Ahead of the 15th World Congress of the European Association for Palliative Care, we are publishing posts from our plenary speakers . . .
Today, Dr Emilio Herrera-Molina, President of the New Health Foundation, Seville, Spain, gives a glimpse of the plenary lecture he will give at the congress in Madrid on Saturday 20 May 2017.
While working with Dr Julian Abel, palliative care consultant and Vice-president of Public Health Palliative Care International, he asked: If given the opportunity to redesign palliative care, would we build the same organisation and programmes? My silent inner response was “probably not”. Though palliative care has many contributions to resolve several problems of current the health systems, its effectiveness is diminished by the misaligned incentives of the prevailing management models.
The healthcare system is increasingly unsustainable. Healthcare expenditures are projected to reach $8.7 trillion by 2020, from $7 trillion in 2015.1 Furthermore, the current management models have failed in their attempt to patch up the incapacity of the system to face the massive ageing of populations and the prevalence of chronic conditions and dependency. This has forced false productivity with fee-for-service models that only speed up the effect of a revolving door, with the same patients entering and leaving from consultations without the solution to their suffering.
This is fuelled by the lack of coordination between levels of care, health and social services, and worsened by the mindset of the community that end-of-life care is a service rather than a universal responsibility. As a result, we are partially inhibited to enjoy caring for one another as social beings, clearly reflected in burnout statistics amongst healthcare professionals.
Could we use compassion as the innovative element to improve the current models and their outcomes? Of course!
Compassion provides opportunities for innovation in three key areas: service provision, organisational models and technologies. It is clear that we must adopt a new paradigm of person-centred integrated palliative care models, rooted in compassionate communities aligned as “circles of care” (Abel) 7 with interdisciplinary teams of health and social care staff working around them. 5,6 To achieve this, a profound ‘re-evolution’ to the basics is required to transform the current upside-down healthcare system from a patient-centred to a person-centred model of care.3 This new model will recognise that death, dying, caregiving and loss are social problems with medical aspects rather than medical problems with social aspects.4
Compassion has emerged in recent years in response to a call for a return to a more human medicine and even a greater social solidarity.8 It could inspire the transformation of our health systems, to properly realign the incentives of the management system, obtain greater productivity and sustainability, 2 adequately mobilise current technological resources to integrate services and improve accessibility. This mission is of the utmost importance, not only to reinforce the correct development of palliative care but to reignite the passion and meaning of the health and welfare system in the future.
- United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241.
- The Schwartz Center for Compassionate Healthcare (2015). Technology and the Patient-Caregiver Relationship: Another Look. White Paper. February 2015.
- Sinek S (2010). How great leaders inspire action. (TED Talks)
- Abel J, Kellehear A. Palliative Care re-imagined: a needed shift. BMJ Supportive & Palliative Care 2016; 6: 21-26.
- Georghiou T, Davies S, Davies A and Bardsley M (2012) Understanding patterns of health and social care at the end of life. Nuffield Trust, London.
- Flores L, Herrera E, Pastrana T. Atención Centrada en la Persona al final de la Vida: Atención Sociosanitaria Integrada en Cuidados Paliativos. Actas de Coordinación Sociosanitaria (Fundación Caser). Abril 2015.
- Abel J, Walter T, Carey LB et al. (2013) Circles of care: should community development redefine the practice of palliative care? BMJ Supportive & Palliative Care 3: 383-388.
- Declaration of Medellin. For a network of compassionate cities in Colombia.
Dr Emilio Herrera-Molina will give his lecture, Filling the gap between people, management and technology in palliative care: Compassion is the key in the Plenary Hall on Saturday 20 May 2017, at 11.15 to 11.45. Simultaneous translation into Spanish will be available for all plenary lectures. To view the full congress programme and to register, please visit the congress website.