In this month's mailbag, H&HN Daily readers weigh in with their thoughts on recent pieces on experiments to redirect non-urgent patients from emergency departments, building trust with so-called "frequent fliers" and whether health care's teamwork trend extends to the C-Suite.

First off, Dave Thomson responded to my blog about efforts by Presbyterian Healthcare Services in New Mexico to redirect non-urgent patients from their ED to primary care providers:

"I believe this experiment was tried in Sacramento several years ago. It did not go well. Dr. Stern seems to have confused costs with charges. They may charge $600 for a sore throat, but the actual cost of care is much lower. By the time the physician has performed the screening exam he is 95 percent done with the care for these minor problems.  He might as well finish the job by writing the prescription."

Reader Lisa Sams wrote in to comment on an interview I did with Douglas Eby, M.D.,vice president of medical services for the South Central Foundation in Anchorage. Eby discussed his health system's efforts to build relationships with so-called "frequent flier" patients who consume a major share of U.S. health care resources and also often turn to emergency departments for primary care.

Here's Lisa's take:

Engaging patients with the right information, awareness of their needs as opposed to our needs (to get "the numbers" right), and building the trust is central to our biggest challenge, which is changing our cultures of care. Bringing the consumer into the discussion about healthcare needs to be a national initiative. Many try but are often rejected as "problems" because they ask too many questions or bring information with them seeking our input on how this relates to their problem. It is impossible for clinicians to change the culture of acute care without a tidal wave of patient/family engagement in the processes of care. After decades of practice I am convinced it will take a consumer revolution as the chief driver to decrease HAIs, stop medication errors, and prevent falls and pressure ulcers (to name a few). Our hope lies in partnering with our families for improved outcomes...everyone wins!

And finally, Ken Phillips, M.D., weighed in on a blog I wrote that pondered whether hospital CEOs are embracing health care's increasing emphasis on teamwork by becoming team players themselves:

1) It depends on which team is considered: Is any CEO on EACH patient's team? Is there any other team? 2) Medical-legally, physicians are considered 'the captain of the ship' for medical malpractice cases; what is difficult for non-physicians (read: hospital administrators) to understand is this: We physicians are on each patient's team, and don't understand those within the hospital who are not.

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