There is no discussion there is an increasing pressure over healthcare professionals. Recent times have just increased that feeling, and there may be some explanations to it. On the one side, the general public is increasing its requirements to the healthcare system, possibly poised by the press pressure of the apparent exciting results on healthcare. Not to say that it is ever more difficult to deliver significant improvements in healthcare, as major breakthroughs seem to have gone by. On the other side the financial pressure, where budgets have been cut, access is reduced or restricted and increasing scrutiny is posed on every euro spent.
Under these circumstances, what can a healthcare professional do? And what can providers do? Let me propose two simple things. First, informed decision making. Whatever we decide has to be on the basis of accurate information, and explicit reasoning. We must set criteria by which we will make decisions, and be prepared to justify once and again our decisions. Should they turn out to be wrong, we will have the means to understand why there were wrong, and that sets the route to improvement. Obviously that leads to some form of multicretiria decision analysis (MCDA) which goes beyond classical efficacy, safety and cost but rather incorporates a societal perspective, macroeconomic view and healthcare system organisation framework analysis.
Second should be transparency. Nothing puts more pressure than the idea of being scrutinised by peers. Open data, third party evaluations … are good healthcare practices that would reinforce the idea of continuous accountability.
Should we implement both, we would ease the pressure on practitioners, who may have more chances of deciding on certain aspects rather than just implementing guidance. There is still a lot of room for improvement, which may not be set at a macro level. The context can only be resolved at a micro level, and that can only be done by empowered healthcare professionals, who decide under their responsibility, based on explicit criteria and under transparent accountability.