disease and then offer a reduction in the premium as an incentive. Yet in Australia it is actually illegal for the health insurance to provide this service.

The final issue I will mention is that of training ‘carers’ – those 2.5 million ‘workers’ – often family members – who look after the aged, disabled and chronically ill. Much of this workforce is unregulated, many poorly paid – if paid at all and most desperate to learn so that they can provide better care. We really do need to address this issue as the Productivity Commission Report on Ageing (2012) suggested that Australia will need another 600,000 carers to be recruited by 2018! The University of Tasmania has created a MOOC (Massive Open Online Course) for carers of dementia patients. This program has over 25,000 registrants from 96 countries with completion rates of 40 %.

SUMMARY

We have a challenge in how to educate the health workforce of tomorrow so they are work ready and can deliver health and care in a different and more patient centred way. We do need to engage the community seriously in teaching them about the most important thing they have – their own body and how to keep healthy. At a government level Departments of Health and Education need to work closely together to ensure regulation does not impede progress but also create an environment where the quality and safety of educational offerings is assured.

That is a challenge in this fiscally constrained environment.