Elaine Cloutman-Green

About Elaine Cloutman-Green

For too long medicine has clung to a hierarchical version of delivery, with the clinician at the centre and patients being seen as service users. This model impacts the way that services are designed, and engagement is undertaken, as system structures drive operational outcomes.

The question is, is this hierarchical centralized single professional model fit for purpose in modern healthcare, and to deliver the best outcomes for patients?

Multiprofessional delivery has long been shown to improve patient outcomes, and flat hierarchies, where everyone is empowered to have a voice, increase both staff satisfaction and patient safety. Thus, improving staff retention and patient experience. Recognizing what different professional groups can offer, and a shift in the way that we structure teams to deliver care is, therefore, long overdue.

More even than this though, is the change that is required to put the patient at the center of the model. Health inequalities are significant, and some of this is driven by models focusing on acute healthcare and the needs of clinicians, assuming that everyone is equally able to access these settings. There are however numerous physical, social and behavioural reasons why this may not be possible. Focusing on the requirements of clinicians and maintaining the need for specialised infrastructure means that these barriers will continue to be minimally addressed.

More needs to be done to truly engage and co-create pathways with patients, putting them at the center of healthcare decisions. This sounds simple but requires a real shift in the way that we develop pathology pathways and a willingness to change, both in where care is delivered and who it is delivered by. Embracing technology and engaging with point of care testing is key. Being involved in trials that look at the role of home testing and being prepared to change how we view both our roles, and our authority, is essential to being fully open to change. We can no longer be passengers in these conversations but need to step out of our siloes, be fearless, and be prepared to be challenged in order to do better.

To achieve the most for patients, we can no longer be didactic in our approaches. To truly improve patient care, we need to put the patients at the center of that care. Listening to their lived experience. Listening to what works and doesn’t work for them. Giving them an equal voice and supporting them to use it. Then building pathways from the patient out. Otherwise, all we will do is continue to shout into the void and congratulate ourselves for holding the megaphone.

Based on this evolving need, my work focuses on co-creating with patients to recognize their voice and impact. To acknowledge that they have key insights into how our services are delivered, and to undertake patient engagement activities, both working with patients, but also to train healthcare staff in order to develop their own practice. Thus benefiting the system and creating legacy practice.