OATH

Interactive Infographic

We define access as the fit between the needs, capacity and abilities of patients and those of healthcare staff. As we're all human, we call this 'human fit'. This interactive infographic can help you think about what affects human fit at each step of the healthcare journey.

TAKE ME THERE

FURTHER RESOURCES

Transparency

Health beliefs

Health literacy

Norms & culture

Outreach

Location

Expectations

Trust

Screening

Personal characteristics

Personal characteristics

Autonomy

Healthcare System

Information

Opening hours

Health & Society

Cultural & social values

Mobility & transport

Professional values

Appointment systems

Coordination

Opportunity costs

Social capital

Assets

Continuity

Direct costs

Empowerment

Health insurance

Indirect costs

Adequacy

Motivation

Information

Technical & interpersonal quality

Living environments & social support

Be appropriate

Appropriateness in healthcare means services meet patients’ needs through timely care, thorough assessments, and effective treatment. For those with chronic conditions, gaps in continuity can make it feel like they’re starting over with each new provider. Complex referral processes and scattered services across locations can also create barriers.

Have you experienced similar challenges in your practice?

Be affordable

Affordability in healthcare reflects whether people can afford the time and money needed to access appropriate services and engage with care. Costs may be direct (like fees or transport) or indirect, such as lost income from taking time off work. On the provider side, training, equipment, and the opportunity cost of offering one service over another also play a role.

Approach

Approachability includes the ability of staff to approach patients and to be approachable.Approaching patients includes things like appropriate outreach. Being approachable means creating a space where patients feel safe and encouraged to seek care. It involves healthcare staff offering clear communication, showing compassion, and actively removing barriers such as stigma. While technology and websites can make healthcare information more accessible and transparent for some, they don’t guarantee that services feel easy to navigate.

Can you think of other examples?

The needs, capacity and abilities of patients and healthcare staff must fit together at each of the different stages of the healthcare journey.From perceiving a health care need, to deciding to seek care, reaching care, affording care, and engaging with care, factors on both the patient and staff sides can affect whether there is a good fit or a gap. A lack of human fit can lead to inefficient use of people’s time, poor health outcomes for patients, and low staff morale.

• Can you think of examples from your experience where there is good human fit?
• Can you think of examples where there is a gap in human fit?

• Think of the people on both sides and what is affecting their abilities, needs, and capacity in their roles as patients and staff. What can we do about it?

Seek

Once a patient realizes they have a healthcare need, the next step is to try and get help. Many things can affect whether patients are able to seek healthcare. For example, a patient with a history of abuse or neglect might find it hard to ask for help. Different people might decide when and how to get healthcare in different ways. Practice appointment systems including online forms have also changed how patients can seek care. Some may find it easy to understand and use these systems. Others may struggle or find it very hard and off-putting.

Can you think of other examples?

Reach

Reaching care can be about getting to an appointment, connecting on the phone, or having an exchange over text message. Things that can affect patients’ abilities to reach care include practical issues such as limited mobility or caring responsibilities. Or, for example, a worker might not be able to leave work for an appointment or receive a phone call.

Can you think of other examples?

Accept

Acceptability relates to healthcare staff’s abilities to be accepting of, and create an acceptable service for, patients with diverse backgrounds, beliefs, and needs. It involves nonjudgmental, inclusive care where patients feel valued and heard. For some women, cultural norms may make seeing a male doctor less acceptable—especially if appointments with female doctors are limited.

Have you considered what factors might make access to a service more acceptable?

Health & Society

Many things affect how patients can access health care. Things like gender, knowledge, and beliefs can change whether someone seeks healthcare and how they engage with their healthcare team. These factors can affect a patient’s journey to and through healthcare services, and they come into play at different stages. You can think about these in more detail, keeping in mind factors in the healthcare system that affect what staff are able to do. These factors affect whether or not there is a fit at each stage between patients and staff.

Be accomodating

The ability to accommodate means adapting services to meet patients’ diverse needs. This includes flexible scheduling, accessible facilities, and personalized care that respects cultural, physical, and medical differences. Access can be limited when services are unevenly distributed, focus too much on specialty over primary care, or lack out-of-hours appointments. Limited capacity and rigid booking systems—like online-only scheduling—can also be barriers for some patients.

What else might affect how well a service accommodates patients?

Engage

A patient’s ability to engage means getting the most out of their conversations with healthcare staff. This depends on how much they can take part in decisions about their care and treatment. Some patients might have trouble explaining their health problems or feel less confident in discussing their care. Others might feel anxious in crowded waiting rooms or feel rushed during short appointments. This can make it hard for them to engage fully. These things can also affect how well patients follow advice and treatment plans.

Can you think of other things that might affect engagement?

Healthcare System

Aspects of the healthcare system like funding and policies can affect the ability of healthcare staff to meet patients' needs. Many of these factors are interlinked with those discussed in health and society. These factors affect a patient’s journey to and through healthcare services, and interplay at different stages. You can think about these in more detail. These factors affect whether or not there is a fit at each stage between patients and staff.

Afford

Being able to afford healthcare isn’t just about paying for an appointment.It can include other things like time and cost of attending. For example, some patients might not be able to miss work if they lose income to go to an appointment. Others might find it hard to pay for transport or for someone to take care of their children.

Can you think of other reasons it might be hard to afford healthcare?

Perceive

The first step in accessing care is realising there is something you need help with. Many things can make it hard for us as patients to notice or understand our health needs. For example, some might not see losing weight without trying as a cause for concern. Patients’ health beliefs, levels of trust, and expectations can affect their ability to perceive a healthcare need.

Can you think of other examples?

Personal characteristics

Patients’ personal characteristics such as age, gender, ethnicity, education level or being a carer can affect whether or how they seek care. This can be based on their life experiences, or previous health care experiences, in which these characteristics were relevant.

Patients

Sometimes, we are all patients.

• Some have carers or people who can help when they are patients.
• Some of us are carers for people in our lives.
• Others may not have anyone who can help them.

We live in communities, where we can share knowledge about health and help each other access the care we need. You can think of patients at a GP surgery, or people in an area, and their different needs.

Cultural & social values

Patients’ cultural and social values can affect whether and how they seek health care. There may be cultural differences in norms of what symptoms require health care. Some people might have others in their family or community to seek advice from about whether to seek care, but others might not.

Mobility & transport

Patients’ personal mobility and their access to transport impacts whether they can reach care. For patients with reduced mobility, telephone calls when appropriate can reduce the need to physically travel to the practice.

Direct costs

There are direct costs of accessing care, which include appointment fees in some healthcare systems. In the NHS the main direct cost of care is prescription fees for those who are not exempt. Direct costs of care need to be considered as potential barriers for those with fewer financial assets.

Health literacy

Health literacy means being able to find, understand, and use information to make informed health choices. For example, some patients might not seek health care if they don't understand how serious their symptoms are, or if they don't realize how important it is to manage their health or illness.

Professional values

Professional values in healthcare, such as compassion and integrity, affect staff ability to deliver respectful, ethical, and high-quality care.

Norms & culture

Institutional norms and values can impact the provision of services, affecting how staff approach patient care. Aspects of working that are normal for staff, might not be obvious to patients. It can be helpful for staff to think about their work from the patients perspective, in order to identify where gaps in understanding can be addressed.

Healthcare staff

Some of us work in healthcare. We may be doctors, nurses, reception staff or managers. We all work alone as well as together in teams in practices and in communities. It can also be helpful to think of the skills and capacity of the whole NHS workforce.

Social capital

Social capital relates people’s relationships and their role in society. Some people have flexibility in their work roles or their caring responsibilities to be able attend and afford healthcare. Others do not. Some people have others in their families or communities who can help them seek care, or help with caring responsibilities, so they can attend care, and others do not. It is important to recognise these differences in social capital and the role they play in being able to afford health care.

Needs, fit and capacity

How patients and healthcare staff work together depends on their needs, capacities, and abilities to seek and deliver care. The interaction or fit will vary from person to person based on their needs, how they access care, and how healthcare staff can help them. You can think of this ‘human fit’ on an individual, practice, local or national level.

Assets

People have different assets that can help them afford health care. Money, to pay for the direct costs of care, like prescription fees, and the indirect costs of care, like transportation costs, is an important asset. Time, to seek care or attend appointments, is also a relevant asset. Assets can vary between patients, depending on their circumstances, and this needs to be considered when making sure all can afford the care they need.

Living environments & social support

Where patients live and the support they have around them affects their ability to reach care.

Adequacy of service provison

Whether services are adequate to people’s needs relates to the volume of services and their overall appropriateness. The resources available, including funding and workforce, affect capacity of staff . This includes the skills of different staff members and how much time staff have to listen to patients and discuss their concerns.

Personal characteristics

Personal characteristics of healthcare staff such as age, gender, ethnicity or education level can affect how they interact with patients. They may affect which patients staff naturally have empathy for and which patients they might need to put in more effort to understand in order to best meet their needs.

Health insurance

In some countries, people need health insurance to be able to affordably access health care. In the UK, the National Health Service (NHS) is available to everyone who lives here. The NHS is paid for by National Insurance contributions. There are still some direct costs (like prescription fees) and indirect costs (like transportation) for patients that affect whether they can afford care. Some people also choose to have private health insurance to cover services beyond what the NHS can offer or to reduce the wait for certain types of care.

Health beliefs

Patients believe different things about health. This can affect how they understand their own symptoms and whether they think they need care. Some might wait to get care because they think they can treat themselves. Others might go to the doctor more often because they trust the medical team or are worried about their health.

Autonomy

Autonomy means that people have the right to make their own choices about their health based on what they believe is best for them. This can affect how, when, and where they access health care.

Appointment systems

Practice appointment systems include the rules for how and when patients can ask for care, who gets an appointment, and whether appointments are in person or by telephone. These rules and systems can vary from practice to practice and change over time. If the rules are too complicated or the processes require a lot of time, some patients will not be able to successfully seek care. Practices can think of those struggling and ways they can be accommodating.

Opportunity costs

Choosing to seek and attend care can have consequences for some patients, especially when processes are time-consuming. Patients may not have the flexibility within their job to receive a phone call. They may have caring responsibilities when some practice systems allow appointment requests. Being aware of the opportunity costs for patients can help staff accommodate and close gaps in care provision.

Opening hours

The hours a service is available can affect whether patients can attend care and how they engage with the service. A lot of attention has been given to opening hours in general practice in past policies.

Motivation

Patients’ motivation to engage and commit to care is impacted by many earlier factors, such as lack of information, health beliefs or costs to care. These affect whether patients and staff can reach an agreed plan that will work for that patient.

Screening

Screening services can detecting diseases early, allowing for timely treatment and better health outcomes. Appropriate screening can help identify patients that might not seek care or realise they have a problem.

Outreach

In addition to being approachable, staff need to be able to appropriately approach patients, via outreach. This includes invitations to attend care or going out to meet patients where they are. For various reasons, some people who need care do not seek it. Outreach services can help bridge gaps by bringing health care directly to the community reducing barriers such as transportation and cost. For example, mobile health clinics in rural areas or vaccination hubs in shopping and community centers help people who might otherwise struggle to visit a GP.

Information

Providing clear information about healthcare services helps patients make informed decisions. It is important to ensure that information is accessible to all populations, and can include translated brochures or materials for visually impaired patients.

Coordination

Coordination of care allows for the people involved in a patient’s health care to work as a team. Sometimes this involves communicating with staff in other parts of the healthcare system to organise care for patients. Information systems can affect coordination of care and how that feels for patients.

Location

The location of a service will impact how the local population interacts with it. This can include whether it is easy to travel to the service using public transport or if there are adequate parking spaces. Staff should keep this in mind when consider where gaps might exist for patients. Using telephone calls, when appropriate, can make location less of an issue for patients in terms of travel time and convenience.

Transparency

Transparency in health care includes clear communication and information about services. This can helppatients understand their treatment options, wait times, and referrals. For example, sharing wait times for appointments allows patients to make informed decisions about their options.

Indirect costs

Indirect costs of care include things like transportation costs, potential loss of wages if work is missed, and cost of alternative care arrangements to be able to attend appointments. It is important to recognise the indirect costs of care as potential barriers for patients. Practices and staff may be able to accommodate patients to help decrease these costs through changes in their service provision. For example, offering telephone appointments where appropriate, being flexible with the time and mode of appointment if possible to fit with patient’s circumstances.

Expectations

Patient expectations include what they are hoping to get from a health consultation or a contact with their surgery. These expectations are often based on previous experiences and their knowledge of the system. Expectations can change over time.

Information

The more information patients have about healthcare services the better they will be able to use them. This includes information about staff and their roles. It also includes patients’ knowledge of health conditions and relates to health literacy.

Continuity

Continuity of care involves consistency. It can mean that patients know the members of staff and have members of staff who know them. Seeing or speaking with the same member of staff if possible can help build patients’ trust in the service. It has also been proven to improve health outcomes.

Trust

Trust is about the belief and confidence that patients have in their healthcare staff and practice. For example, if a patient knows their doctor or nurse well, they may be more likely to trust them and seek help when they need it.

Empowerment

Patient empowerment means giving people the knowledge, confidence, and skills to take charge of their health and make decisions about their care. An empowered patient will feel confident to speak up for themselves and ask questions if they feel unsure or disagree. This can lead to safer and better outcomes for patients.

People

We are all people with our own thoughts, beliefs, experiences, skills and roles. These can affect what we expect and how we interact with each other.

Technical & interpersonal quality

The technical and interpersonal qualities of both patients and healthcare staff play a key role in creating a positive environment with open communication, trust, and effectiveness. Healthcare staff who use strong communication skills can help reduce the anxiety that many patients may feel.

Further Resources

• OATH Website
• OATH Resource set
• Accessing primary care and the importance of ‘human fit’: a qualitative participatory case study
• A paradox of problems in accessing general practice: a qualitative participatory case study
• A paradox of access and how we can address the increasing demand in general practice podcast