How Vanderbilt Delivers Authentic Patient-Centered Care

Vanderbilt's executive CNO describes how the medical center made patient-centered care an integral part of its organization's culture rather than just a buzzword.

I once had a manager who declared that, "taking it to the next level," was our new departmental goal. When I asked for specifics on what the effort would entail, I was met with a deer-in-the-headlights look.

We use clichés, and their shorter, snappier cousin the buzzword, because making vague generalizations is quicker and easier than the laborious process of fleshing out the specifics of big concepts.

Take, for example, the idea of patient-centered care, which the Institute of Medicine defined in its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, as being "respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions."

Many organizations boast that they follow patient-centered care models, but as the authors of this 2011 piece from the Annals of Family Medicine point out, what some call patient-centered care is really just the addition of hospitality industry amenities such as designer wallpaper, complimentary manicures, and eye-catching lobbies.

These enhancements may boost patient satisfaction scores, but if an organization fails to make changes to its clinical and organizational infrastructures and care models in addition to aesthetic improvements, then that's not true patient-centered care, it's—to use another cliché—just putting lipstick on a pig.

So what does an authentic model of patient-centered care look like? Marilyn Dubree, RN, MSN, NE-BC, executive chief nursing officer at Vanderbilt University Medical Center in Nashville, TN, was able to answer this for me during a recent conversation. The transcript below has been edited for clarity and brevity.

HLM: Sometimes I hear leaders say, "We're really focusing on the patient," but when you talk to the rank and file they think it's a lot of lip service. How do you make patient-centered care genuine and get staff on board?

Dubree: Most nurses, physicians, and other clinical staff would say that we have, for many decades, placed patients at the center of what we do. So the new focus that comes out of regulatory and financial models can sometimes be seen as false to them.

The way I think you make [the emphasis on patient centered care] genuine is to say, "You're already doing that; you already put the patient at the center of what you do."

The reality is that this is a space where, nurses in particular, have a very high value focusing on patients, focusing on their families, and understanding in a very intimate way the challenges that an individual has.

That's something that nurses are very close to. The ability or the need for us to measure it, or measure it in a different way, may be new. And to have it expressed as something that people are monitoring and that's being shared publicly— that's very different than what any of us on a care team experienced in the past.

Yet, if it helps to bring our work to a higher and better level, then that's a good thing.

HLM: Organizations sometimes say they put the patient first but, if they truly did we probably wouldn't have half the challenges that we have in healthcare today. What are your thoughts on this?

Dubree: I think, individually, people put the patient first, but perhaps the systems don't do that. For example, if you ask someone if they have had an experience with a nurse, they'll recount a fabulous interaction with a nurse. But they may [also] say, "I had to wait in the clinic. I couldn't get an appointment. The hospital wasn't as clean as it needed to be."

Individual interactions can be very patient-centered, but the systems that surround the care may not be experienced in quite that way. We still have work to do in that space.

I talked to someone the other day about how nurses have been [ranked] the most trusted profession, except for [2001] the year of 9/11, since Gallup's been doing the poll [on honesty and ethics in professions].

I think that's because individuals who've encountered nurses see them coming to their work without a motivation for money, without a motivation for status, but with a great motivation for caring for individuals and their families with compassion.

That's the way most people interact with nurses. And it's magnificent. That's why it's a magnificent profession. And yet some of these other things that swirl around us—like billing systems and insurance—things that are really important to making the systems work, are a little bit more difficult and challenging when you're interacting with that.

HLM: At Vanderbilt, what does putting the patient at the center of care look like? What are some things that make that happen?

Dubree: We have a lot of strategies to do that. We have a very robust collection, not just one, but a collection of patient and family advisory councils. We look at those councils as our board. They give us feedback about what we do well and what we should or could do better.

We use them for reviewing our healthcare portal, evaluating choices of new furniture for patient care rooms, and reviewing patient education material. [Our council members] are very important to us and we try to use them in a way that is not superficial, but in a way where they can be deeply involved. They have work plans and we report out on that work. Most of our big committees, like the nursing quality committee, have patients or family members on them.

We try to make sure that we are not just listening at the intersection of care or the intersection of service, but that we also have built systems and processes to involve them in how we plan care or plan changes. I think that's been very powerful.

We have patient care centers [a configuration of the individuals that provide care to a diagnostically coherent group of patients] and service lines throughout our medical center and those streams of work are led by a physician, a nurse, and an administrator.

We call this a paired leadership model. We believe that the best work outcomes are achieved when they are led by those three individuals.

We structure ourselves so that every patient care center has those roles. The individuals that lead those patient care centers are responsible for the entire continuum of care and looking at how to achieve value in clinical, financial, and quality outcomes across the continuum.

It's a model that makes a lot of sense, and people see the logic in it, but they haven't see it quite so robustly implemented. I think it's reflective of our collaborative culture. It reflects the parity of the importance of their roles and it lets us get to much better outcomes. I think our performance is much better because of that.