Carnegie HCQ Introduction 6200 Final Paper

Table of Contents

Patient-Centered CareDonna-Mae CarnegieGeorge Washington University, MBA ProgramMBAD/6200 – Introduction to Health Care QualityOctober 13, 2019Professors: Melanie Bujanda-Romero;  Kenneth Harwood;  Randall Kiser;  Melanie TraskPatient-Centered CareCenturies ago, in the absence of research, comprehensive treatment was driven largely by caring and compassion. Today, however, the advances in science and technology have distanced the interconnectedness between the patient and the physician. This has created an environment where patients and their families have been disempowered and are left wondering how to best navigate their health issues through diagnoses and different treatment options. How the health care that we currently have as opposed to the health care that is possible is not just a gap, but a whole void in the delivery of care. This paper will seek to discuss patient-centered care and the need for patients to be in complete control of their decision making and treatment options. The need (a) for awareness, (b) that the information is understood, and (c) that the information is viewed as useful before (d) it can be used in making any decision. Literature ReviewIn 1988, the Picker Institute, came up with the term patient-centered care, with the intent to shift to a preventative approach to care – a health care system that is centered primarily on the patient and their family – rather than one driven by diseases and treatments. The terminology was used to highlight the importance of understanding the patient’s experience and how to better address their needs despite the fragmentation and complexity of the healthcare system. The Institute partnered with patients and their families and did multi-year research where they identified eight characteristics of care from the patients’ view, which has been the most important indicators of what quality and safety, should be (Barry & Levitan, 2012). The characteristics listed were: respect for the patient’s values, preferences or expressed needs; coordinated and integrated care; clear high quality information and education for the patient and family; physical comfort – which included pain management; emotional support; relief of fear and anxiety; family members involvement; continuum of care to include discharge follow-up and continued access affordable care.These characteristics were introduced in what became the landmark Institute of Medicine’s (IOM) report, crossing the quality chasm as one of the most fundamental approaches in how to improve the quality of healthcare in the United States (US). As IOM’s definition implies, the most critical components of patient-centered care is (1) the active engagement of patients when important health care decisions need to be made (2) when a patient is at a crossroads of medical options and (3) where different paths have varied consequences that can be permanent with damaging implications. Decisions include major surgery, life-long medications for chronic conditions, screening, and diagnostic tests that cause multitudes of stressful interventions. The patient-centered care model is a collaborative engagement that determines shared goals. The Institute of Medicine (IOM) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that the patient values guide all clinical decisions (IOM, 2011).” As providers, we should introduce innovations in care delivery, to adopt the lean and standardized processes to improve quality, increase the use of automation and nonmedical staff members to change how our clinical workforce is deployed, and employ new technologies to deliver better quality care. This approach would involve patients more closely in their care delivery and rapidly gather accurate patient-generated data to personalize treatments. There is a process called shared decision making, which is where the best decision is arrived at by the patient when at a tough health intersection, and this involves both clinician and patient and possibly other family members or close friends, and other health care teams. This is where information is shared – not exchanged – and the doctor explains the benefits and risks; the doctor helps the patient to explore different options, and where the patient expresses her values and preference(s). Both parties are now better placed to understand important factors, their responsibility and how to go forward. Patients should decide what course of action needs to be taken, based on the information, advise and support from their physicians. The patient should fully understand the process and treatments to undergo if the clinicians are to make them knowledgeable and comfortable as possible to make them more engaged. Patient to physician communication plays a vital role in patients’ health, by empowering them to take better control of their health discussions. The patient-centered practice is based on value, hence the current surfacing of the value-based care model. Microeconomics of healthcare deals with a price to cost relationship. The supply and demand seem like a natural starting point, as the law of demand applies to health care as in other markets: as the price of health care increases, you demand less of it. True, but we must be careful because what matters is the price of health care to the individual. Under most health-insurance contracts, the marginal cost of care to an individual is so much more than the marginal social cost of providing that care. The household has an incentive to purchase a lot of health-care services because it is believed that more is better patient-centered care, and health care organizations are not divorced from the larger economic problems in society as many have come to believe. One of the greatest challenges for patients is health-care costs and care. Patients go to their physicians with two complaints but get treated for only one because the insurance will not pay for two. This creates inconvenience where the patient feels cheated, as at times the physician will not even discuss or explain the other problem, instead recommends making another appointment. For care to be patient-centered, it must be affordable, accessible and electronic patient information has to be interoperable. As a body, healthcare organizations have to move away from a cost and affordability focus, to that of absolute efficiency and quality care. Treatment and physicians must shift to a more personalized approach in order for it to have value. Laws, regulations, and policies that govern healthcare payment, rising cost and utilization, quality and outcomes can be hindrances to value-based, otherwise called patient-centered care. This is where leadership, courage and emotional fortitude in practicing medicine differently than how it is been practiced currently; in addressing issues that are difficult for any patient, such as end-of-life. Value-based payment models that are based on measurable outcomes are important to transforming to patient-centered care. As professor Bujanda-Romero says so eloquently “it is difficult to disagree that the patient should not be the center of care. After all, they are the customer and their skin continue to be more in the game each year.” The continuum of care is so lacking in interconnectedness and interoperability, that this undermines patient care. Due to the litigious nature and atmosphere we find ourselves, healthcare organizations seemingly lack the compassion and regard that is needed, instead of placing patients in palliative or hospice care, they are sent to the intensive care units. This creates another burden where the patient never leaves the ICU, yet their families are left with this huge bill to contend with. To offer value-based care, social determinants such as food, housing, and education must be addressed in order to provide better value.Patients’ belief influences how resources are used. Increased participation during visits reduces anxiety and their need for investigations and referrals. If patients believe that the doctors do not understand their problems, this usually provokes insecurities that cause requests for further unnecessary medical interventions. Medical education should go beyond skills training to encourage physicians’ responsiveness to the patients’ unique experience. Therefore, involving real patients and standardized patients in teaching programs is recommended (Stewart, et. al., 2000). Health care organizations must recognize that efficiencies and effectiveness come through patient-centered practice and must encourage these practices through different structures that elevate the continuity of the patient-physician relationship. Patient-centered communication was correlated with the patients’ perceptions of finding common ground. In addition, positive perceptions were associated with better recovery from their discomfort and concern, better emotional health, and fewer diagnostic tests and referrals. Patient-centered communication is shown to influence patients’ health through perceptions that their visit was about them, and especially through perceptions that common ground was achieved with the physician. “The most important attribute of patient-centered care is the active engagement of patients when fateful health care decisions must be made; when they arrive at a crossroads of medical options, where diverging paths have different and important consequences (Barry & Levitan, 2012).” This he said seven years ago which today, is the loudest argument in the improvement to healthcare delivery.Medical decisions, at times, may have reasonable paths, the option to do nothing or combinations of possible healing effects and side effects. There are decisions for therapy in the case of early-stage cancer, medication for the prevention of coronary heart disease, regular screening tests are such. In these cases, having patient involvement adds substantial value, to their care and outcome. For decisions where there is no intervention that meets this standard, patients have to be involved in the selection of the health strategy that is compatible to their values and preferences.If there are multiple options, doctors can help with shared decisions by encouraging the patients to open up and share what matters to them in order to assist them in better understanding their treatment options and the possible outcomes. This kind of assistance can help to develop and communicate informed preferences, particularly if the outcome will be a foreign experience. Barry speaks of the Cochrane review in 2009 (Barry & Levitan, 2012), where the use of the patient decision guides for a range of preference decisions, led to heightened knowledge, accurate risk perceptions, a reduced level of internal decisional conflict for patients, and fewer indecisive passive patients. This is suggestive of the fact that shared decision making, helps address the problems of overdiagnosis and overtreatment.There is much talk about patient-centered care in current health care. One of the greatest challenges of having it become total reality continues to be engaging patients in decision making. To address this critical issue of quality and safety, critical barriers between clinicians and patients need to be removed. Continued communication must be made to patients about their health education and the role they play in decision making; and offered effective tools to help them understand their options and the consequences of their decisions. Clinicians, on the other hand, need to relinquish absolute control as the single authority and learn to become effective coaches; learning how to ask the patients what matters to them most and why. Patient-centered health information technologies should be interoperable to be able to help clinicians connect and identify patient’s information, who are facing fateful health care decisions and to more efficiently understand and acknowledge their preferences.Barry believes that if we view the health care experience through the patient’s eyes, then we will be more responsive to their needs and, become better clinicians. He believes that we will succeed in building a truly patient-centered health care system when an informed woman can decide whether to have a screening mammogram or an informed man can consider whether to have a screening prostate–antigen test, and not have the doctor impose their decision with a disregard to the patient’s values and preferences (Barry & Levitan, 2012). The creators of patient-centered health care understood the moral implications of what they meant, and this was modeled on a simple deep respect for patients as unique living beings, with different needs and the commitment to care for them on their individualistic terms (Epstein & Street, 2011). Patients should be treated as people of their own social worlds, listened to, informed, respected, involved in their care and where their wishes are honored and respected to the very end of their health care journey. Some believe that with so much focus on patient’s individual needs, this can create a rift with an evidence-based approach, which focuses on population health. Incidentally, patient-centered care and evidence-based medicine consider both the art of generalizations and the science of particulars (Epstein & Street, 2011). RecommendationBearing in mind all the benefits and looking at some of the challenges, it would be best to say heading in the direction of a patient-centered care system, is the way forward for health care. For a patient-centered environment, disruption must take place in this industry for it to elevate by proactively engaging in new business models to move forward. Decisions not to launch new transformative initiative processes should be carefully mapped so as not to put the health care system behind leading rich countries. Nor is it to become less able to respond to the growing needs of our aging population. Interesting to note, is that for the health-care industry to become focally patient-centered the nurse to patient ratio needs to be aligned based on the acuity of the patient. Leadership should also look into alleviating these issues: the plausibility of having a three patient workload one day and compromise patient safety with the same workload another day. Why the training period for new employees has decreased, in an effort to provide coverage. Even though this provides more bodies on the floor it is inefficient patient coverage, which can result in an unsafe working environment for both staff and patients. Nurses are not given enough time to talk and touch their patients, which would allay underlying fears, allowing patients to be their own advocates. Some of these patients focus more on the room they are getting, whether it is private or not and the view, thus proving they sometimes cannot be their own advocates, creating challenges for the nurses who find it difficult to humanize. Address why nurses do not have a lot of time to administer medications thereby improperly following protocol. Health care leaders should also look into mandated overtime due to staffing shortages, which leads to staff burnout, loss of knowledge, lower productivity and low retention. Cross-training employees instead of finding replacements that result in greater workload. Health-care leaders should find a way to help nurses reduce endless paperwork that takes away from patient care. ConclusionPatients and families must be engaged in the spirit of partnership, collaboration, and mutual respect. Patient-centered care is a quality of personal, professional, and organizational relationships. Thus, efforts to promote patient-centered care should consider the patient-centeredness of patients, clinicians, and health care systems.  If patients are helped, they will be more active in consultations and will change years of physician-dominated dialogues to those that engage them as active participants. Physicians will be trained to be more mindful, informative, and empathically transform their roles from one of authority to one that has the goals of partnership, solidarity, empathy, and collaboration (Epstein & Street, 2011). There is much confusion as to what patient-centered care really means, where efforts can seem superficial and unconvincing. In the name of patient-centeredness, health care systems have been adopting models used in customer service industries, hotels with greeters, greenery, and gadgetry (Epstein & Street, 2011). These niceties may enhance the patient’s experience but will not achieve the goals of patient-centered care. Changes, such as electronic health records and access schedules, may help to move medical care into the 21st century, but they should not be confused with achieving patient-centered care. Implementing an electronic health record in and by itself is not patient-centered unless it enhances the patient-clinician relationship, heightens communication, be informative to the patients, and ensures their personal involvement. With social changes in medicine, the operational definition of patient-centered care is changing, and measures should reflect those changes. The patient-centered care holds future trends of how the health system will deliver their roles, values, and mission to the communities. The trends of the health care future will determine how well patient-centered care has accomplished their past missions and values of the health system with this valuable information. Quality care should be safe, effective, patient-oriented, efficient, affordable and accessible to all which I believe is the foundation on which patient-centered care is written. Patient safety, after all, is quality, and quality is the balance where possibilities are realized with a framework of values and norms.ReferencesBarry, M.J., Edgman-Levitan, S. (2012). Shared decision making – The pinnacle of patient-centered care. The New England Journal of Medicine.Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J. (2000). The impact of patient-centered care on outcomes. The Journal of Family Practice. 49(9)Institute of Medicine (2011). Crossing the quality chasm: A new health system for the 21st Century. Shaping the future for Health. Retrieved from: “Crossing the Quality Chasm: A New Health System for the 21st Century”Epstein, R.M., & Street, R.L., (2011). The values and value of patient-centered care. Annals of Family Medicine. 9(2), 100-103. DOI:10.1370/afm.1239