The first meeting of the European Commission’s Health Policy Platform Thematic Network on “Profiling and training the health care workers of the future” took place on Tuesday 7 April via webinar. The event was organised by Health First Europe and the EHMA, as coordinators of the Thematic Network, to discuss best practices in continuity & coordination of care and how to prepare the health care workforce to provide coordinated care and meet the need of chronic patients. The discussion, moderated by Giulio Gallo (DG SANTE) and Lucia Medori (Health First Europe), was enriched by the presentation of two case studies on diabetes and heart failures.
A right skill mix is needed to provide continuity and coordination of care, especially to those chronic patients that need frequent controls and support in self-management. Prof. Tatjana Milenkovic (IDF Europe) in presenting her case studies on diabetic patients’ care, stressed that all health professionals should be educated to be able to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. This approach is key to improve outcomes for people with diabetes having in mind the complexity of the disease and the huge range of complications that can arise. Prof. Milenkovic guided the participants of the meeting throughout the experience of a patient with diabetes, from diagnosis and treatment to make clear how it looks like in real life for some of them.
Mrs. Smith is a married shop assistant in her early forties with two children in high school. She made an appointment with her primary care physician since she was always thirsty, increasingly losing weight, irritable, and fatigued. At the end of her visit, physician informed Mrs. Smith that she needed to have a laboratory test for thyroid problems, anaemia, or diabetes. The physician explained that she will be called if the results were abnormal; otherwise, she would receive a letter in the mail. After 2 weeks of no correspondence from physician, Mrs. Smith called the doctor’s nurse to inquire about her test results. The physician returned her call the next day and apologized because her lab results had been filed in her chart instead of routed to his attention. The physician informed her that the test results revealed she had Type II diabetes, and she needed to make an appointment with him. Until their next visit, the physician advised her to watch her diet. The doctor described the long-term complications of Type II diabetes, such as cardiovascular disease, eye disease, and kidney disease, advising Mrs. Smith to buy a glucometer to monitor her blood sugar levels and made an appointment for her with a dietician in 1 month.
Mrs. Smith had many questions related to how diabetes would impact her roles as a wife, mother, and employee, but her discussion with physician focused on physical symptoms. She left the appointment feeling very frustrated and unsure of how to manage her condition. After visiting with the pharmacist Mrs. Smith read extensively about the complications of diabetes and became acutely anxious about the possibility of daily insulin injections. As a result, she drastically reduced her food intake because she thought doing so would control her blood sugar levels and prevent complications. Soon she developed sleeping difficulties and ongoing anxiety, and missed many of her work and family activities. After her appointments with her physician, dietician, and pharmacist, Mrs. Smith continued to have many questions about diabetes and the effect it would have on her life.
The case study results in 10 recommendations for health-care professionals how to improve performance in a modern health-care system:
- Care is based on continuous healing relationship
- Care is customized based on needs and values
- Patient is in control
- Knowledge is shared and information flows freely
- Decision-making is evidence based
- Safety Is a system property
- Transparency (information is available for informed decision)
- Needs of patients are anticipated
- Waste is continuously decreased (resources and time of patients and professionals)
- Cooperation amongst clinicians is a priority (importance of multidisciplinary)
Moving on the case study on heart failure, Ed Harding (Heart Failure Policy Network) stressed the importance of boosting a multidisciplinary team approach, integrated care models, invest in specialists, as well as the important role of generalists. As was also highlighted by Prof Milenkovic, effective communication (among the care team and with the patients) is the condition sine qua non of continuity of care and for supporting self-management.
In a multidisciplinary and integrated care approach, patients are involved in each stage, empowering patients, their families, their career. Those have been shown to be best practices, in reality they are not put in practice (e.g. patients experience major changes in medications when they transfer to other clinicians). Dr. Josep Comin-Colet (University Hospital Bellvitge, Barcelona) presented the organizational challenges of building the workforce for multidisciplinary teamwork. In the scope of delivering multidisciplinary and integrated care, the following measures resulted in 50% reduction in hospitalization:
- Endorsement of health pathways by managers
- Give access to KPIs to professionals: quality improvement
- Population-based approach (tailored intervention for each patients)
A Nurse-led HF management programme in primary care in Barcelona showed great results. Healthcare institutions in the Litoral Mar area in Spain and the Catalan Health Service developed a nurse-led multidisciplinary HF care model that integrated care and reduced the risk of readmission and death. Adding a telemedicine component has further reduced hospital readmission, length of hospital stay at readmission and cost per patient. This care model is being implemented and improved in South Metropolitan Barcelona with coordination from the Bellvitge University Hospital.
The case study resulted in the following policy recommendations:
- Boost HF specialists while supporting generalists
- Equip specialists
- Streamline care
- facilitating formal accreditation for different specialty
- removing legal barriers to clinical delegation of tasks (e.g. nurses can prescribe, GP can ask for diagnosis procedures, etc.)
- considering the value of recognizing the specialist disciplines other than medicines
- formalizing person-centered skillsets
How can we support health care professionals in implementing those changes and innovative model of care in different settings? Antanas Montvila (European Junior Doctors Association) stressed the need to shift the paradigms in medical education: medical care is focused on treating diseases, more soft-skills and technological skills should be added (team work, prevention, better digital healthcare, patient-centered care, etc.). Medical workforce shall be encouraged by the health care systems and to implement innovative way of providing care. Health care systems shall promote entrepreneur spirits Critical-thinking abilities (choose right tools, right apps for patients).
Ber Oomen (European Specialist Nurses Organisation) added that European health systems and policymakers shall also solve the fragmentation in the nursing professions across Europe encouraging uniformity in education and standardization on what nurses should bring into healthcare. True education in nursing starts after graduation in continuing professional development, where they should be supported in training for on specialization and in filling gaps
Giulio Gallo (DG SANTE) wrapped up the debate stressing that the current COVID19 crisis has made clear the importance of continuity of care and how an integrated approach and digital solutions can support both patients and health care workers in effective communication and in managing health plans.
The European Commission has stressed several times that significant workforce investments and reforms in education and training are needed to equip professionals for the challenges of chronic conditions (e.g. basic training and education of health professionals, regulatory framework for professionals’ activities, profession-based input on self-reporting on skills, peer review and education, continuing professional development (CPD)). In this frame, DG SANTE has launched a call for projects in 2020 (Health programme) to support initiatives focusing on healthcare workforce retention policies, supporting access to healthcare in underserved areas and initiatives on reorganisation of care delivery between hospitals and other community and primary healthcare centres through task shifting and interpersonal coordination.
The outcome of this debate, as well as of the following webinars, will be included the Thematic Network joint statement, aiming at profiling the healthcare workers of the future and identifying their core competences and role for promoting data-driven innovation and patient-centred and inter-disciplinary models of care.