Making the Patient Experience Paramount

Including patients and families as part of the care team will transform the way we practice medicine

nurse with patient“I have never had an anesthesiologist who listened so carefully to my litany of sensitivities and treated each with such respect.”

“She makes me feel as if I am her only patient and concern.”

“Our pediatrician wiggled his ears, making our daughter smile before a scary lumbar puncture procedure.”

“She let me cry and break down, not rushing me, staying with me until I was calm.”

“This physician attentively listens to nurses’ concerns, immediately and appropriately addressing issues. His compassion, knowledge-base and empathy are admirable. His handwriting is even legible.”

These are real words of grateful patients, repeatedly citing our faculty and caregivers not only for their clinical expertise, but for their willingness to take a few moments out of their busy schedules, slow down, and tune into what really matters to patients.

“When we take time to listen and involve patients and families as integral members of the care team and necessary participants in the treatment plan, we restore to them a sense of autonomy that’s so vital to successful recovery,” said URMC CEO Bradford C. Berk, M.D., Ph.D. “This concept of caring with patients and families instead of for them is essential to our program.  Pausing to care for patients in a way that truly values their input – fears and all – should be our hallmark, our way of doing business.”

And that’s why, starting this February, Strong Memorial Hospital is making a concerted effort to deliver a kind of medicine that consistently engages the patient and his or her loved ones as part of their own care team. Called “patient- and family-centered care,” this brand of healing promises to not only dramatically improve patient satisfaction, but may also provide a framework for delivering better-quality care more consistently and more cost-effectively.

In pursuit of patient satisfaction

URMC has always paid careful attention to issues of quality, safety, and service-excellence, but this recent commitment to patient- and family-centered care represents a more disciplined effort to involve all faculty and staff.

“We launched our Strong Commitment service excellence program in 2005,” said Steven Goldstein, CEO of Strong Memorial and Highland hospitals. “What’s fundamentally different now is that we’re shifting our management plan so that it engages both faculty and staff in a hospital-wide effort to deliver patient- and family-centered care. We anticipate that this concerted approach – with everyone focusing on the same issues – will transform our organization and raise satisfaction to a new level.”  

 Jackie Beckerman, director of the Strong Commitment program, agreed.

“Patient- and family-centered care integrates all the traditional customer-service elements we’ve focused on in the past, and then goes a step further, asking patients to partner with us as active participants in their own care,” she said. “What a difference this makes. Not only does it improve patient, family and staff satisfaction – it produces better outcomes.”

Engaging physicians in patient- and family-centered care

doctors consulting with patientIn recent years, we’ve witnessed an incredible shift towards transparency in health care. Consider Hospital Consumer Assessment of Healthcare Providers and Systems (pronounced ‘H-caps’ for short), an initiative to standardize and report patients’ opinions of hospital care nationwide – or government regulations compelling hospitals to track and publish data about how effectively they prevent hospital-acquired infections.

“This mandatory quality reporting allows customers to ‘comparison shop’ for hospitals, even for specific physicians,” said Jean Joseph, M.D., professor of Urology and Oncology, who is tasked with leading physicians along the journey to more routinely engage patients and families in the care process.

“As outcome, process and satisfaction data becomes more readily available, we plan to move ahead of the trend, getting in the habit of sharing this information with individual providers and giving them the tools they need to improve their scores,” Joseph said. “Data doesn’t lie, and having the buy-in of our physicians is critical to us making patient- and family-centered care work here at Strong.”

Goldstein’s conversations with leaders from other hospitals further underscore the power of this kind of data to drive change. Massachusetts General, for instance, not only monitors and reports unit-specific satisfaction data, but goes a step further, tracking physician-specific statistics; it’s a standing part of supervisor evaluations and physician reappointments, and these scores – and any vulnerabilities they uncover – shape management plans.

Also at Massachusetts General, cross-disciplinary teams gather to share stories; they hope that lessons learned in part of the hospital can be instructive to other areas facing similar challenges. These faculty and staff teams also discuss how patients’ winding journeys – as they to receive care at numerous touch points across the institution – color their care experiences.

“Part of improving satisfaction scores has to do with how fluidly we coordinate care throughout our system,” Goldstein said. “We don’t want patients to deal with us as silos; we need to crack through our silos and establish a flow of care within our institution.”

The ‘human side’ of medicine

Inspired by a harrowing bicycling accident and time spent as a patient himself, URMC CEO Bradford C. Berk sees health care reform as a real opportunity to return to the human side of medicine.

Since he’s been back at the helm, he’s delivered dozens of lectures on the power of compassionate care. He’s also pushed for a more formal effort around patient-centeredness (charging committees to tackle patient-flow challenges, first impressions, patient communications, and more), championed a need to revisit our organizational mission, and has funded the hiring of local brand strategy experts (from Rochester-based Brand Integrity Inc.) to help us distill what patient- and family-centered care looks like in terms of concrete, job-specific behaviors.

“While it might sound like a lofty ideal, patient- and family-centered care is highly practical and confers great safety advantages,” Berk said.

For instance, involving a patient in education about his own medicines empowers him to watch for potential side-effects and complications. And putting stock in a spouse’s instincts when he or she simply “senses” something is wrong with their loved one can enhance clinical decision-making.

Granted, there’s an undeniable investment up-front – it takes time to equip patients and loved ones to be active participants in their own care experience.

“There’s more patient education. We have to work differently,” Berk said. “But the payoff is undeniable. Research shows that organizations that practice patient- and family-centered care see their risk for medical errors shrink dramatically. Their patients enjoy better outcomes, and are consequently more satisfied. And their patients are also less likely to take legal action if outcomes don’t meet their expectations.”

What we’ll see at Strong

As we brace for a health care environment that consistently places the patient experience front and center – whether it’s by putting more and more quality data at their fingertips, or making sure morning rounds happen right at their bedside – you’ll notice substantial changes at Strong.

We’ve already tapped teams of faculty and staff to develop our personal brand of patient- and family- centered medicine – from a re-worked mission statement, to redefining our values, to testing practical applications of how to more routinely involve patients in their own care. We’ll also be asking that every URMC employee – whether they interface with patients or simply their colleagues – sign a new ICARE commitment, making a personal pledge to practicing job-specific behaviors that will help them live-out the ICARE values in all aspects of their professional life. To support them in this effort, we’ll examine current processes and operations – asking how we might improve each so that it more naturally fosters these new behaviors.

“We’re braced for real change. Improved efficiency, empowered patients, greater staff engagement, safer hospitals, fewer readmissions – they’re all interwoven,” Berk said. “Success in one area spills over to the next. We have to transform the entire patient experience. It’s about practicing the kind of health care that we’d want for ourselves and our families.”

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