Taking charge in an era of health care uncertainty

Taking charge in an era of health care uncertainty

Here is a simple definition of patient-centered care: “Nothing about me without me” (Delbanco et al, 2001).

by Ruth Tarantine — 

While the U.S. has unrivaled status in many areas, health care is not one of them. In 2000, the World Health Organization (WHO) ranked the United States 37th in health care quality in the world. In the years 2004, 2006, 2007 and 2010, the Commonwealth Fund, an organization that conducts independent research and provides grants to improve health care practice and policies, completed more studies.

These studies compared the United States to six other industrialized countries (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom) on measures of health system performance. Performance was measured in five areas: quality, efficiency, access to care, equity and patients’ ability to lead long, healthy, productive lives.

Despite spending the most money on health care, the United States ranks dead last. The most significant way the U.S. differs from other countries is in the absence of universal health care coverage. But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures (Commonwealth Fund, 2010).

As a result, governing bodies are insisting that hospitals improve care by moving toward patient-centered care, as well as other quality improvement measures. The surveys you receive after visiting a doctor or medical facility are designed to measure patient satisfaction and the level of patient-centered care. Medical provider reimbursement will be increasingly based on these scores. Accordingly, everyone in health care is talking about it.

Here is a simple definition of patient-centered care: “Nothing about me without me” (Delbanco et al, 2001). The landmark report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” by the Institute of Medicine (IOM), however, makes the definition a bit more complicated. This report defines patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs and values, and [ensures] that patient values guide all clinical decisions” (IOM, 2001).

According to the IOM, patient-centeredness is one of six aims for quality improvement in health care. The others are safety, timeliness, effectiveness, efficiency and equity.

Although foreign to longstanding practice in U.S. health care, research shows that patient-centered care yields better results:

• Patients who participate in their care have better overall outcomes.
• Patients are more likely to follow a plan of care when they help to design the plan.
• Patients who receive patient-centered care report higher patient-satisfaction scores.
• Unfortunately, for most patients, patient-centered care is an anomaly.

Hospitals are rapidly trying to change the culture to one of patient-centered care. Even so, hospitals often miss the mark. A great deal of money is being spent on educating hospital staff on the definition of patient-centered care. The problem, however, is not a lack of understanding the definition. The problem is putting patient-centered care into practice. The culture of control is so ingrained in U.S. health care that a major shift in thinking is needed.

Patient-centered care will require a dynamic human interaction between patient (and advocates) and health care provider. Each patient will have different input because each person is unique. It is the provider’s job to integrate the patient’s input into the plan to achieve optimal results.

You might think of it as going back to the golden rule of treating others the way you want to be treated. Unfortunately, the way you want to be treated is not necessarily the way someone else wants to be treated. Care that assumes the provider knows what the patient wants is still provider-centered. Patient-centered care requires providers to ask the patient or family what the patient prefers. Patient-centered care thrives on two roles for patients and/or their advocates — partner and source of feedback.

The patient or advocate functions as a partner, working in collaboration with the physician and staff. They collaborate with the health care provider to make decisions and help manage the patient’s care. Collaboration with a physician helps that physician care for the patient based on patient needs, values and priorities. Active participation in a partnership role is crucial for a successful outcome.

In addition to acting as health care partners, patients and/or advocates are a source of essential feedback to the medical team. The patient’s perspective provides unique feedback to the provider, helping gauge the effectiveness of care, as well as the performance of the provider or organization. Patient surveys provide helpful feedback after the fact, but no one should have to wait for a survey to communicate.

Providers naturally look at things through the lens of a physician or nurse, rather than the lens of the patient. If you are unhappy with your care or see an opportunity to improve it, speak up. This is your obligation. Providers cannot make a course correction after the fact. They cannot fix a problem until they know they have one. Your participation in providing feedback is crucial for a successful outcome.

Ways to participate in your health care and reduce medical errors

• Speak up — Never be afraid to speak up, ask a question or challenge something that does not look right. Odds are that if something does not look right, it is not right.
• Be informed — Use the Internet to perform your own research. Read the info packet given to you at the hospital. Know your rights as a patient; they must be posted on every floor in the hospital.
• Be flexible — Be aware of the hill you will die on and the ones you will not. Acknowledge that the goal is always quality care.
• Know the name of each provider — Know the role that your provider plays (attending, resident or intern) and who the decision makers are in your care (besides you).

Here’s a quick rundown of providers:

Residency is a 3+ year training program in a medical specialty. The first year of training after medical school is called internship or, more commonly, first year of residency or post graduate year 1 (PGY-1). The following years of training are called second year resident (PGY-2), third year resident (PGY-3), etc.

The training completed after a residency (in a subspecialty) is usually called a fellowship. Examples of specialties requiring a fellowship are cardiology, neurosurgery, critical care medicine, etc. All of these levels require the supervision of an attending physician.

Once a doctor has completed residency training and fellowship (if required for a specialty), he or she will be considered an attending physician and can practice medicine on his or her own. In most states, this is when the medical license is given.

• Ask for a copy of the results of any procedure and diagnostic test, and keep them in your own medical file or binder.
• Know your medications and dosing. Always have a list in your wallet. Question new medications, a change in dosage or a pill that looks different from what you usually take.
• Demand to be included in implementing your plan of care. This includes being informed of any changes to the plan prior to the change. Remember the definition of patient-centered care: Nothing about me without me.
• Demand that all providers check the patient ID band before giving any medication, procedure or patient interaction.
• Demand that all providers wash their hands.
• Be present for your loved one or have a loved one with you if you are the patient. This is the number-one way you can ensure better care.

In many cases, you will not receive patient-centered care unless you relentlessly pursue it. With perseverance, however, you can get exceptions to hospital and insurance practices to customize your loved one’s care and improve his or her quality of life. Be present. Ask questions. Speak up. Keep good records. Learn to think beyond how it is always done and to speak in dollars and sense. Refuse to be intimidated. Most importantly, do not give up.

Sources: Committee on Quality of Health Care in America. Institute of Medicine. (2001). Crossing the quality chasm: A new healthcare system for the 21st century. Washington, DC: The National Academies Press.

Davis, K., Schoen, C., & Stremikis, K. (2010, June). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally, 2010 update. The Commonwealth Fund.

Delbanco, T., Berwick, D.M., Boufford, J.I., Edgman-Levitan, S., Ollenschläger, G., Plamping, D., & Rockefeller, R.G. (2001). Health care in a land called PeoplePower: Nothing about me without me. Health Expectations, 4 (3), 44-50.

Ruth Tarantine serves as the chair of online nursing graduate programs and nursing faculty at a private university. With 25 years of nursing experience, she has a master’s degree in nursing and a doctorate of nursing practice.  She is the author of Against All Odds: How to Move From Provider-Centered to Patient-Centered Care. healthcareagainstallodds.com.

Reprinted from AzNetNews, Volume 33, Number 5, October/November 2014.