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The Patient as Care Team Member

By Sandra Gittlen  
   November 23, 2015

An engaged patient can and should be involved in the decision-making process. But don't think of patient-centered care as a customer service program.

This article first appeared in the November 2015 issue of HealthLeaders magazine.

Joan Kelly

Joan Kelly knows what it's like to be left out of critical care decisions in hospital and ambulatory care settings. Her parents suffered from chronic, debilitating diseases, leaving her to seek out their doctors for insight into their diagnoses and treatment. Too often she and her parents received instructions on—rather than involvement in—the direction of their care. Now as chief patient experience officer at NYU Langone Medical Center in New York City, which includes numerous outpatient locations as well as more than 1,000 beds among four inpatient facilities, Kelly has made it her mission to make shared decision-making a core principle for the academic health system.

"Shared decision-making is not about handing a patient a brochure and asking if he or she understands it," Kelly says. Instead, she wants all physicians, nurses, and other clinicians to help patients and their families to become informed enough to be actionable about their care.

Kelly is not alone. A movement is afoot in the healthcare industry to make patients fully participating members of their own care teams. Proponents of shared decision-making believe that greater patient awareness, education, and involvement could boost the likelihood that a patient will follow through on a care plan, leading to improved outcomes and satisfaction. But issues such as out-of-date processes, a patient's health literacy level, and a hospital's communication culture could impact the success of a shared decision-making effort.

At NYU Langone, Kelly's ideal would be for each patient to have a "journey map" created at the time he or she first contacts the hospital; the map would illustrate the entire care experience, including diagnoses, medications, and his or her care plan. Not only would clinicians contribute to the journey map, but so would patients and family members who are likely to notice changes in weight, diet, sleep habits, and other health indicators.

Developing a map, which would sit in the electronic medical record system and be accessible through the patient portal, would enhance shared decision-making because everyone would have access to all aspects of a patient's medical status, says Kelly, who brought the idea from her earlier career in consumer marketing.

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