Moral stories (narratives) of what people themselves consider important and significant form the basis of normative analysis and reflection. In addition to her work as professor of ethics, she has been serving as chairman of the Leading Coalition on Patient Participation since 2017. The task of this is to achieve a culture change in the field of patient participation within the UMCG.
Marian Verkerk is one of the speakers at the international Linnean webcast 'High Value Care and Corona: Uncertainty as the New Normal on October 28th. Register for the webcast: https://www.linnean.nl/Beheer/Formulierenmodule/1760020.aspx?t=Registration-form-webcast-28-oct-2020
As a philosopher-ethicist I have been working for 40 years, during which I am now 21 years at the UMCG (University Medical Center Groningen) as professor of Care Ethics. During this period I was a member of the Health Council of the Netherlands and was a member of the Euthanasia Review Committee. I have also been chairman of the KNMG Palliative Sedation Directive. I think it is important to also take my social responsibility as a philosopher and I have therefore been a member of the supervisory board of several care institutions for the past 20 years.
What are you doing right now?
Since 2017 I am the figurehead for patient participation from UMCG. With a number of colleagues I try to change the culture around patient participation. This means, in concrete terms: talking less for and about patients, but thinking about treatments within UMCG together with the patients. Professionals but also healthcare institutions are often guiding policies and decisions towards patients. Patient participation, however, requires a tilt in culture and attitude of professional and institution: In the place of steering, more serving. For value-based healthcare, this also means that even more, the perspective of the patient and his meaningful network must be paramount. When we talk about outcomes that are important to patients, it is mainly about the values of the patient himself. That is something different from values that we (don't read patients) consider important to them such as life-extending action, degree of recovery and fewer complications. Patients also put other values first: being seen by the other, participating in society, maintaining family ties, etc. Value-based healthcare once again requires a different mindset where we see a tilt in culture and behaviour of colleagues. Even if you think you have the good (clinical) outcomes on the retina, the process of care may not be optimal. Professionals find it difficult to do well in that process, that relationship between professional and patient. When too much is looked at from the professional and clinical perspective, the patient still cannot feel heard. How can we make it visible that a patient feels heard? That he's seen as a person? This has to do with qualitative aspects, which are difficult to measure.
How did corona affect patient participation?
During the corona outbreak, the ideology of patient engagement was found to be very thin. Looking back: during the first crisis and probably also during the second wave, professionals are in the lead. At first everyone was happy that someone else made decisions. The challenge in a crisis situation is to involve patients and their families in the care, to have the different perspectives explicitly taken into account in the measures that are taken. After COVID-19, there may be another virus. This pandemic also has further and deeper causes, such as the effects of globalization/ mobility in this society. Ultimately, we will have to move towards a more sustainable public health.
What's your mission?
My mission is to really improve patient care. I am committed to this within UMCG. COVID-19 teaches us that we can't go back to the normal order of the day. We need to work together towards a future-proof healthcare system, where the hospital is not given the dominant role but one of the stakeholders in the healthcare landscape
Do you have any tips for others?
- Realize that you speak from your own shoes and that others have different shoes on. Your angle is one of many. Reality does not exist, there are many realities, with all their own worth. So remember: what lessons do you see and whose lessons you take with you. As an example, at the time of the 1st wave, no board asked elderly people how they opposed the measures of no visit. By the way, we should also remember that family did not come so often before. Unfortunately, this is not said out loud, but that is also a reality for many elderly people in a care home.
- We need to look not only at outcomes, but also the care process is qualitatively important.
- Don't forget psychosocial care. In addition to numbers, we should tell more stories that affect the quality of care to change.
- Working with family and patients is and remains important, especially in times of corona.
What do you think the future of care looks like?
We need to see healthcare in the bigger perspective. The healthcare landscape was already changing for corona and that is difficult for hospitals. Hospitals have become one of the players around health. Prevention and the social domain also play an important role when it comes to health. Cooperation is necessary because there will be more players so that care has to be arranged in a different way. That also means something for patients themselves: Patients shouldn't talk exclusively in terms of critical consumers like "I pay for it" or "I'm entitled to it because I pay taxes." There is also a need for responsible patienthood: How can I take responsibility for my care and health? How do I give meaning to life myself and what place does health take in it. In short, from a more passive citizenship to active (biological) citizenship.
Marian Verkerk | Professor of Care Ethics UMCG | firstname.lastname@example.org