The right kind of assistance

ITIJ 208, May 2018
Medical care isn’t just about providing the treatment, it’s also about providing the patient with a kind of comfort blanket
Juliane Kause
Chief Medical Officer
Anvil Group

ITIJ caught up with Juliane Kause, Chief Medical Officer at Anvil Group, to talk about the importance of frontline experience, the need for good preparation and the advantages of in-house medical assistance

How did you first get started in the assistance industry and how did you progress to be in your current role?
You could say I came into it by accident. Back in 1996 I was working for the UK National Health Service (NHS) when an anaesthetist colleague had a stroke whilst on holiday in Spain. I was totally intrigued by the treatment she would receive, how she would get home safely and how the communication around her case would be handled. Having looked into it further and spoken with CEGA, a local air ambulance and medical assistance company, I actually ended up working for them. Believe it or not, I became part of the team that eventually brought her home! 
I worked for CEGA for a number of years, rising from flight doctor to chief flight doctor and then general manager of the air ambulance. There are certain times in life when you can’t fly – during pregnancy, for instance – but this actually provided new opportunities as it gave me the chance to become more involved in other parts of the business. Whilst grounded, I was able to provide medical assistance over the phone, monitoring critical care cases and supporting other clinical care providers in the office … so I’ve experienced both the frontline and the engine room, so to speak.
I then worked with AirMed for five years, again, covering a number of roles including deputising for their medical director. Alongside this, I’ve also developed various educational programmes with other establishments such as the fire service and numerous NHS specialist care providers. I’ve even advised the Scottish Government on air ambulance services and remote location working best practices. The experience and insight gained working with large and established air ambulance and medical assistance providers – and the NHS in my capacity as an emergency physician – stands me in great stead for heading up Anvil Assist.     
Can you tell us a bit about the decision for Anvil to establish its own in-house medical assistance service? What are the benefits of keeping these services in-house?
The Anvil team believes in a continual programme of improvement, so bringing the medical assistance provision in-house, alongside their long established security and journey management teams, just seemed the obvious step to take. It allows us to offer a truly integrated end-to-end service and deliver some real differentiators including the continuation of care for patients after they return home. Typically, when patients touch home soil, that’s the end of the care provided by assistance companies. Anvil sees it differently. It’s absolutely about ensuring that patients continue to receive the appropriate follow-on care and treatment in their home country. 
We also don’t just look after patients’ acute medical needs, but can also provide psychological support when needed. Every case is treated as an individual and it’s this type of approach that sets Anvil apart. We wouldn’t be able to do this through external partners.   
Bringing medical assistance in-house has also enabled us to raise the bar in case handling. All cases are handled by senior clinicians, so patients and clients can be confident that they’re dealing directly with experienced medical practitioners. The medical team is exceptional and I’m honoured to be heading up such a skilled and experienced group of people.  
What attracted you about the opportunity of joining Anvil Assist as Chief Medical Officer?
It was obvious that we shared the same ethos. Throughout my career, putting the patient at the centre of what I do has always been number one, and that’s exactly how Anvil operates. 
Also, the fact that their travel risk, security and medical assistance services are so integrated makes them unique. There are obviously companies that can handle each of these separately but the fact that Anvil can pull all of these together is very powerful, as is the fact that, due to their years of handling risk and crisis situations, they’re great at dealing with the unexpected. Knowing that my team has this level of support, both in the office and on the ground, is extremely reassuring.  
Anvil Assist aims to help globally mobile corporate employees. In what seems to be an increasingly dangerous world, how can assistance companies best serve the needs of workers who may need to carry out their duties in unsafe areas?
It starts with good preparation, good communication and appropriate training. We need to ensure that the right vaccinations have been taken, that travellers are informed of the local situation – from both a healthcare and security perspective – so that they can prepare appropriately. Should the worst happen, having worked with the client on this initial planning, we’ll be in the best possible position to provide the right kind of assistance, often foreseeing and mitigating risks before they even occur.  
What sort of insight has your time as an aeromedical physician given you in terms of the provision of medical assistance? Do you think that people in lead roles such as yours would benefit from more frontline experience?
You really have to be there to understand it. It’s the attention you need in all aspects, from arranging the logistics to communicating with all stakeholders to ensuring that the right medical skillset and capacity is matched with each patient. Falling ill abroad can have a huge psychological impact on patients. They’re away from their usual support network, possibly facing a different healthcare culture and language barriers. As the medical assistance provider, one deals with a far greater need than the defined medical problem, and that really is the crux of any effective service – appreciating and dealing with those complexities. Medical care isn’t just about providing the treatment, it’s also about providing the patient with a kind of comfort blanket – making them feel protected when they’re at their most vulnerable. 
So yes, it’s absolutely essential that those in lead roles spend time on the frontline. It’s the only way you can fully understand the real challenges that everybody faces – from the call handler taking the initial call to the pilot flying the plane, to the patient themselves, everybody is affected in some way and we need to be able to empathise with all of them. 
You are a founding member of the International Society for Rapid Response Systems. What was the thinking behind establishing this organisation? Has the Society seen much success in the achievement of its aims?
It was started by a group of about 20 like-minded global professionals who’d already worked together on a number of academic and quality improvement projects. We came together in order to improve the safety of hospital-based healthcare and to deliver safe and reliable emergency treatment for patients who find themselves unexpectedly ill. 
The society has helped to develop rapid response systems (RRS) to proactively identify patients at risk of clinical deterioration within hospitals and to deliver reliable, safe, quality treatment to those individuals. The RRS expands care for the critically ill across the whole hospital and is now well established or standard of care in many countries. It’s gathered significant momentum and our 14th international congress is being held this July in Manchester, UK. 
What are the most challenging aspects of your job?
In this line of work, every day can be a challenge but that’s one of the reasons I enjoy doing what I do. I relish it. I suppose the hardest thing when dealing globally is knowing how to handle so many diverse cultures and differing expectations around standards of treatment and care. You need to demonstrate understanding and respect whatever the situation. 
What are your proudest achievements, both professionally and personally?
Professionally, it’s less of a single event and more an ongoing sense of achievement in bringing different professionals together to work towards a common goal. Being an expert in something specific is easy – you can know everything that there is to know about your particular specialism – but to get these experts – doctors, nurses, pharmacists, therapists, telephonists, claims handlers, paramedics, linguists – communicating and working together in a way that improves the care of the patient, that’s the real achievement.  
I’ve also had the privilege of being able to combine an exceptionally fulfilling career with my role as a parent, bringing up healthy and happy children. I manage to pursue a number of passions outside of work, from growing my own food and tending livestock on my small-holding to playing the violin in a semi-professional orchestra. So on a personal level you could say I’ve managed to achieve the perfect balance. Now that’s an achievement!
If you could do any other job in the world, what would it be and why?
That’s a tough one as I absolutely love my job and can’t imagine doing anything else. At a push though, it would have to be something that could potentially help to improve the lives of millions. That may sound brash but it really would have to be something amazing to make me want to change what I do now.


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