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As health care professionals, it's easy to view the hospital as a place of work instead of a place of healing. The demands of the job are great and little time is allowed for reflection and looking beyond the immediate needs of the patient.
Health care is, and always will be, a complex system. As reform places even greater pressure on hospitals and health systems to achieve better outcomes with fewer resources, the transition to patient-centered care will take on greater importance. But first, organizations need to see beyond the touchy-feely, nice-to-have component of the patient-centered care model and recognize that it's an evolution that shifts the focus from the problem to the patient, a shift that can result in significant improvements in clinical outcomes and cost reduction.
"Patient-centered care is the right thing to do for patients and for the organization," says Gladys Epting, senior manager of research, University HealthSystem Consortium, Chicago. "It's a moral imperative."
The business case is clear. Evidence shows that patient-centered care improves outcomes by reducing length of stay, readmissions and emergency department visits, and enhances patient compliance with care plans. In a patient-centered environment, employees are more satisfied with their work and are more willing to stay in their jobs. Patient satisfaction is, in turn, improved. "We cannot be successful as an industry if we do not focus on the patient," says Sue Collier, vice president of service and patient and family experience, University Health Systems of Eastern Carolina, Greenville, N.C.
Developing a patient-centered culture, however, takes time. It requires a shift in health care delivery in which the focus at all times is on doing what's best for patients and their family members. It recognizes the individual needs of the patient, empowers patients and their families to become active partners in their care and delivers care in a healing environment that supports patients' physical, emotional and spiritual needs.
"Addressing the physical aspects of patient-centered care is easy," says Susan Frampton, president of Planetree, Derby, Conn. "Changing the culture is difficult to do." Adds Tracy Gaudet, M.D., director of patients centered care at the Department of Veterans Affairs, "Culture is a product of every person within the organization. All of us need to be a part of a new way of thinking and being."
A good place to start is with an organizational assessment to determine the readiness. Many organizations may feel they are providing patient-centered care, but an assessment will identify gaps and target areas for improvement. The next step is to educate the staff and the community about the need for change. "This is not the way health care has evolved," says Kathy Vermoch, project manager of quality operations for UHC. "It's not the way society looks at health care."
Measurement is a critical component to the achievement and sustainability of a patient-centered culture, but it must be used in combination with a commitment from senior leadership, standardized processes, an engaged workforce and patient population and accountability systems that monitor outcomes. "Hospital executives should recognize that patient-centered care is a differentiator," Frampton says. "Patients are more willing to go to organizations where they perceive they are getting better care."
>> Assessing Organizational Readiness
This checklist provides organizations a sense of where they stand when it comes to patient- and family-centered care, effective communication and cultural competence. Hospitals can use it to identify areas that should be addressed to ensure that the unique needs of patients and their families are met.
• Demonstrate leadership commitment to effective communication, cultural competence and patient- and family-centered care.
• Integrate unique patient needs into new or existing hospital policies.
Data Collection and Use
• Conduct a baseline assessment of the hospital's efforts to meet unique patient needs.
• Use available population-level demographic data to help determine the needs of the surrounding community.
• Develop a system to collect patient-level race and ethnicity information.
• Develop a system to collect patient language information.
• Make sure the hospital has a process to collect additional patient-level information.
Patient, Family and Community Engagement
• Collect feedback from patients, families and the surrounding community.
• Share the information with the surrounding community about the hospital's efforts to meet unique community needs.
• Target recruitment efforts to increase the pool of diverse and bilingual candidates.
• Ensure the competency of individuals providing language services.
• Incorporate the issues of effective communication, cultural competence and patient- and family-centered care into new or existing staff training curricula.
• Identify staff concerns or suggested improvements for providing care that meet unique patient needs.
Provision of Care, Treatment and Services
• Create an environment that is inclusive of all patients.
• Develop a system to provide language services.
• Address the communication needs of patients with sensory or communication impairments.
• Integrate health literacy strategies and patient- and family-centered care concepts into care delivery.
• Incorporate cultural competence and patient- and family-centered care concepts into care delivery.
Tip: Share information you have collected with the surrounding community about your hospital's efforts to meet your community's unique needs.
Source: Advancing Effective Communication, Cultural Competence and Patient and Family-Centered Care: A Roadmap for Hospitals, Joint Commission, 2010
>> Key Attributes of Patient-Centered Care
1 | Leadership Commitment: Senior leaders and the board must set a clear vision and demonstrate commitment to patient- and family-centered care.
2 | Workforce: The hospital and its staff, including the medical staff, must commit to meeting the unique needs of the patients they serve.
3 | Healing Environment: The hospital must provide a nurturing environment that supports the health and well-being of patients and their families.
4 | Data Usage: Hospitals must collect, analyze and act upon data that identifies what's important to patients and families during their stay and use that data to make meaningful change within the organization.
5 | Supportive Work Environment: The work environment should facilitate employee engagement, provide employees tools they need to do their jobs and treat them with dignity and respect.
6 | Communication: Effective communication is essential to the establishment of a patient-centered culture. Leadership must continually communicate the organization's commitment to patient-centered care and clinicians must establish open communication with patients and their families to involve them fully in their care and ensure their needs are met.
7 | Patient, Family and Community Involvement: Hospitals must be responsive to the changing needs and values of patients, families and the community.
Source: H&HN research, 2011
>> How to Use Data to Enhance Patient-Centered Care
Data from patient-satisfaction and engagement surveys and the Hospital Consumer Assessment of Healthcare Providers Survey — HCAHPS — provide organizations with an understanding of compliance and effectiveness of various aspects of patient-centered care. A more robust look at the data can provide a sense of organizational culture and relationships, serve as a building block for innovation, and can identify and build on areas of excellence.
Six Techniques for Using Data Effectively
1. Action Item: Prioritization
- Use data as a tool to help identify priorities.
- Avoid trying to focus on everything at once.
- Avoid changing priorities constantly.
2. Action Item: Integration
- Integrate all data sources and types to gain a better understanding.
- Relate the data to organizational context and goals.
- Recognize that data cannot capture everything that is important.
3. Action Item: Identification of best practices
- Use data to help you identify what is already working well in your organization (e.g., high-performing units).
- Identify successes not only based on top performance, but also on improvements in performance.
- Use data as a way to evaluate the success of improvement strategies.
- Avoid measuring progress too narrowly.
- Avoid getting "trapped" in the data — data themselves are not the objective.
4. Action Item: Communication
- Provide data in a format that is intuitive and actionable for users.
- Tell the stories behind the data.
- Be flexible and creative.
- Avoid providing data only, without interpretation or support for improvement.
- Avoid focusing only on the negative.
- Avoid concentrating on isolated incidents, as opposed to broader concerns.
5. Action Item: Comparison
- Measure to improve and not just to make an impression.
- Look at the bottom box scores, as well as the top box scores.
- Manage based on recent data, not older publicly reported performance data.
- Use trending to compare against yourself.
6. Action Item: Celebration
- Celebrate meaningful successes.
- Avoid overreacting to random variations in performance.
Source: Patient-Centered Care Improvement Guide. Planetree and The Picker Institute, 2008.
North Valley Hospital
As a critical access hospital, North Valley Hospital has special ties to the community. Nine years ago, the hospital adopted the Planetree model to help distinguish the organization from larger hospitals in neighboring communities. "We are a small hospital. Our patients are our loved ones and neighbors," says Mary Sterhan, North Valley's Planetree coordinator. "That makes it vital. That makes it personal." All decisions are based on what's best for the patient, and patients and families are empowered to take part in their care. The little things matter, as well. Same-day surgery patients are provided lunch to take home, for example. "It's one less thing they have to worry about," says Sterhan. The focus on healing design, communication, education and complementary therapies has been equally important for the staff. "Patient-centered care is something all employees can buy into. It has tremendous value," she says, adding, "We are No. 1 in the state for patient willingness to recommend. Patient-centered care is what brought us to that."
University Health Systems of Eastern Carolina
University Health Systems, comprising 10-hospitals in eastern North Carolina, began its focus on patient- and family-centered care in the late 1990s. Initial efforts proved valuable, but did little to advance patient- and family-centered care across the system. In 2007, an employee shared the experience of her brother's care in the intensive care unit. Strict visitation policies caused extreme anxiety for the patient and the family, and the patient died alone with no family at the bedside. Over the next three years, UHS began to hardwire best practices in patient- and family-centered care. "We identify what's important, measure, hardwire and audit that performance," says Sue Collier, vice president of service and patient and family experience. Leadership and bedside staff bundles are used to align behaviors with patient experience. The bundles help leaders track implementation and continued use of best practices and patient engagement during hourly rounds and other patient encounters.
How We Did It: This gatefold was produced by researching published studies and articles and conducting interviews with hospital and industry executives.
Research: Lee Ann Jarousse, firstname.lastname@example.org
Design: Chuck Lazar, email@example.com