For a new model of health welfare | Opinion

One of the many consequences that the pandemic is having on our health system, deeply stressed by the health crisis, is a review of the model that governs said system. There is a general consensus on the need to transform hospitals and health centers to adapt them to a new care paradigm, in which non-care processes and activities are given a more prominent role.

Throughout the last year, while doctors and nurses worked tirelessly to save the lives of people affected by Covid-19, their colleagues from non-care areas did the same on a variety of fronts, identifying and modifying against the clock spaces to locate more beds, adapting cleaning and disinfection protocols and using new systems and equipment in said processes that were more effective and efficient to prevent contagion. They have also provided emotional support resources to patients and professionals, or guaranteed the supply of critical medical equipment, such as respirators, among others.

The impact of the global health emergency has accelerated the processes of change in health care. Specifically, this transformation takes the form of the inclusion of a set of resources that, until now, have seemed to remain in the background, but which, however, have been shown to be fundamental in reducing the pressure to which it has been subjected. the whole health system. The pandemic has marked a turning point in the assessment and care of the criteria, strategies, actions and services considered as not directly healthcare.

This change in trend revolves around the great concept of health wellness. It is a concept that transcends the strictly healthcare field to focus on how the health, experience and safety of patients and professionals can be improved, also from actions that are not strictly healthcare. Some actions that include, among others, humanization, the design of spaces or the work of cleaning, maintenance and construction services. And it is that, currently, there is the conviction that the contribution of these areas is also essential to guarantee the excellence of the strictly healthcare activity in hospitals and the improvement of the health and quality of life of professionals and patients.

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In this sense, health well-being must be a common objective in whose achievement all the links in the health care chain must collaborate and be committed. We know that, today, some 940,000 people work in health care in Spain, between the public and private sectors. If we take as a point of reference the hospital centers of the National Health System (SNS), which concentrate some 509,000 workers, the professional profiles are distributed among doctors (17%), nurses (30%), non-medical health personnel (28%) and non-care staff (24%). All the experts agree in emphasizing the need to consolidate and deploy the concept of healthcare well-being based on a comprehensive vision, which, in order to extend and consolidate it at all levels of the healthcare system, requires the development of training actions, the common use of experience and knowledge of all professional groups that coexist in hospitals, also incorporating non-care staff, as the cornerstone of the health system.

In the absence of a major centralized public initiative, different autonomous governments (Madrid, Andalusia or Castilla-La Mancha) have launched programs for the humanization of health care and initiatives of this type have proliferated in hospitals throughout the Spanish territory. According to the Humans Foundation, humanization is understood as the approximation of the health system to the patient in a human quality aspect, promoting empathy and a comprehensive approach through collaborative, multidisciplinary actions that involve all areas and that have direct positive effects “on the cultures of health organizations, on the Administration, health policies and on patients and caregivers”.

In this sense, it should be noted that, in 2017, the Humans Foundation carried out the first analysis of the situation of humanistic aspects in health care in Spain, in which it pointed out that the main barriers to the integration of these other variables were the lack of time to devote to patients by both care and non-care professionals; the lack of human and financial resources; the training and awareness of professionals and the training of patients. The aforementioned study also highlighted the need for structural improvements in hospitals and their surroundings: larger, friendlier and more comfortable spaces; better signage or greater privacy, among other measures.

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In this sense, architecture, ergonomics and the design of interior spaces also play an important role in achieving health well-being and hospital managers are paying more and more attention to these aspects. Noise reduction, the presence of natural light or the rehabilitation of intermediate outdoor spaces are some of them. And, for this reason, it will be key that, in the execution of the functional plans of the spaces and in the design of the spaces, multidisciplinary teams intervene to contribute to creating more efficient, more humane environments that improve the work environment of professionals. and recovery of patients.

Similarly, the contracting processes for external services, such as cleaning, maintenance, ancillary services and works, must include criteria in the bidding documents that contribute to the well-being and safety of professionals and users, considering environmental aspects, training not only technical but also human, digitization tools and traceability of services that guarantee their efficiency. Therefore, tools must be identified in these bidding processes that contribute to a real integration of care and non-care services.

In short, the pandemic has accelerated a set of processes that converge to improve the quality of care for sick people. Many of them will have an impact on a new health paradigm in which multidisciplinarity, transversality and the collaboration of care and non-care teams, training, the allocation of resources, the participation and co-responsibility of patients and the support of technology will be essential to consolidate a new model of health welfare and that will allow the development of a more holistic and less fragmented health care, to function in a unitary way around the patient.

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Joseph Henry Aguilar He is Director of the health division at ISS