At least in theory, the raison d'etre of healthcare institutions is to care for patients. Yet patient experiences often speak to the contrary. Other than upgrading technology and paring costs, most U.S. providers have done little to change their model of care during the last several decades.
Why aren't more hospitals taking a chapter out of the patient-centered lexicon? Planetree -- a model of patient-centered care and a powerful force for healthcare innovation -- has been pointing the way to better care for some time. Committed to healing relationships, with providers as partners, the Planetree model has encountered problems in many healthcare settings.
In one situation, our firm found the administration using a patient-centered philosophy to persuade nurses and physicians to work overtime without additional pay and to make "the necessary sacrifices" on behalf of patients. In another, the Planetree moniker was used as a marketing technique, but the effort ultimately failed; as quality problems surfaced, nurses were laid off and serious financial difficulties arose.
Planetree's success notwithstanding, a majority of healthcare organizations seem stuck in the past, making little effort beyond cosmetic customer-satisfaction initiatives. In recent surveys, healthcare chief executives report again and again that their efforts at organizational change did not yield the promised results.
When things fall apart, we try to exert more control through regulation as though that will be the solution. Instead, the focus has to shift back to innovative systemwide solutions.
Building a patient-centered environment isn't easy, but here are some elements with which to start:
- Develop a patient-centered vision. Innovation and quality improvement must be integral to an organization and cannot be easily replicated in an organization with a different culture. This calls the entire movement toward "best practices" into question. Attempting to bring patient-centered concepts into a culture that is fraught with power struggles and devoid of trust will meet with futility. Offering a patient-centered vision with a few guiding principles rather than endless lists of procedures and instructions is the essential starting point.
- Let a patient-centered focus emerge. It is often said that people resist change, but they don't; they resist having change imposed on them. Without being overly prescriptive or confining, leaders can let the new patient-centered direction emerge in a flexibly structured environment based on a few guiding principles. Those include adopting the idea of working for the patient and not seeing the patient as the passive recipient of our treatments and technology; being guided by the patient's needs for rest and nutrition as well as the patient's pathology; and seeking opportunities to spend as much time as possible with patients to comfort and heal.
- Shift focus from hierarchies to networks. Networking requires a profound change in leadership, away from top-down directives accompanied by threats of sanction toward collaborative models using education, inclusion and persuasion. Many institutions haven't adopted patient-centered models because it requires a power shift in the institution from dominance and control to partnerships and collaboration.
- Create a learning environment. It is crucial for leaders to understand the limits of top-down directives as engines of change. It is well known that professionals don't follow instructions well. After listening to the latest edicts of senior management at a meeting, many can't wait to run out of the room, consult with colleagues in their informal network and figure out a way around the new rules; that is, to do exactly what they want to do.
- Move from acute, episodic patient care to continuous healing relationships. Medicine is still much more an art than a science. Only a small portion of medicine is actually scientifically based. From this point of view, the Institute of Medicine rightly points out that the basic unit of healthcare should not be visits or encounters but healing relationships that allow patients to obtain the trustworthy information and emotional support they need.
Because emotional support and trust are established not only by continuous attention to day-to-day patient needs but also to the vigilant anticipation of patient needs, the recruitment and retention of a capable, enlightened nursing staff is crucial in creating and maintaining a patient-centered environment.
However, many hospitals have not yet developed an adequate appreciation of the vital healing link that nurses provide to the patient. The current, unprecedented shortage of nurses in hospitals is the result of a failure to understand and acknowledge nurses' critical proximity to patients and their importance in the healing process.
- Listen to patients. Develop patient councils at the board level or clinician-patient networks in the community that allow healthcare organizations to learn what has meaning to patients.
Pamela Maraldo is a partner and Eric Lister is the managing partner of Ki Associates, a strategy consulting firm based in Portsmouth, N.H.