Q&A: Mountain States Health CEO on Patient-Centered Care

Next spring, Mountain States Health Alliance will accept the National Quality Forum's 19th annual Quality Healthcare Award for meeting quality-focused goals and achievements.

Since 1990, MSHA President/CEO Dennis Vonderfecht, has led the Johnson City, TN-based health system that serves 29-counties in a mountainous four-state region that includes Tennessee, Virginia, North Carolina, and Kentucky.

Vonderfecht recently spoke with HealthLeaders Media about the health system's decade-long journey toward patient-centered care.

HL: When did MSHA adopt the patient-centered care model?

DV: I had about 10 years ago been reading quite a bit about patient-centered care and some leading edge organizations that were implementing that primarily on the West Coast. I became interested in it to see if it did make a difference in how we related to our patients. I took about 14 or so of our key leadership to the West Coast to visit a couple of hospitals.

They were among the first in the nation to do this. I felt like our group going there and interfacing with the leadership of those two organizations would really tell us if there was a difference or not. We did see a difference and we were very impressed.

We came back and formed a steering committee and from that we developed our patient-centered care philosophy statement and the 10 Guiding Principles. Over time we've done a lot with that.

HL: What was it you were seeing 10 years ago that needed to be improved upon at MSHA?

DV: What I saw then and really what exists too much today is the processes and systems we put in place in healthcare are very much geared around our own team members as opposed to the patients and their families.

Some new ideas at that point involved going directly to the patients and their families and asking them 'what do you want to see? What is the ideal interaction you would have with your healthcare provider? How would you structure that?' It gives you a whole new way of looking at things.   

One problem very clearly was visitation hours. A good example was our ICU units at the time before we implemented patient-centered care had very restrictive visiting hours and that was strictly for the convenience of our staff.

We generally had an attitude of 'you're getting in the way. We don't need you here. We know what we are doing for your loved one and we will inform you when we see the need to do it, but not any sooner than that.' So, one of the things we did early on, one of our guiding principles is that family and friends of the patients are considered an essential part of the care team. We opened visitation hours.

We came to realize that our patients, most of the time, when they come to us have a family member or friend who has brought them there and they stay with them a good part of the time while they are patients.

Many times they are the caregivers for that patient after they leave us. We put together the Very Important Partner program. If a patient desires to have a family member or friend to be that VIP then that VIP will get some training from nursing staff.

And they are actually involved in helping do some of the care for the patients knowing they are probably going to be the caregiver for the patient when they leave us.

HL: Can you provide some examples of how patient-centered care changes processes at MSHA?

DV: In the past, with construction projects or even equipment purchases, we as the caregivers would decide what we were going to get for the patients. We would build something or buy that equipment and find out it didn't work for the patients. For some reason we never bothered to ask them.

We changed that. A few years back we put beds out in the mall in Johnson City and we let people try them and rate them. We ended up making a bed selection off of what the people were telling us they would like if they were a patient at our hospitals.

In almost all of our construction projects consumers are involved with the architects to help lay out the design from the patients' standpoint. That is a change in philosophy that we never had before. Other times we will ask patients in the hospital, 'We are in the process of buying this equipment. What do you think?' We let them try that out in the hospital.

We created out of this a book about three- or four-inches thick with all the patient-centered care parameters that our construction projects are going to have. We didn't do any of that before. Now we use a lot of natural light, [for] way finding. All the things The Center for Health Design said you should be doing our hospitals have in them.

HL: Asking the patients' input seems so obvious. Why wasn't it done before?

DV: We got so centered on us having all the answers as caregivers that we didn't really think about the patient actually being the one using the services and really having the answers. It gives you a whole new way of thinking about it that seems so commonsensical you think we would have done it. But we weren't.

HL: How do you get staff to buy into the mission?

DV: Whether you provide direct patient care or indirect patient care, we are all considered caregivers because we are all here for the benefit of the patients. That is something that is taught to all new team members at orientation.

We have created our highest awards in the system, called the Servant's Heart Award, around patient-centered care principles that honor those who truly are the epitome of those principles and actions not only in our organization but in our community as well.

We do videos of these folks and what they mean to the organization. There are community testimonials from fellow team members, physicians and managers. They are available on our Web site. It really provides that example for our team members of what they need to strive to emulate.

HL: What's next for MSHA as you continue on the patient-centered care journey?

DV: I see two areas that we are focusing our attention on. No. 1 is putting metrics to these 10 Guiding Principles. We have patient advisory groups in MSHA and we asked them 'here are these guiding principles. What do they mean to you?'

It was interesting because the definition of what we thought it meant was different from what the patients thought it meant. We want to define them from the patient standpoint to tell us if we making progress with this principle or not. That is new to us this year and we are already seeing some great value there.

Secondly, we just need to figure out a better way to engage physicians than what we have now. About 400 of our approximately 1,200 physicians are employed but each person will have to buy in for themselves no matter if they are employed or not.