What if every patient in every hospital and clinic across the country had documented daily goals for what they wanted to get from their care? A few weeks ago, I had the pleasure of interviewing a patient — Jamie — who had been in and out of the hospital over the last decade with various health problems. After talking about her care, our conversation turned to her job. Jamie is a school teacher, and each year she gets 20 new students. I asked if the students were mostly alike, and she said, "No. They're all very different." So I asked how she taught them, given the differences. Jamie explained that she has a simple, but successful, formula:
- Huddle with all the students' prior teachers and map out a history from their point of view.
- Meet with the family to understand the home context.
- Meet with the student and set goals for the year, month by month.
These three simple but essential steps, if translated to health care, are exactly what we mean by patient- and family-centered care. Many organizations are starting to implement processes like Jamie's, but not enough. Another recent experience exemplifies the problem.
A family member of mine was a patient at a hospital here in Boston. As his condition worsened, his care team grew, which resulted in decreased coordination and clarity of communication. One doctor told him to take as much pain medication as he needed; another warned him not to take too much. One doctor advised him to walk around a lot; another recommended rest. There were conflicting interpretations of test results, conflicting recommendations about colostomy, and throughout it all, a total absence of post-discharge planning.
We know that care coordination improves outcomes and patient satisfaction, and can reduce costs by shortening length of stay and avoiding complications. I'm encouraged that more and more organizations are following the lead of places like ThedaCare and Gundersen Lutheran in Wisconsin, both of which have used robust care coordination models for years. But for organizations still struggling with this essential aspect of patient-centered care, I have a suggestion: A whiteboard next to every patient bed. On that whiteboard, write daily (and longer-term) goals with the patient. Develop these goals during multidisciplinary rounds with the care team and the patient or family member.
The whiteboards should include clinical goals, like lowering BP, and patient-directed goals like the one I heard from my colleague in Saskatchewan, Dr. Susan Shaw. Her patient's daughter excitedly greeted her one day, showing her a piece of paper on which the mother had written, "My goals: 1) heal this broken body; 2) cut grass." The patient simply wanted to be healthy enough to mow her lawn. Dr. Shaw noted the inspirational power this wish had on her and her team, and the clear direction it gave them about how to plan the patient's care.
Every patient should have the opportunity to set, understand and strive for clinical and personal goals. Every clinician should develop these goals by asking the question my colleague Susan Edgman-Levitan proposed: not "What's the matter?" but "What matters to you?"
Maureen Bisognano is president and CEO of the Institute for Healthcare Improvement. She is the recipient of the 2012 TRUST Award from the Health Research & Educational Trust. She can be reached firstname.lastname@example.org.
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