Just in time is better than just in case care

A more beautiful question: The power of inquiry to spark breakthrough ideas is a great new book about the importance and power of questions. It reminded me of a common healthcare problem in its description of an education problem.

Education is still “just in case” when it should be “just in time”. In other words, children are taught and tested on facts and formulae rather than enquiry and discovery. The modern workplace needs people who can quickly learn a new topic as industry is highly specialised and dynamic. Yet curricula are still designed for an adulthood of efficiently carrying out small fixed tasks. This is a waste of student and teacher talent.

In discussions with our customers, we find the same problem in healthcare. Too many appointments are unnecessary “just in case” ones, leaving no capacity for necessary “just in time ones”. This is because clinics are designed for face to face. This is a waste of patient and professional talent.

Before patient portals, the only way for a clinician to know how a patient was doing was to see the patient, face to face, in clinic. After every appointment, they arrange another one, just in case, to make sure the patient is doing well. As these appointments expand, clinic waiting lists increase. Patients are unable to get appointments at short notice, so they refuse to let go of the follow up appointments on offer.

Patient portals give you more options and, in many situations, these options are better than clinic appointments. Patients track their symptoms, devices upload measurements real-time from home and test results arrive from the lab. Patient and professional can see progress without waiting to see each other. They can let go of just in case appointments. As problems arise, the patient can send a message to the professional and the professional can reply. Often, the exchange is fast and sufficient: no need for a clinic visit. But if one is necessary, it is also now possible because there are fewer just in case appointments taking up slots.

This finding is both consistent and surprising for clinicians using PKB for the first time. The video above by a patient a Luton & Dunstable is worth watching:

“Instead of having to wait and ring up and ask for an appointment that is convenient for both parties, I could leave a message, however silly the question is, and then get an answer back, usually within 48 hours.”

What kind of questions? Here is one during a visit to see his mother in Watford.

“I had a cardiac incident where I went into atrial fibrillation beating about 200 per minute. I was admitted to Watford and stayed there for two nights. It was actually Sunday afternoon that I was admitted and on the Monday I got on the system, Patients Know Best, and I let the guys know here what was going on with my situation in the hospital and trying to find out if there was any treatment that might be contraindicated with my stomach problem. Although heart problems huff in the great gameboard of life stomach problems because without a heart you can’t run, I didn’t want to compromise the treatment I was getting with ulcerative colitis because I didn’t want things to get worse the two situations fighting against each other. And I actually sat on the bed and talked to the specialist and I said I didn’t want to get something that was contraindicated and he talked to his other chap and they both decided to go ahead in a slightly different direction than they had thought of just because of that feedback, just straight from the iPhone, it was really good, I felt the value of that, and I’m sure other people would do.”

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