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 email@example.com.
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The AHA unveiled an election year initiative in June designed to engage members — and hospital staff, patients and communities — in a multipronged effort to ensure that lawmakers and other key stakeholders understand the immediate challenges facing the health care field. The initiative, called "We Care, We Vote," equips members with facts about a variety of funding issues requiring action by the end of the year and into 2013, when the national debt will become the primary focus of whichever candidates win in November. The AHA also has developed a toolkit for hospital leaders so that everyone involved in the "hospital family" can understand the magnitude of the challenges that hospitals face, the steps hospitals are taking to increase value, the public policy changes to support and the changes to oppose. Visit www.aha.org.
Ian Morrison essays collected
An updated collection of essays written by Ian Morrison for H&HN, H&HN Daily and H&HN Weekly that address how to build viable systems in health care finance and delivery is available. An AHA Press release states, "readers will find Morrison's wry observations and wicked ideas entertaining, irreverent, thoughtful and inspiring. His analysis offers lively starting points for provocative and memorable board room discussions." Visit www.healthforum.com and click on Online Store.
Board members surveyed
The AHA's Center for Health Care Governance and Hospitals in Pursuit of Excellence initiative are surveying board members from nonprofit hospitals to learn about their changing role under a value-based health care system. The survey was emailed in June and continues a discussion started with the AHA Committee on Performance Improvement's 2011 report "Hospitals and Care Systems of the Future." CHG and HPOE will report the survey results this fall, which will help organizations understand what boards are measuring today and what they should measure tomorrow to lead a successful organization.