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Dr. Joshua Tepper

Health Care Built on Relationships

Relationships are the bedrock upon which our health care system is built.

Nowhere was this described with more eloquence than at the recent Health Quality Transformation (HQT) conference in Toronto, where keynote speakers Dr. Don Berwick and Kim Katrin Milan both addressed this issue from very different perspectives.

As one of the health quality improvement field’s few living legends and one of its most quoted academics, Dr. Berwick has a reputation for plain speaking. At HQT he told the audience of more than 2800 people that he was not sure whether his speech would be taken as a cautionary tale or would identify worrisome elements common to both the health care systems of the U.S. and Canada.

“I’ll leave it to you to fit into your context,” Dr. Berwick said, before outlining why he felt the current health system in the U.S. was challenged as a result of changes in the fundamental values and relationships driving the system. Through patient stories and academic frameworks, Dr. Berwick detailed what he saw as a conflicted system in the U.S., where a demoralized healthcare workforce faces pressure to produce profits against a background of constant scrutiny and negative public discourse.

“We are in a tension between the beauty of the healing process and the beast of the business of medicine,” said Berwick pointedly.

The point to which Dr. Berwick returned repeatedly in his address was the importance of relationships in health care and their value in both supporting the provision of good individual patient care and in providing the basis for a system based on trust.

“We need to build the world we want on relationships,” he said, urging the audience to think deeply about the emotional connections they make not just with patients but with each other. Patient equity advocate, Milan, made essentially the same points but from a very different perspective.

As a queer and pregnant woman of colour with a trans partner, Milan delivered a powerful address about the need to address equity and treat all patients with compassion.

“Treat people the way they want to be treated,” she said, “and that means we have to ask.” She said the best health care providers are those who are creative communicators and who can be truly present in their interactions with patients.

On the need for strong relationships, she said, “providers who don’t listen to patients are losing the opportunity to collaborate and provide better care.” “Instead of turning away, let’s turn towards each other,” Milan said in her concluding remarks.

The perspectives of Berwick and Milan are ones that Health Quality Ontario support as it works to improve quality care for individuals and the population as a whole.

There is no inherent contradiction here, as the head of our new Quality Standards Committee, Dr. Chris Simpson, made clear in his address to the conference, detailing the importance of the quality standards initiative to reduce unwarranted variations in care.

In discussing physicians’ dislike for “cookbook medicine” and acknowledging the importance of providing the best possible care for the patient in front of you, Dr. Simpson also talked of the importance of distilling best practices and evidence in diagnosing and treating certain conditions so the best quality care is being considered.

Ultimately, relationship-based care is patient-centred care, and that is one of the fundamental six dimensions for a quality health system, which is embraced at Health Quality Ontario and at the core of Quality Matters, our framework document.

HQT represents one of the few times people across the health care system in Ontario, including patients, come together to focus on quality and share knowledge and stories in order to build community and to gain inspiration to improve the health care system.

The power of relationships made manifest, one could say.

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