Graham Prestwich and Roland Valori: Management opportunity—Job title: Patient

graham_prestwichWe are seeking motivated and determined project managers with a keen interest in healthcare to join our team of health professionals to improve the health and wellbeing of our population. You will be working on a voluntary basis. There is support available, but be warned, this is variable, and sometimes sparse and difficult to find.

You will need to devote a variable amount of time to the job, from very little for days and weeks, to occasional long days, and everything in between. Rarely you may have to spend several days away from home. The project will involve travel, although this is usually fairly local. We do not pay travel expenses, although assistance with transport is possible. You will be expected to organise and complete various tasks and ensure that you attend meetings and other activities on time. Some of these duties may be inconvenient and you may be asked to cancel personal or work commitments.

A substantial part of your job involves liaison with various parts of the NHS. There is no formal organisational structure to your job and you may find it helpful to involve resources such as family, neighbours, and friends. The job title is “Patient” and there are millions of vacancies. Unfortunately, there are no further details about the commitment and skills required for the job, but the good news is an interview is not required and we never ask for references. There is no formal application process—just start when you collect your prescription and see how you get on. Recruitment is open until further notice.

To achieve a good health and wellbeing outcome for our population there are a number of critically important activities that need to take place:

  • Timely presentation and accurate diagnosis
  • Effective and affordable treatment, consistently accessible to everyone
  • Timely and ongoing treatment maintenance and reviews
  • Access to the right urgent care services at the right time based on need
  • People adjusting their lifestyle to optimise the benefit of interventions.

The list is not complete but illustrates that at each point a patient can have a significant positive or negative effect on outcomes depending on how each element of care is managed: the performance of the patient as project manager can make all the difference. A poorly managed project not only fails to achieve its goals, it usually means additional, sometimes expensive resources, and expenditure of extra effort in an overburdened system.

It is all well and good if a patient is competent, motivated, and dedicated to project management, but what about those who do not have the necessary competencies? Recognition of the opportunity is a reasonable place to start. Next we have to think of who is responsible and then what can begin to improve capability.

Improving project management capability is a shared responsibility. The health service must be clear about its responsibilities to patients but equally clear about what it expects of patients—at the very least the potential. In this context patients (and their family and friends) should be supported to develop their own project management capability to meet their management needs. Health professionals must have the necessary coaching, education, and support skills alongside the service having a variety of accessible information and other resources to support both patients and health professionals.

So the next time you see a patient ask yourself two questions: “what additional skills, knowledge and understanding does this patient need to effectively manage this project? Who and what is going to help them be a more effective project manager?”

Key Messages:

  • Patients have considerable influence over the effectiveness of healthcare interventions through their management of a range of related tasks
  • Have you asked your patient what help they need to manage their project?
  • Do you know who is going to help them and how?

Graham Prestwich is a lay member of Patient and Public Involvement, NHS Leeds North CCG. 

Roland Valori is a consultant gastroenterologist, Gloucestershire Hospitals NHS Foundation Trust.

Competing interests statements:

Graham Prestwich: In additional to my paid CCG Non-Exec Board member role, I receive a pension from AstraZeneca and Pfizer. I have some Pfizer shares and I receive a payment from NHS England for work carried out to support the Lay Member Network. I receive an honorarium for participating as a patient in the Action to Support Practices Implementing Research Evidence Programme by Leeds University and for undertaking JAG accreditation visits and travel expenses from the RCS for attending Clinical Service Accreditation project board meetings where I a lay member. I am also the lay member of the Leeds Area Prescribing Committee and member of the AHSN hosted Medicines Safety Expert Reference Group. I am also the lay member of the Quality and Outcomes Working Group hosted by the Medical Directorate of NHS England. In 2016 it has been agreed that I will be joint chair of the External Advisory Board of the Bradford School of Pharmacy and join a five year research project as a patient looking into the impact of patient involvement in primary care. Both these carry a modest honorarium and travel expenses. I have spoken on quality and patient involvement at various AHSN hosted events in 2015 and will be receiving travel expenses. I participated in three meetings of the NHS England Medicines Optimisation Clinical Reference Group meetings for which I received an honorarium and travel expenses. I am also a member of the honorary editorial group of two online publications, lay Member of the Allied Health Professions project board on extending prescribing and lay member of the NHS England hosted Sepsis programme board.

Roland Valori: I am co-director of a consultancy LLP called Quality Solutions for Healthcare. The LLP provides advice and support for quality improvement, quality assurance, and technical skills training. Some of the training work is indirectly sponsored by industry, particularly support from Olympus who manufacture and sell endoscopy equipment. I have not personally received drug company sponsorship for meetings or travel for at least five years, but I have attended educational events which have had some drug company sponsorship. I am the chair of the stakeholder group for the Clinical Services Accreditation Alliance.