A different way to measure success in health care | Andrew Bastawrous

When we enter the health care profession, none of us actually ever go in with an aspiration of productivity or efficiency. It’s called health care for a reason. We go in because we care. Currently the pressure on the health care system means we'll choose to see someone three or four times superficially, rather than once or twice deeply. I'd like us to show the evidence that once or twice deeply actually leads to better outcomes for both the patients and the health workforce. My name is Andrew Bastawrous. I’m an eye surgeon, a professor of global health and founder and CEO of Peek Vision. Years ago, when I worked as an eye surgeon in the UK, I was running a really busy clinic. I knew that I had at least another four patients to see that day, and I was already at time for the end of the clinic. We had a clock on the wall. I could just hear ticking. And that tick seemed to be louder and louder. I'd also be more tuned in to everyone outside complaining that they hadn't been seen yet. And a lady came in to see me. She looked weary, like life had been hard. And she'd also come in very late for someone with cataracts in the UK. Most people don’t come in near-blind. And she shared that the reason she hadn't come was she'd been nursing her daughter for four years, and her daughter had had cancer, and she'd only just died. In that moment, it felt like she'd shared something sacred with me. And just to pass it by felt like I was doing her an injustice. I didn't really have to say anything, I just listened. I think it was maybe around 10 minutes, but that 10 minutes I know meant more to her than the 10 minutes I spent operating on her eye. Her cataract operation went well, and a couple of days after that I saw her in my clinic. So I expected her to come in pretty happy. She did come in with a bag, but it wasn't a box of chocolates. It was a photo album. And one by one she showed me these pictures of her with her daughter. And the whole time I looked at her and I realized she hadn't mentioned that she could see. So I waited for her to mention something. I even prompted her and I said, "Jackie, how's your eyes?" She said, "Oh, it's fine, it doesn't hurt." And then she finished showing me the photos. She closed the album and she said, "Thank you. You were the only person that listened to me." The greatest gift I could give her was not her sight but to have her be truly seen. I think there's very few things in life that are as joyful as being able to help a fellow human being. People aren't inherently not caring or not compassionate. It's if the environment is one that doesn't allow people to stop and care, then people don't live to their values. Peek Vision started as a concept in 2012 whilst I was living in Kenya, and we were setting up 100 temporary eye clinics, taking equipment and trained staff to all of these remote locations. And it dawned on me that this would never solve the problem at scale, that there had to be a way to reach more people. And so we built ways of being able to screen and diagnose and refer people, all on a smartphone. In 2014, we’d seen 7,000 people over two years, but today we reach a million people every two months. One of the questions my team and I have been asking is what are the unintended consequences of scaling? And I went back to that experience I had with Jackie, where there was pressure to see as many people as possible. And we realized we were potentially creating that same pressure. There was all of these metrics that allowed people to know how many seconds it took them to identify a person with vision loss. How many seconds it took to refer someone. And it was tracking everything around that efficiency performance. And we've decided, well, we started this not as a means of efficiency, but as a means of compassion, and this idea that compassion is actually inherent, provided the environment is conducive to people being allowed to care. And so now we're trying to encourage that when a screener finds someone with a vision problem, that they stop and they slow down, and they listen. We want to move from having soft evidence that being compassionate is a good idea to hard evidence that actually it yields better numbers. So we have run this trial with our partners in India, where half the group of screeners are given extra time and different measures of outcomes. Their key performance indicators are going from how many people they've screened and referred to how many stories they remember of the people they've seen. You'd expect if you're spending that much more time with people, you'll get through much fewer people per day, and we expect that to be true. However, we expect many more people overall to turn up for treatment. For many people, even going to see a doctor is a huge step of courage, and a decision to take treatment that you don't necessarily understand or have evidence that it works is all down to the relationship that you have with the person who suggested it. And so if that person's under pressure just to diagnose and send the referral, we think that's one of the reasons why not that many people turn up who need it. And so if trust is built, then we think they're much more likely to take up the care. The secondary effect is the doctors and the nurses providing the care will burn out less because they're more connected to the work that they're doing, and they'll feel less pressure to see numbers and more pressure to see people. If patients are given more time to be heard and doctors have more time to listen, everyone will be happier and the results will improve. We tend to measure progress or success in terms of who's got the most, and that could be measured in market share or the most dollars or the most power. But we all deeply resonate with there being something more than that. There's got to be a different game that we're playing. The measure of a life well lived isn't how much we do, but how much we connect with one another, with the people that we love and the people that we serve.