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Patient-Centered Surgery

Elyas Bakhtiari, for HealthLeaders Magazine, May 12, 2010
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Making surgery more patient-centered requires careful coordination and better feedback from patients and their families.

Surgical services are a leading source of revenue for many hospitals. The operating room increasingly acts as a financial engine for the organization, and more complex surgeries and greater overall volume typically add up to a better bottom line.

But from the patient's perspective, surgery is an entirely different animal. It is scary and unknown. Even minor elective surgeries hold the potential of permanent injury or death from a medical error. Whereas hospitals and physicians increasingly depend on surgical volume, patients want to be cut open as infrequently as possible—ideally, never. These disparate views on surgical services converge, however, in the growing movement to make healthcare more patient-centered. As one of the most frightening, expensive, and bewildering stages in the care continuum, surgery has the most to gain from a more patient-centric approach. And while there are many high-minded and idealistic reasons for emphasizing the patient's needs, it is also perhaps one of the best ways to achieve the volume and efficiencies needed for financial success.

"When you think about the business of a hospital, if I'm a smart business woman I know that a patient that has a nice experience is going to come back again. They might be one of my best marketers or referrers out there. A patient that has a more pleasant experience is actually going to do better from an outcomes perspective," says Holly Lorenz, vice president of patient care services and chief nursing officer at UPMC Presbyterian, a 765-staffed-bed, Level I regional resource trauma center in Pittsburgh.

So what exactly is the difference between a surgical process that is patient-centered and one that isn't? The Institute of Medicine defines patient-centered care as care that establishes a partnership between providers and patients that provides patients with the support they need to make decisions and participate in their own care.

That is easier said than done, however. No hospital is as patient-centered as it can be, says Lorenz. And there are many reasons patient-centered care remains a struggle. The engaged, highly informed patient of the future is still a rarity. Healthcare consumerism has stalled because the system lacks the transparency that makes markets work. The reimbursement system discourages care coordination and integration, which are the foundations of patient-centered care.

Despite the obstacles, many providers are making strides in involving patients and families in the surgical care cycle. Those that are successful often see the benefits in better outcomes, lower costs, and higher overall patient satisfaction.

"I know that if I don't focus on this, I'm going to spend more time chasing my tail. It's so much more appropriate and easier to provide a good patient experience than to do service recovery on a bad experience," says Lorenz.

Success Key No. 1: Link the care continuum
Making surgery more patient-centered actually begins well before surgery. By definition, it begins with the patient, so each point of the care continuum must play a part in involving the patient in his or her healthcare decision-making. Often the most important step is determining whether surgery is the best treatment approach, says Frank G. Opelka, MD, FACS, vice chancellor for clinical affairs at the Louisiana State University Health Sciences Center, which coordinates care for the seven-hospital LSU Health System.

"Sometimes the best surgical care is making the decision when not to operate. Thinking about it in that sense, we're no longer focused on surgery; we're focused on the patient," he says. "We need to think of the patient more longitudinally, about what happened to them that brought them to the point of needing a surgical assessment." That outlook also extends to what happens to the patient after surgery, into the rehabilitation and recovery process. In a truly patient-centered system, the transitions would be seamless and the patient would have a clear view of the entire care pathway—from diagnosis to surgery to recovery. UPMC Presbyterian has developed what it calls "patient flight plans" to map out the entire surgical process, much like airline flight plans give pilots an idea of what to expect from takeoff to landing. "That's just a really catchy phrase relating to how we better communicate the same message for patients and families," says Lorenz. "They know here's what to expect, here's how long you'll be in hospital, here's the physical therapy you might need before or after surgery."

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