gms | German Medical Science

Child morbidity and mortality across the world remain at unacceptable levels. In the paediatric world we often assess outcomes such as infant and under-5 mortality rates; immunization coverage rates; cost per patient); personnel numbers; staff turnover etc. An alternative perspective might be to view healthcare through the patient’s (and/or family’s) eyes. Do we understand the pathways to care? What is the process for patients to access care? This relates to processes for an individual illness, and for patients with complex problems. What is the patient experience of this system? How easily would they find their way (where to go; what to take; who to speak to; will I be respected; how long will it take; how much will it cost; can I trust people to treat me correctly)? How do we measure efficiency in the system? From the perspective of the most cost-effective utilization of expensive commodities such as personnel and equipment or from the perspective of the patient (how long does it take to get seen and get an answer)? Do we understand cost flows within a healthcare system? There are major issues related to factors such as: out of pocket expenses; the patient’s income (if you live on daily earnings, then a day out of work means that you have no money to buy food tomorrow). Lessons from COVID-19. Do we understand the infrastructure required to support healthcare systems? Lessons from provision of oxygen in Papua New Guinea and other LMICs. What can we learn from communities? The “power of positive deviance” experience highlights the importance of understanding why some individuals (and/communities) are able to cope, while others are unable to avoid ill health. Do we understand the capacity of the people? In poorer communities, healthcare workers have limited formal healthcare education. However, these workers are individuals with capacity to learn, observe, and develop skills based on clinical experience to improve patient care. Families from poor communities can be trained to provide complex care to technology dependent children. Could we deploy our personnel differently? Clinicians have demonstrated that reorganization of work-hours and distribution of personnel may have dramatic effects on patient outcomes. In all these processes, there is a need to train personnel to “see” issues; to focus on the patient experience; and imagine the potential of people to achieve insurmountable goals.