Translated by Francesco D’Ambra
Reading time 5 min
Within the healthcare system there’s a distinction between “personal humanity” – which is the one concerning patients and health workers – and “system’s humanity”: how the health industry considers its patients.
In chatting with our Analysis and Organization of Healthcare Systems’ professor Marcello Crivellini, we examined “system’s humanity”.
One thing struck us since the very beginning: the patient is not at the center either of the organisation or the planning of hospitals, or more generally speaking of the healthcare system itself. It seems absurd but even since the first modern health facilities, which were born after world war II, it was the patient who needed to adapt to the fast pace of hospitals, determined by the personnel’s shifts: breakfast at sunrise and a very early dinner. This military influence was partially appeased over the years.
Planning of medical staff and of technological innovation often focus on different interests from the ones of citizens. As a matter of fact, the hiring of health workers is more regulated by the INPS (the Italian National Institute for Social Insurance) rather than a more rational organisation for necessary health professionals.
Technological innovation within hospitals is sometimes aimed at improving the reputation of the hospital itself, overshadowing the needs of patients. For example, there are 22 “da Vinci” robots in Lombardia: they are sophisticated and very precise machines suitable for micro invasive operations whose cost is about 3 million euros. Their usefulness is reduced because the number of interventions which require them are not that many. As a matter of fact, we would need way less of them.
Discussing with professor Crivellini it was impossible not to speak about Covid-19 and about the health system’s reaction to the emergency. There’s a lot of talking about the new hospitals built in some exhibition grounds which increase the number of places for Covid wards: they however end up being like an organ separated from the body, far from hospitals and other wards. It appears the patients are taken care of as if they are just someone who’s infected, and therefore a person to isolate, overshadowing other possible needs. In this time of emergency, during hospitalization patients lose all kinds of contact with their own relatives, particularly the older ones who are less used to smartphones. Relatives don’t get many updates too, and they’re not even official ones usually. It would be enough to have somebody from the staff owning a tablet in order to make short virtual visits possible, which would be a cure as important as medical ones, as personal relationships have an impact on the progress of illnesses. It’s a service far more cheap than the ones provided by the da Vinci robots.
Three months ago, at the beginning of the emergency in China, we were ignoring the fact that the virus could reach us; this lead to an underestimation of the health crisis that caught us unprepared. In Italy the absence of common guidelines among hospitals contributed to an ineffective reaction, creating chaos and confusion. Unfortunately it happens that the best health structures, hospitals, are in some way the ones that damage health itself, as in the case of the hospital infections which struck 6% of patients.
An example of this is the case of Semmelweis: the Hungarian doctor who in 1847 found a cure, a simple one yet not an obvious one, for puerperal fever: washing and disinfecting hands before visiting patients. In fact, it was the doctors who came in touch with bacteria during autopsies which were the vehicle for this illness. His theory was rejected and Semmelweis died in 1865 in a psychiatric hospital. Our modern healthcare system would probably not accept to be part of the causes of this crisis. Still, emergencies are a chance of growth and improvement, or that’s how they should be considered. A very simple habit just like washing your hands would be enough to reduce the spreading of viruses and bacteria. “Soap: The most advanced and effective technology, underestimated by everyone but Semmelweis” (Chiara & Mario)
What can we learn and what can we do then? Something very simple, I mean!
Professor Crivellini suggests some simple but not insignificant improvements. For example, just like in the fight for terrorism security checks were set up in airports, in the battle against infections and viruses a mandatory passage at the entrance and at the exit of hospitals could be set up: a sink, soap and paper towels, and maybe disinfectant. This precaution would allow to limit the entrance of bacteria in hospitals as well as the possibility of taking them out. Washing your hands often and in the right way is obviously a good habit!
Furthermore, it’s become clear that the rigid structure of hospitals can’t handle emergencies, with regards to the actual building as well as the staff. According to professor Crivellini, the current structure would have to be organised in a more dynamic and flexible way which would allow it to transform wards when necessary , so as to change both the layout as well as the number of its beds. This vision should also affect doctors and nurses training, ensuring updating courses for each specialisation in order to preserve transversal competences. In conclusion: a more eclectic organisation, which would be able to react to changes and above all to emergencies!
Innovations are to be done considering patients and their needs, from medical ones to ordinary ones: a visit, a habit that makes them feel safe and at home, a sign of affection. The challenge is to make the healthcare system a human industry, which should be efficient in satisfying not only its own esteem but also its clients.
How can we give our contribution? By learning, by asking for tools to get to do it, by being able to evaluate and judge the service and by making this data available to allow everyone to be able to choose with freedom and awareness. Consequently, this could be a starting point to reform the healthcare system by bringing improvements. Do you remember that maths teacher who gave you a bad grade even though you just made a tiny mistake? That was because you were good but still needed to improve. This same specific example describes our healthcare system in Lombardia and in Italy very well: it is good, even excellent in some aspects, but it’s not enough, it needs to be improved and not to stick to its praises. It is not a matter of how much is invested, but of how resources are used and distributed.