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Putting Patient-Centered Care Into Perspective

 |  By kminich-pourshadi@healthleadersmedia.com  
   May 02, 2011

I write about healthcare all the time, and as CFOs you live and breathe it. However, if you aren't looking at your hospital or health system through the eyes of a patient, then no matter what your role in the C-suite, you're missing the future of healthcare.

Everyone in healthcare knows all about the rising cost of care, and how patients and payers in the U.S. pay double for average care, while in countries like Australia the cost is less and the outcomes better. Could it be, in other countries, something other than reimbursement drives the system?

Before I continue with that train of thought, let me recount a very personal story. Last July was the first time I was ever admitted into a hospital. Although it was for a very happy reason—to give birth to my son—it was also quite scary. As I lay in the hospital bed in one of New England's largest and most well-known healthcare facilities, I was awash with mixed emotions and adrenaline. I was excited to meet my son, yet fearful of the pending C-section.

Just an hour before my surgery, two anesthesiologists entered my room and rattled off choices on which drugs I could have; what the ramifications of the drugs could be; how each anesthetic is administered, and a host of other details. Then they asked which drug I wanted and put a consent form in front of me to sign.

Now to the hospital's credit, they had given me some literature to read prior to the physician's arrival—and I did read it—but even for my education and healthcare background, the adrenaline got the better of me. My brain was a swirl; and the physicians standing in front of me trying to clarify details actually confused me more.

Now I applaud the physicians for speaking to me like an intelligent person, but the fact is at that moment I wasn't operating to the height of my intellect. So I looked at both doctors and sheepishly said, "I'm really not clear about anything you just told me, or how you will be doing it. Could you draw me a picture?"

Although I felt like a child for having to ask them to literally draw me a diagram, they complied with my request. The visual aid helped put the information into context and gave me a chance to process it. Then I asked them for 15 minutes of time before I signed the form. It was then that they pushed back. They told me they couldn't wait or the procedure might be delayed.

Now I felt rushed and irked. I basically told them "Too bad, I need time."

The physicians were clearly not pleased, but they did give me the time. Now the difference between me and many patients is I didn't just nod my head pretending that I understood what was about to happen, and then sign the form. Many patients do this because they are dazed about their situation and they feel rushed. It's an awful feeling to be at your most vulnerable, then to have unfamiliar terms tossed at you, and then to be hurried into a decision that impacts your life. 

The Beryl Institute, an organization advocating for better patient experiences within the healthcare system, last week released a study of more than 790 hospital executives that looked at the state of the patient experience in the nation's hospitals and identified the greatest road blocks to implementing change. 

Patient experience/patient satisfaction ranked number two (21%) in terms of top priorities for the C-suite, second only to quality/patient safety (31%), according to the study. Despite its prominence on the hospital executive priority list, nearly (73%) of executives do not have a formal definition for patient experience. Ergo, many are addressing the issue tactically, with the top three priorities being:

  1. Noise reduction
  2. Discharge process and instructions
  3. Patient rounding

Interestingly, while executives don't feel they've gotten their arms around this 900-pound gorilla, nearly 61% of respondents felt positive or very positive about their progress in addressing the issue.

Let me summarize my interpretation of these findings in one sentence: We don't know what patient-centered care means nor do we know how to approach it, but things are going great.

I cannot imagine any other industry in which you guess what your customers want without asking them, and yet while attending healthcare conferences and conducting countless interviews I've found that many hospitals do not have a single patient on their small patient-experience committee (of which the study says 42% of folks are using to drive this initiative). Imagine a quality committee without your quality officer or your electronic health records initiative without the CIO.

But back to my story; to the hospital's credit, this process was somewhat patient-centered. Somewhat. While they did draw me a picture, my physicians' desires to proceed at a swift pace were great for the hospital, the staff and the OR turnover, but it wasn't great for me.

That's where the lesson lies, as does the simple definition of patient-centered care: it's not about your hospital's goals or anyone else in it, true patient-centered care is all about me—the patient.

Now for a longer definition of patient-centered care, I like this hybrid—I feel it best reflects my needs as a patient. Care of a patient should involve education about the patient's illness (acute or chronic), an understanding of its impact on the patient and family as a whole, a full explanation of the proposed therapy (ideally with multiple treatment options), and engagement of patients as members of the overall care team.

You may be wondering why, as the financial leader of your hospital or health system, that patient-centered care should be so important to you. Aside from the Medicare changes to reimbursement for 30-day readmission, there's money to be gained from this approach. Consider this data example from the IBM white paper Capturing Value from Patient-Centered Care:

"We used a hypothetical private, 800-bed academic medical center operating in the United States with net revenues of about $1.5 billion. This hospital uses a mix of fee-for-service, managed private care, public insurance reimbursements and direct payments by patients. The model estimates that the total annual economic benefit it could achieve from the implementation of patient-centered care approach is $81.3 million."

Patient-centered care is not only great for your patients, but there are potentially millions at stake for enacting it—that should be more than enough reason to make you a champion for this cultural shift. But if you want more reasons why patient-centered care is the model of the future, you may want to listen in to a recent presentation I attended, Patient Centered Accountable Care, which outlines in greater detail the financial and clinical benefits of this approach.

What I found most appealing about this presentation on patient-centered care was that the facilities involved have embraced this philosophy completely, making it a part of their overall culture. This meant they sought the guidance and insight of their patients in as many areas as possible. In doing so, these hospitals have made huge strides not only in their patient satisfaction, but also in their cost reduction efforts and quality.    

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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