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The Patient as Care Team Member

By Sandra Gittlen  
   November 23, 2015

Bernard Roberson, MSM

The Center for Shared Decision Making is instrumental in prepping patients with certain diagnoses for their consultations. The center provides decision aides and the center's health coaches offer decision-support counseling for patients. For instance, before a patient meets with the breast surgeon, a decision aide provides information about lumpectomies with radiation vs. a mastectomy.

"Rather than a doctor having to spend all the appointment time educating the patient on options, together they can decide which is the better option based on the person's lifestyle and values," Berg says. "It's a much more personalized conversation, and we've found that people are more likely to follow through on a recommendation if they were involved in the decision."

Culture shift
At Georgia Regents Health System in Augusta—which had nearly 500,000 inpatient and outpatient visits in 2014—the 478-bed Georgia Regents Medical Center is moving toward shared decision-making and has required some pretty drastic changes, according to Bernard Roberson, MSM, the administrative director.

The transformation began with the pediatric ICU at Children's Hospital of Georgia because parents were concerned about how they were being treated while their children were patients. The change continued with GRMC's neuroscience department, which had low patient and staff satisfaction scores, and needed to improve metrics for patient length of stay and medication errors.

A cross-functional team of physicians, nurses, and patients helped revamp the department. A key task for the team was to have everyone in the unit reapply for their jobs and then undergo interviews. In 2005, Roberson was hired to implement patient and family-centered care throughout GRMC.

The team asked questions such as, "How do you feel about families being at bedsides 24 hours a day?" and some staff responded, "We don't like families questioning us." Roberson says it was clear which clinicians would have a difficult time accepting a shared decision-making environment and, indeed, nurses and doctors opposed to a more open environment did not stay on. Within 18 months of restaffing the unit, patient satisfaction went from 1% to 60%, and within 24 months, it climbed to 90%. One of the biggest changes Roberson has seen is that families are invited to stay at the patient's bedside 24 hours a day, automatically helping them to be an integral part of the patient's care.

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