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EXPERT OPINION


onsider a fictional woman named Sara. She discovered a lump


under her arm. She had a friend who had breast cancer and thought that was a possibility. She talked to another friend who told her not to worry, it was probably a cyst. But it played on Sara’s mind as she experienced a range of emotions from feeling a fool and not wanting to bother a doctor to imagining her children living without a mother. After a few weeks she decided that it must be serious and went to see her primary care doctor. The primary care physician suggested it was a swollen lymph node; which itself could mean a number of things, many of which were little to be concerned about. But cancer was a possibility. She was referred to her local hospital for a biopsy. Sara, deeply worried by this stage,


entered an environment many of us are sadly familiar with. Because of poor communication she was not notified quickly about her appointment at the hospital and waited some weeks. She eventually found herself in an overcrowded waiting room and, rather than being greeted by a sympathetic clinician, she was dealt with by an overworked and flustered administrator who simply wanted to verify her identity and ask a lot of seemingly basic questions (which Sara thought the hospital must, surely, already know). She waited over an hour before being told that the doctor hadn’t received her notes and there would be a delay. Unfortunately, by the time the notes were located the doctor had disappeared to go and deal with something in one of the theatres. Could Sara come back in a week? An administrative nuisance for the hospital, but for Sara this meant another week of terrifying anxiety as, by now, she feared


FEATURE EXPERT OPINION


THE ANXIETY OF OUTPATIENTS C


the worst. Is this an extreme case? I suspect it is more


common than we would like to imagine. This, earlier part of the patient journey,


is often neglected by researchers and managers who are interested in improving the experience of patients. Often they are more interested in later stages in the process, after the patient has been admitted. But shouldn’t more attention be given to the analysis of the patient experience in outpatient services, precisely because people are often so anxious at that stage? I was reminded recently of the common situation with patients when cancer is diagnosed or suspected. Frequently, after hearing the world ‘cancer’, patients fail to hear any other part of the conversation with the doctor. They often go home and cannot remember what the doctor recommended, what they should do next or where they should go. A really good response to this situation is for the referrer and hospital to communicate closely, contact the patient quickly and see them very soon. And to ensure they are seen at their appointment time with the doctor and all the other resources in attendance. This is not just about cancer of course. Patients get anxious about all sorts of


conditions: the young man who thinks that his amateur football career might be over; or the expectant mother who fears for the well-being of her unborn child; or the middle-aged man who has noticed recently that he sometimes can’t remember where he left things and wonders whether it’s something more serious. Patient concerns of this kind need to


be at the heart of thinking about how outpatient services are managed. They need to be a central consideration for managers and clinicians who organize outpatient resources, manage referrals and scheduling and see patients when they attend. Such scenarios need to be reflected in the training of clinicians and administrators and need to be reinforced regularly. Patient-centered care does not happen automatically and it cannot be gained through the good intentions of a few kindly employees. Organizations need to develop systematic approaches by setting objectives, planning in detail and implementing and maintaining change with a firm hand. They need to keep an eye on their targets and managers must intervene swiftly when things start to go wrong. Many hospitals that fail to provide


good outpatient services do not do so because of a lack of resources. Often the failure is a function of inadequate leadership, poor team-working and, critically, a lack of communication, internally and with patients. The good news is that many organizations don’t need more money or people to make these services a lot better; they just need to organize what they have a little differently. ■


AH


 MORE INFO: Philip Leonard is a Director with Ernst & Young and the Sector Leader for Healthcare Advisory Services in the Middle East & North Africa. He can be contacted by email: philip.leonard@bh.ey.com


Arab Health Issue 4 2011 9


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