“I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.”
“Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see”!”
Great healthcare systems put patients first; patients hold top priority. How we view patients impacts treatment. What then does “put patients first” mean?
- Do we envision product placement, like ‘put magazines in front of customers’?
- Or do we mean a ceremonial nod to a notion that germinated Medicare?
- Or do we mean something like, “Go Blue Jays!”?
Individuals versus Herds
A system cannot put patients first. A health care system cannot function by considering patients as individuals. To design a service that cares for 11 million people, we ignore individuals and focus on herds. We step away from the bedside and envision patients as discrete atomic units or numbers.
Furthermore, systems are impersonal. Only people put patients first. Systems grow out of complex relationships between organizations, providers, suppliers, regulatory authorities, governments and a crowd of others. Systems cannot put patients first without intent and effort.
Medicine is ineradicably individualistic. The doctor-patient relationship defines medicine. Unless a healthcare system intentionally measures its policies by whether or not it puts patients first, patients will get treated as members of a herd.
Put Patients First
It means we assign or attribute value to patients above innovation, budgets, quality, regulation, efficiency or any other important issue that systems tackle. Patients must be seen as individuals with unique perspectives, genetic make-up and experience of disease and health; as units of social groups, communities and families; as members of society with complex roles to play in other patients’ lives.
It relates to how we consider patients when we think about healthcare systems and design. It implies that our thoughts about process and efficiency place patients’ needs and unique expectations before system policy, budgets and regulatory restraints.
A vision for healthcare must start by adopting an intentional, arbitrary standard of putting patients first. ‘Intentional’ because systems can function efficiently without considering patients. ‘Arbitrary’ because systems can choose to not put patients first. Next time we see heads nodding when you talk about putting patients first, make sure we say what we mean.