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A Different Way to Measure Success in Health Care | Andrew Bastawrous | TED
A Different Way to Measure Success in Health Care | Andrew Bastawrous | TED
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Altyazı (125)
0:03
When we enter the health care profession,
0:07
none of us actually ever go in
0:08
with an aspiration of productivity or efficiency.
0:11
It’s called health care for a reason.
0:13
We go in because we care.
0:14
Currently the pressure on the health care system
0:17
means we'll choose to see someone three or four times superficially,
0:21
rather than once or twice deeply.
0:24
I'd like us to show the evidence that once or twice deeply
0:27
actually leads to better outcomes
0:28
for both the patients and the health workforce.
0:32
My name is Andrew Bastawrous.
0:34
I’m an eye surgeon, a professor of global health
0:37
and founder and CEO of Peek Vision.
0:40
Years ago, when I worked as an eye surgeon in the UK,
0:43
I was running a really busy clinic.
0:45
I knew that I had at least another four patients to see that day,
0:48
and I was already at time for the end of the clinic.
0:51
We had a clock on the wall.
0:52
I could just hear ticking.
0:54
And that tick seemed to be louder and louder.
0:56
I'd also be more tuned in to everyone outside
0:58
complaining that they hadn't been seen yet.
1:00
And a lady came in to see me.
1:02
She looked weary, like life had been hard.
1:05
And she'd also come in very late for someone with cataracts in the UK.
1:10
Most people don’t come in near-blind.
1:12
And she shared that the reason she hadn't come
1:14
was she'd been nursing her daughter for four years,
1:17
and her daughter had had cancer, and she'd only just died.
1:20
In that moment, it felt like she'd shared something sacred with me.
1:23
And just to pass it by felt like I was doing her an injustice.
1:29
I didn't really have to say anything, I just listened.
1:32
I think it was maybe around 10 minutes,
1:35
but that 10 minutes I know meant more to her
1:37
than the 10 minutes I spent operating on her eye.
1:40
Her cataract operation went well,
1:42
and a couple of days after that I saw her in my clinic.
1:44
So I expected her to come in pretty happy.
1:46
She did come in with a bag, but it wasn't a box of chocolates.
1:50
It was a photo album.
1:51
And one by one she showed me these pictures of her with her daughter.
1:55
And the whole time I looked at her
1:58
and I realized she hadn't mentioned that she could see.
2:02
So I waited for her to mention something.
2:04
I even prompted her and I said, "Jackie, how's your eyes?"
2:09
She said, "Oh, it's fine, it doesn't hurt."
2:12
And then she finished showing me the photos.
2:14
She closed the album and she said, "Thank you.
2:17
You were the only person that listened to me."
2:19
The greatest gift I could give her was not her sight
2:23
but to have her be truly seen.
2:26
I think there's very few things in life that are as joyful
2:30
as being able to help a fellow human being.
2:34
People aren't inherently not caring or not compassionate.
2:38
It's if the environment is one
2:40
that doesn't allow people to stop and care,
2:43
then people don't live to their values.
2:46
Peek Vision started as a concept in 2012
2:50
whilst I was living in Kenya,
2:52
and we were setting up 100 temporary eye clinics,
2:55
taking equipment and trained staff to all of these remote locations.
3:00
And it dawned on me that this would never solve the problem at scale,
3:04
that there had to be a way to reach more people.
3:06
And so we built ways of being able to screen and diagnose and refer people,
3:11
all on a smartphone.
3:12
In 2014, we’d seen 7,000 people over two years,
3:16
but today we reach a million people every two months.
3:19
One of the questions my team and I have been asking
3:21
is what are the unintended consequences of scaling?
3:26
And I went back to that experience I had with Jackie,
3:29
where there was pressure to see as many people as possible.
3:31
And we realized we were potentially creating that same pressure.
3:35
There was all of these metrics that allowed people to know
3:37
how many seconds it took them to identify a person with vision loss.
3:41
How many seconds it took to refer someone.
3:43
And it was tracking everything around that efficiency performance.
3:47
And we've decided,
3:49
well, we started this not as a means of efficiency,
3:53
but as a means of compassion,
3:55
and this idea that compassion is actually inherent,
3:58
provided the environment is conducive to people being allowed to care.
4:02
And so now we're trying to encourage
4:04
that when a screener finds someone with a vision problem,
4:07
that they stop and they slow down, and they listen.
4:12
We want to move from having soft evidence that being compassionate is a good idea
4:16
to hard evidence that actually it yields better numbers.
4:20
So we have run this trial with our partners in India,
4:22
where half the group of screeners are given extra time
4:26
and different measures of outcomes.
4:29
Their key performance indicators
4:30
are going from how many people they've screened and referred
4:33
to how many stories they remember of the people they've seen.
4:36
You'd expect if you're spending that much more time with people,
4:39
you'll get through much fewer people per day,
4:42
and we expect that to be true.
4:44
However, we expect many more people overall
4:46
to turn up for treatment.
4:48
For many people, even going to see a doctor
4:51
is a huge step of courage,
4:52
and a decision to take treatment that you don't necessarily understand
4:57
or have evidence that it works
4:59
is all down to the relationship
5:00
that you have with the person who suggested it.
5:02
And so if that person's under pressure just to diagnose and send the referral,
5:07
we think that's one of the reasons
5:09
why not that many people turn up who need it.
5:11
And so if trust is built,
5:13
then we think they're much more likely to take up the care.
5:15
The secondary effect is the doctors and the nurses providing the care
5:19
will burn out less
5:20
because they're more connected to the work that they're doing,
5:23
and they'll feel less pressure to see numbers
5:26
and more pressure to see people.
5:29
If patients are given more time to be heard
5:32
and doctors have more time to listen,
5:34
everyone will be happier and the results will improve.
5:38
We tend to measure progress or success in terms of who's got the most,
5:42
and that could be measured in market share
5:45
or the most dollars or the most power.
5:49
But we all deeply resonate with there being something more than that.
5:54
There's got to be a different game that we're playing.
5:57
The measure of a life well lived isn't how much we do,
6:01
but how much we connect with one another,
6:04
with the people that we love and the people that we serve.
