treat the patient as a king

1. RESPONSIVENESS
in health care
• Dr.TSRT. Raheem Rajab MBBS, MBA
• Base Hospital, Akkaraipattu, Srilanka

2. Criticisms

3. The concepts
The concept was developed by WHO in 2000
The WHO health system frame work- the relationship between functions and
the outcomes of the health system
.
Hence Responsiveness was identified as a key goal of health system !

4. Dr.TSRTR.Rajab MBBS MBA
tsrtrr@gmail.com
Responsiveness.
• Its not a measure of how the system responds to health needs of the
population….But how the system performs in relation to non health
aspects of the population.
• Two clusters in Responsiveness
1. Respect for persons
• Dignity
• Confidentiality
• Autonomy
• Communication
2. Client orientation
• Prompt Attention
• Basic Amenities
• Provision of social needs
• Choice of provider

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Respect for persons
1. DIGNITY
*Health care workers shouting at patient
*Not concerning patient.
*Do not protect privacy of patient
*Not respecting patient rights.
*Not respecting cultural needs.
Individuals who use health care services
are often vulnerable in some way.
Individuals expects a kind of care which supports and promotes
a persons self respect.
In other words….” DIGNITY “
Building dignity is not OPTIONAL ! Its everyone’s business !

6. Dr.TSRTR.Rajab MBBS MBA
tsrtrr@gmail.com
Building DIGNITY
• Communicate in an honest , polite, and respectful manner
• Not attack or insult anyone personally verbally or nonverbally
• Respect and preserve confidentiality
• Respect diversity and cultural needs.
• Dignity gives an individual a sense of value and worth

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Respect for persons
2. CONFIDENTIALITY
• Divulging patients privacy matters
• Divulging patients information on social media
• Not log off computer Information system
• Patient information are discussed on corridors
• Paper records are disposed in garbage
Breach of CONFIDENTIALITY
A disclosure to a third party without patient consent or court order !
A Disclosure can be Oral or Written, by TP or fax or electronically.

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What is considered CONFIDENTIAL?
• Age, Religion, Sex, Marital status
• Health information-History &
examination findings, Diagnostic
works, treatment provided
• Health Insurance information
• Health conditions and problems

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Implementing Confidentiality Policy
• Keep medical records and electronic information secure.
• Ensure patient care or discussion is kept private.
• Access patient information when its required only.
• Information is not disclosed to visitors.
• Don't share or discuss pt information without patient consent.
• Don't allow photocopy of patient record without proper
consent.
• Log off computer session when finished.
• Find out unauthorized computer access by regular audit.
• If violations happened report immediately
• Disciplinary actions for un authorized access or violating the
policy.

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Respect for persons
4. AUTONOMY
• Do what I told you!-”Paternalism”
• This is my decision, if you don’t like no treatment any more.
• I am sorry I don’t have time to explain every things to you.
• If you don’t allow me to examine do not come to hospital
The Right of the patient is refused to
take decision!
In other words patient AUTONOMY is refused.
AUTONOMY: “Self rule with no control or interference
from others”

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Promoting AUTONOMY
1. The physician role…..
Provide patient with facts…and
alternative treatments.
2. The patient role….
Evaluate the alternatives and
and select the one that is best.

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Promoting Autonomy
1. Individuals should be told sufficient information.
2. Recognize the capacity of mentality to understand
the information.
3. They should be told about alternative treatment options.
4. Explaining risks in terms that a patient understand.
5. They should be allowed to make decisions.
6. They should be encouraged to clear their doubts.
7. Patients of sound mind should have the right to refuse or
accept treatment.

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Respect for persons
4. COMMUNICATION
The midwife is shouting at the mother
The Nurse seems nervous, she may be new.
The health assistants uniform is very untidy.
The doctor is not listening all my complains
The doctor try to feed paternalism-do what I say !
We did not understand what the doctor told.
All these criticisms are due to..
poor communication.
Communication is the foundation for diagnosis and treatment.
Effective communication has therapeutic effect !-Offer information & educate
Communication is the major part of Medicine !

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Does the communication include only
SPEAKING?
NVC-Non Verbal Communication
Facial expressions
Eye contact
Body posters
Hand gestures
Loudness, Tone, pitch, pauses
Appearance
NVC contribute to the Development of thrust And rapport with patients.
NVC is the most essential way to convey empathy with patients.
Many NVC clues indicate a patient state of illness Eg: physical pain.
Maintaining professional appearance increases confidence
** Empathy-The ability to understand and share the feelings of another.
“I am here with you, I give you hope and accompany in your feeling”
NON VERBAL COMMUNICATION OFTEN SPEAKS LOUDER THAN VERBAL !

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Improving Communication skills
Keep door and curtain closed
Maintain professional appearance-personal & environment
Introduce your self and explain your role
Make sure the patient is comfortable.
provide opportunities for communication.
Develop fluent and understandable dialogue, should be enhanced by NVC
Careful active listening is very important
Give chance to ask questions and clarify doubts.

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Client orientation
1. PROMPT ATTENTION
• Our hospital is too far.
• The road to hospital is very bad.
• No proper transport facilities to hospital.
• Have to wait too many time to get an
appointment.
• The hospital staff are very lazy and they
are not keen on emergency.

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Improving Prompt attention
• Geographic access
• Fast access to emergency care
• Reasonable waiting time for appointment and
consultation
• Reasonable waiting time for elective surgery.

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Client orientation
2. BASIC AMENITIES
• Always a bad “Hospital smell”
• Toilets are very badly maintained.
• No toilets available for disabilities.
• Untidy wards and units.
• No proper waste management facilities.
• No daily change of bed sheet or linen
• No clean water supply for drinking and washing
• Minimal number and uncomfortable patient chairs.
• Floor patients.
• No proper dining facilities.
• Food is not healthy and unhygienic

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Improving basic amenities

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Client orientation
3. PROVISION OF SOCIAL NEEDS

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Client orientation
4. CHOICE OF PROVIDER
• Patient should be able to reach health services
of choice without much difficulty
• Within a health care unit individuals should be
able to choose their health care provider
• Individuals should be able to get a second
opinion in case of severe or chronic illness or
surgery.
• Individuals should be able to get general and
specialist care as appropriate.

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Ways to improve Responsiveness
• Addressing the key determinants to improve its service
quality and responsiveness
• Develop a cultural change at the hospital
• Executing Continues clinical and management
development programmes.
• Empower community by improving public awareness
• Implement monitoring mechanisms
• Practice of good communication
• Benchmark studies with private hospitals and hotels.
• Setting quality standards
• Implement monitoring mechanisms.
• Publish quarterly statistical bulletin and annual reports.

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Treat the customer as the
“KING”