When the Valley Hospital in New Jersey started to think seriously about putting its customers at the center of all that it did, patient volunteers were brought in on discussions about workflow, how patient forms should be designed and nearly everything else that came to mind.
Pamela Bell, director of patient family-centered care at the hospital, recalled when a patient was helping review rehabilitation exercise instructions sent home with surgical patients. The instructions referred to the patient's upper left extremity.
“You mean left arm?” the patient asked.
For Bell, it was one of many epiphanies that patient input could lead directly to improved health outcomes.
A group of healthcare industry heavy hitters who want to promote value-based care have developed a set of principles to help providers make patients the top priority in everything they do. The Health Care Transformation Task Force paper includes six guiding principles, each with key questions providers can ask themselves to gauge progress in following the principle.
Bell said that while the patient-centered concept sounds like a no-brainer, many providers have designed systems around doctors and what they think is best without consulting patients.
“It's so impactful to try to realize we don't know everything,” she said. “And even if we do, it's about communicating. And if people aren't understanding what we're saying, it doesn't work.”
Task force Executive Director Jeff Micklos, who once served as general counsel for the Federation of American Hospitals, said the principles were designed to be somewhat broad so that they can be adapted by different organizations and applied in a variety of settings. The task force intends to follow up with tool kits and information on best practices to further help providers with implementation.
The principles include involving patients in decisionmaking at all levels of care, designing alternative payment models that benefit consumers and continuously working toward quality improvement. They also encourage providers to consider how people can best use information technology and how their organization's practices promote health equity for the entire community.
Some of the sample questions are: Do alternative payment models achieve cost-savings only through improvements in health and healthcare and ensure beneficiary rights and protections? Are patients/consumers and those who support them at the center of the care team?
The Health Care Transformation Task Force includes more than 40 executives from health systems, insurance companies, advocacy groups and consulting firms.
It includes well-known experts such as Advocate Health Care Chief Medical Officer Lee Sacks, former CMS Administrator Mark McClellan and executives from Aetna, Ascension, Montefiore, Optum and Partners Healthcare. Some have already put a focus on patient-centered thinking.
Trinity Health President and CEO Rick Gilfillan recalls Trinity staff putting such principles to work when faced with a patient who would take an ambulance to the emergency room several times a week. Each time he was treated and released, but he continued to return because he didn't understand his condition.
Some providers went to the patient's home and talked with him about his medications and his symptoms. They developed a care plan specifically for him. His trips to the ER decreased drastically after that. In the next quarter, he was there only three times.
“It was about taking the time to see the patient in all aspects of his life and creating a care plan around him,” Gilfillan said.
Task force member Sue Sherry, deputy director of the patient advocacy not-for-profit Community Catalyst, said consumer advocates have long been pushing providers to view patients as partners and participants. It's a sea change for a traditionally patriarchal system, and the private sector in particular has been slow to adapt.
Providers often worry that patients will undermine them or that working with patients will result in wasted time and money. When patient-centered values are implemented, however, these concerns fail to appear, she said.
Debra Ness, president of the National Partnership for Women and Families and a task force member, said patients are the ones who are present at every aspect of healthcare treatment, so their opinions should be valued.
“If you really want to create a system that is creating health, then you need to engage with and co-create with the very people you're trying to help,” she said.
Discussions with patients have led hospitals to conduct nurse shift changes in front of patients and families. This can provide information that family members may have missed and also serves as a check on proper medication, doses and other instructions, she said.
Patients also brought up a relatively minor issue that had not occurred to the providers. They noted that patients may have an appointment where they know they are supposed to give a urine sample, but when they arrive they have to sit in the waiting room, possibly for quite a while, before they are approached.
“It's simple things like that,” Ness said.