Dr. Vaughan Glover

Defining the People-Centred Lexicon

Dr. Vaughan GloverAs an experienced writer and public speaker on people-centred healthcare issues, CAPCH president and co-founder Vaughan Glover is tireless in his pursuit of health system reform. For over 30 years, together with a “very special” team, Vaughan has run a people-centred dental practice in Arnprior, Ontario. His book Journey to Wellness outlines the vision and model for a truly people-centred health care system.

Passionate, committed both professionally and personally, Vaughan is adamant about the reality that one of the biggest problems in health and health care is that “no-one is speaking the same language. Everyone has their own interpretation of the terms commonly used.” He feels we must begin clarifying what ‘People-Centred health care’ really means, as opposed to the many lip-service versions currently gaining fashion.

“In a sentence, to me People-Centred Health Care means to help each person be all they are capable of being with respect to their personally-defined balance of mental, physical, spiritual and emotional well-being… while accepting the time, energy, social, financial, and environmental realities in their lives at a given point in time.”

He adds, “I realize this is a long definition, but each word has meaning!”

In fact, says Vaughan, “The only way to properly share what People-Centred Health Care means is to examine each word, because otherwise there are too many assumptions. People need to stop throwing words around and hopefully agree on, but certainly understand, meanings.”

He points out that whether for an organization like CAPCH or when communicating with anyone around health issues, it is essential to understand the language of the audience you are addressing. For example some provider groups like to use the word ‘patient’, others ‘client’, and still others ‘consumer’, but most important is what the words mean to both parties.

“It’s exciting that in the past couple of years virtually every stakeholder group is incorporating ‘people-centred’ as part of their vision, mission and public dialogue. What’s scary however is that no-one agrees what it means.

“I was speaking with a group of health care providers and asked what ‘People-Centred’ meant to them. I was shocked at one particular response: ‘It means I like people.’ Believe me, People- Centred means much more than that, and it is time to begin the dialogue so we minimize any misunderstanding” which could derail much-needed reforms.

Not one to shirk, Vaughan goes on to describe what for CAPCH has become a standard People-Centred vocabulary of terms:

People – “In our context, the words ‘people’ or ‘person’ and ‘human being’ are totally interchangeable. In 2001, when we were first thinking about forming a citizen’s organization, the terms patient, client, consumer, user were all part of the short- list. However when we spoke with people, the bottom line is that every single one wants to be treated as a human being, as a person. ‘The Canadian Association for Human Being-Centred Health’ just didn’t sound right, and the acronym was even worse – thus we founded CAPCH. I personally interchange the words ‘people-centred’ and ‘person-centred’ depending on the circumstances. The important thing to remember is that in the health system we all strive for, each person is a unique and very special human being and has the right to be treated as such.”

Centred – “What is the system built around? It should be built around the human being – not built around the providers, political agendas or philosophies. Each person is the centre of their own healthcare system.”

Health – “Health is personally defined, and it’s a balance of mental, physical, spiritual and emotional wellbeing. Health is not just the absence of illness. Health is much bigger than being or becoming free from illness.  In my book I defined health care in five stages that can be closely aligned with levels of Maslow’s hierarchy of needs: Emergency, Illness, Prevention, Holistic Health, and Wellness. They’re all part of our health journey.

“The ultimate health goal for any person is to be all you’re capable of, given your personally-defined balance and reality, at a given point in time. This I refer to as Wellness – and realistically this is the best anyone can hope to achieve in life.”

Care “Care can be many things, but we’re speaking here of ‘care’ as opposed to ‘treatment’. Care is about taking care of the whole person, not fixing pieces of a person. The number one participant in real care is the person themselves; but it also involves their whole support system: family, community, associations, groups, activities, and so on.”

Vaughan expands on the fact that some healthcare terms often get used interchangeably with other activities – and then corrupted. People-Centred care means separating them again.

Health vs Illness systems: “We currently have a system that invests over 90% of its funding in emergency and illness care, but this only represents part of a person’s lifetime of health care and support.  In fact the average person spends less than .04% of their time in provider-centred illness or emergency care as we know it.  A health system would involve support and care for all five levels of health: Emergency, Illness, Prevention, Holistic Health, and Wellness. Thus it is very difficult to say we have a health system in Canada. We really have an illness system.”

Treatment versus Care - “Cancer has taken on a whole new meaning in my life in the past two years. My wife was diagnosed with advanced colon cancer and has been going through extensive treatment. I’ve witnessed many things and gained a better understanding of what these patients experience. For example ‘cancer care’ as it’s referred to right now is centred in hospitals. When my wife Betsy goes in for surgery, she’s in four to five days. This is highly skilled acute illness treatment, requiring very sophisticated facilities and highly-trained teams to carry out life-saving procedures. It’s done in a hospital (by the way the most expensive real estate in the country). The team there is very intense and busy, consumed daily with emergencies and illness.

“Although the people in the teams are some of the most caring and empathetic, the shortage of funding, facilities, and human resources means they’re primarily focused on treatment. They have little time for ‘care’.  So I say it’s time to accept reality. Treatment should be person-centred and where necessary, occur in hospitals. Care should be person-centred and occur before, during and after treatment, and the co-ordination of care should be centred somewhere other than hospitals – ultimately, in the home and community.”

Fixing versus Helping – “An experience early in my career as a health provider taught me something I’ll never forget. I graduated young and did what I was taught to do and what I was rewarded for, which was to fix things. After a few years I began to see that no matter how good I was at fixing, if the person doesn’t do their part to take care of themselves and even if they do, eventually everything in the body will break down.

“Then came a memorable discussion with a wise mentor, Dr. Harold Wirth. Dr. Wirth shared a bit of reality – if you’re trying to fix things in the human body, there’s a 100-percent failure rate. This realization made the life goal of ‘fixing’ things and watching them break down anyway, pretty unappealing.

“Then Dr. Wirth shared how I can move from a hundred percent failure to a hundred percent success, as a health care partner and team member. The key to that perfect success rate is to stop making ‘fixing’ your goal. Make your goal to help each person be all they’re capable of being – and clearly explain to each person entrusted to your care that ‘Fixing is just something I may or may not be able to do.’

“This has changed my whole life in health care, and is the essence of People-Centred: the paradigm shift from fixing things to helping people.”

As Vaughan says, People-Centred reform is more than lip-service. “We have tremendous support from citizens and provider leaders now.” The tide of information is turning in favour of the individual, and “there’s no going back.” Now, “CAPCH wants each of you to be part of the solution.”

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