The pilot, which has earned Fresenius the 2012 Spirit of Excellence Award for Team, resulted in improved compliance within six months for 76% of 732 patients, in 400 of the company's clinics, who were struggling with nonadherence. Designed by social workers, the intervention addresses the root causes.
“Any time anybody starts dialysis, they are going through a whirlwind of change,” says Dr. Dylan Steer, a San Diego-based nephrologist and medical director at Fresenius Health Partners. “They oftentimes become depressed and shut down and withdrawn. It's a difficult time for them, but it's also a time of opportunity to engage them in their healthcare.”
But social workers are often consumed with administrative tasks, and no one in particular takes ownership when it comes to engaging patients. “We realized the social workers were being underutilized for their true skill set,” says Greg Garza, vice president of operations support for Fresenius' West Division. “Most of the time, when we had patients who weren't showing up regularly, it was put in a general context: Mr. Johnson shows up late because he's moody.”
The program, designed by lead social worker Stephanie Johnstone and her staff, built clinical interventions to help reorient and re-engage patients, scaffolding their resilience in the face of adversities they face. This included, for example, a class on “Getting a Good Night's Sleep,” as well as communication and problem-solving training to reduce stress.
“We were amazed at their capacity to change,” Johnstone says. “They needed hope, and they needed direction. Once we provided that, they received it beautifully. Once we saw that [reaction], the more we propelled it.”