This article appears in the October 2011 issue of HealthLeaders magazine.
It is easy to say that patients are at the center of healthcare, but a difficult challenge facing healthcare leaders centers on the question of responsibility for the patients’ care. Some providers are evaluating the patients’ role, moving ahead with commitment and resources to help educate them as to their central place in healthcare and what that is all about. Others are still struggling to understand the impact of patient-centered approaches.
Sometimes, a blunt approach may be needed to get a patient’s engagement. In the foothills of the Appalachian Mountains, one of the 41,000 residents of Guernsey County, OH, is an 86-year-old patient who desperately needed an angioplasty, but was resistant. Her physicians were adamant, and it took some convincing from the doctors and Ohio State University Hospital officials to get her to leave home and travel some 80 miles westward in part because she had never in her life left her home county. Never.
“These are your [arterial] blockages. Do you want to live like this or die?” the patient was asked, recalls Rich Davis, associate executive director of the cardiovascular center for Ohio State University Medical Center in Columbus. The dramatic question convinced her to go to the hospital. She eventually received successful angioplasty and treatment.
The patient had taken a significant step in the development of her own care, even the simple act of going to the hospital. And it was the healthcare providers who helped her take that step.
The bottom line of patient outcomes and fiscal sustainability for a healthcare organization often depends on the patient. Physicians and hospitals are taking steps to do more than ever to educate patients and guide them in care, but providers also are challenging patients to be instrumental in their own care. There is a vast variability in a patient’s role, with healthcare professionals even uncertain about the terms they use in embracing patients in their care; some saying they are “engaging” patients, some say patients are being “challenged,” and others talk about “accountability” or “patient activation.”
The process is changing across generational lines, with younger patients increasingly taking active consumer roles, while older patients, often those with the chronic disease, rely on family members or significant others to help them.
“There is patient responsibility, but you have to help people understand what their responsibilities are,” says Richard Hanke, a member of the patient and family advisory council at the 118-bed Delnor Hospital in Geneva, IL.
For patients, there is “some teaching that is taking place, and that really helps the healing process,” says Hanke, a business consultant with a doctorate in education. “Patients typically say, ‘What is it that you want me to do? What is it I’m supposed to do?’”
Hospitals are in a position to help patients understand that and, in effect, help them take responsibility for their own care. Often that lies within education programs. Hanke began working with hospital officials to improve patient care after his wife was hospitalized and there were problems with her care, “a breakdown in communication,” he says.