CHICAGO — Where does patient behavior end and hospital performance start? It's a timeless quandary in health care, and an issue I've been pondering quite a bit lately in preparation for a series on innovative hospital strategies for treating high-utilizers, or so-called "frequent fliers."


Last week, I wrote about the South Central Foundation in Anchorage, which has made relationship-building a central component of its efforts to improve health outcomes for the chronically ill and often socially isolated patients who drive much of the nation's health care spending. Ultimately, those efforts are designed to build trust with patients whose previous experience with health care providers, and authority figures in general, has been shaky.

Yesterday, I attended the opening session of the American College of Healthcare Executives' 2012 Congress on Healthcare Leadership in Chicago, where former Surgeon General Richard Carmona, M.D., explored the role of providers in effectively communicating with patients to help them reach their long-term health goals. The health care industry, Carmona argued, is often too quick to assign blame to patients for poor outcomes and readmissions, instead of looking in the mirror.

"How many times have you said, 'If only those patients would be more compliant?'" Carmona asked the gathered crowd of health care administrators. "The fact of the matter is, the literature says it's about failing to communicate appropriately."

When Carmona was growing up in New York City, he often took his non-English-speaking grandmother to the doctor. He noted that while he served as an interpreter during those visits, his grandmother wasn't always forthcoming about her medical problems, partly because she didn't feel comfortable discussing sensitive subjects in front of her grandson.

Similar situations play out every day in doctor offices and emergency departments, Carmona added, arguing that providers must learn to effectively transcend cultural barriers if they want to succeed in an increasingly diverse marketplace. The stakes are high: Carmona argued that the ability of hospitals to develop and sustain cultural competencies that resonate with their patient base will prove critical in overall efforts to bend the cost curve.

"We have to translate complex science into sustainable behavioral change," Carmona said. "It's not only to address racial and ethnic disparities, but really to do everyday health care."

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