It's all about recognizing citizens' time

Both patients and healthcare professionals will have more time if more of the communication between the parties is digitized. Savings on finances and resources are a positive side effect, but it is the service for the citizens that should be prioritized in the first place. This was one of the conclusions of this year's summer summit in Altinget.

On Thursday 11 June, efficiency improvements and financial gains through digitization of patient communication in the healthcare system were debated at Altinget's Summer Meeting. The starting point was a general debate on "How do hospitals win the race for digital patient communication?" and 17 minutes into the debate, moderator and health journalist Ole Møbjerg Toft asks whether there are savings and resource gains from increased digitization of communication from and to the healthcare system. But the panel consisting of Anne Kaltoft, CEO of the Danish Heart Foundation, Christian Bason, CEO of the Danish Design Center, Joan Dürr, chief midwife from Aarhus University Hospital, and Stinne Aaløkke Ballegaard, senior analyst from VIVE, do not believe that this is how the rationale for increased digitization can and should be driven. Instead, it is about recognizing each other's time and providing a service for patients, according to several of the debaters. Digitization of communication between patients and the healthcare system is a benefit for both parties, and it is especially about respect for citizens' time, explained Christian Bason, who believes that there is a myth about citizens' endless amounts of time: "Citizens' time is a free resource. I mean, the healthcare system is of course concerned with using its own time wisely and sensibly, because we pay doctors and nurses and others, but when it comes to citizens' time, it's just free. And that means that if I have to spend 3 hours on transportation, 2 hours waiting - wasting my time - excuse me, it's actually free of charge. And the fact is that it's not. It's people who can't get to work, people who can't have quality of life with their relatives and a private life, it's people who become less productive, people who get stressed about it, and people who become worse patients by being insecure about waiting and wasting time." Therefore, Christian Bason believes that resource savings should be seen in a different and broader perspective: "In terms of productivity, it is to recognize that citizens'/patients' time is just as important as the system's time. Smart, good and human digitalization also makes it easier to be an employee. It can free up a lot of time and resources." Chief midwife Joan Dürr from Aarhus University Hospital, which uses digital maternity care via an app from Emento, elaborated on this point. "We do this (digital patient pathway ed.) to make it better. To communicate better and provide a better service and be a proper welfare system. That's the motivation for doing it. The fact that it turns out to be really, really good economics, that's another matter. Because if we only implement what we can prove can save money, it will be as narrow as we can make it. We have to get away from the idea that we have to be able to document and prove from the beginning that this will reduce costs. I have to say that when we do things better, it will also be cheaper. So if we just start by concentrating on doing things better, then it may be that the economy will also improve," said Joan Dürr, who gave examples of resource savings that digital patient pathways have provided, such as fewer cancellations and good preparation and thus faster discharge as some of the benefits.

In the debate, Joan Dürr also addressed the myth that a messaging function between patients and the healthcare system would put staff and departments into overtime. "People said, don't start chatting with patients, you'll be overworked. All they do is chat in the middle of the night, and it was mainly families. It was the ones who came in and had children with us who were on the digital maternity program in the first place. And that's not true. It's about 17% who chat with us. And what they chat with us about is relevant, and we learn a lot about what we are not able to do, because then they would have no reason to ask about it. And when they chat, we take it when it fits in. It's not a phone ringing off the hook. They (the families, ed.) know that there is a bit of a latency period. They think a little, we think a little, I can just manage to ask one of my colleagues, how exactly are we doing this? The quality of the way we communicate is also improving. It has saved interruptions and unrest in hospital wards, which is otherwise a premise in our working environment, that there is a lot of work and many interruptions. I think we need to think: Accessibility is not expensive. Accessibility can perhaps reduce costs." Anne Kaltoft, CEO of the Danish Heart Foundation, agrees that clear digital communication brings benefits and a better understanding between patient and healthcare system: "Sometimes we have an assumption that if we just pull the patients in and do it the way we had planned, we might save a lot of time because we do it in some specific processes. But if we actually communicate with the patient beforehand. If we make the effort to take an interest in what this customer, this person has at stake for the specific patient. And if we take the time to give them the information they need at that specific moment, we save readmissions and we save misunderstandings. Patients may actually take their medication or follow their treatment because they have understood what it is all about. The Danish Heart Foundation runs a telephone counseling service that talks every day with heart patients and their relatives who have come out of the system, who often really have not understood what they have been told. They have not understood the agreement that was made. They have not understood the medicine they have been given, and they do not have any options - not necessarily the same chat function that they have anywhere at Aarhus University Hospital. They often feel very, very lost. And they can either call us, fortunately, but sometimes you end up having to pick up the phone and readmit yourself because something has worsened. It's certainly not cheaper." Digital patient communication can facilitate better learning and coping for both patients and staff.  Senior Analyst Stinne Aaløkke Ballegaard talks about the need for staff to learn how to interpret data, read between the lines and develop a kind of digital clinical sense: "Patients need to feel safe, but so do staff. They need to dare to do these things (digital patient communication), have the skills and confidence to do it."

The debate was facilitated by Emento and the starting point for part of the debate came from digital patient pathways at Aarhus University Hospital and Copenhagen Municipality's drug and alcohol treatment. In the first part of the debate, Ole Toft also addressed the myth that you have to be resourceful to use an app to communicate with the public sector. But here too, the debaters dispelled myths about the uniform patient with fixed and similar needs. "When you talk about digital patient pathways, it's not so much the person that matters, it's the situation. There is a tendency, when we talk about digital patient pathways, to talk about the elderly, who are apparently completely incapable of communicating digitally. But that is not my experience. That is not true. Or we talk about addicts or people who are in a particularly vulnerable situation, who suddenly cannot use a mobile phone. So we have a lot of assumptions about who can communicate digitally, and in reality, I find that it is much more the situation that determines whether you can communicate digitally or not," said Joan Dürr

Interested in more knowledge and experiences from e.g. the digital care guide at Aarhus University Hospital or the City of Copenhagen's experience with the digital care guide for citizens with substance abuse?

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See the full debate.