How to Improve Hospitals: Ask Patients and Families
Why some medical centers are asking for, and getting, their input
Here’s a novel idea to help make hospitals more person-centered: include patients and their families in the key decisions for the medical centers, from strategy to operations. Nutty, right? Well, actually, this is an idea that’s slowly starting to catch hold.
That’s the conclusion of a fascinating recent research report from The Experience Innovation Network (EIN) — a community of U.S. and Canadian thought leaders focused on elevating patient-centered care, reducing health costs and restoring care team resilience and well-being.
Time for More Person-Centered Care
Involving patients, family members and caregivers couldn’t come soon enough. As Dr. Bruce Chernof, president and CEO of The SCAN Foundation, recently wrote: “American health care is too fragmented, too opaque and not person-centered.”
For the study, Co-Architecting Healthcare Transformation: How Leading Health Systems Put Patients and Families at the Forefront of Design, EIN (part of Vocera Communications) surveyed 103 health system leaders and 54 patient/family member partners. "Patients and families are instrumental in shaping a sustainable future for health systems to thrive in an increasingly competitive environment," Liz Boehm, research director for Vocera, said in a statement accompanying the report. "These important stakeholders must be deeply engaged as co-architects to shape all aspects of care redesign because they bring a unique and valuable perspective on what is needed to transform and accelerate health care to the next level."
The gloomy reality, according to the survey, is that hospital systems still generally view patient-family input in decisions as “optional,” particularly for hiring decisions and day-to-day hospital operations. Only about one in five of the health system respondents said their hospitals required patient-family input into strategic decisions such as opening new facilities. And the median annual budget for patient-family partnerships: less than $50,000.
What’s more, patients and families, the study said, still lack representation at the highest board level, “where votes and decision authority often rest.” Only 33 percent of health system respondents said there are patients and families on their board of directors.
But — and here’s the glimmer of hope — growing numbers of hospitals are now insisting that patients and families be part of the decision making process to keep the medical centers running well. The study said 81 percent of system respondents noted their organization has at least one hospital-level, patient-family advisory council. A few states, like Massachusetts, have passed laws mandating such councils.
Hospitals That Get It
A few hospitals include patients and families in much bigger ways, though.
For instance, Bronson Healthcare, in southwest Michigan, involves patient-family “partners” in a variety of way. Marilyn Potgiesser, who is its system manager for patient and family centered care and an RNC (Registered Nurse, Certified), works with a team of patient-family advisers to join nursing huddles, participate in hospital employee events and have seats on most of the health system’s key committees.
These patient-family advisers often attend meetings that are otherwise usually reserved for professional attendees — like the Michigan Health and Hospital Association conference.
University of Missouri Health Care’s Chief Patient Experience Officer Kevin Gwin actively looks for patients and family members who have shown interest in a particular issue. His health system scours patient complaint (and compliment) reports and frequently conducts surveys to ask patients and families about their experiences and what could be improved.
Then, Gwin and his team identify patients and family members who’ve struggled receiving care and who want to help the hospital improve. These people are asked to offer ideas.
The report also cited Daryl Bell, professional practice leader and lead, patient- and family-centered care at Kingston General Hospital, in Ontario, Canada, saying that since 2009, the hospital has seen “dramatic improvements in its finances, quality, safety, clinical efficiency, patient experience and employee engagement.” A chief reason, says Bell: patients are engaged as “true partners in all decision processes.”
Unfortunately, examples like these are still far from the norm. The EIN study said patient-family partners generally have “limited involvement in day-to-day operations.” They only “sometimes” get a say in technology decisions; this at a time that technology is ubiquitous in health care. Usually, when patients and families are asked to be involved in tech decisions, it's after the technologies have been evaluated and implemented, the study said. That’s pretty late to have much effect.
Hospitals appear to think they’re doing a better job including patients and families than they really are. While 61 percent of health system respondents said patient-family improvement partners are involved in deciding what problems need to be addressed, just 42 percent of patient-family respondents agreed.
What Hospitals Can Do
How should hospitals behave to become more person-centered?
The EIN report offered this suggestion: Make a rule that if a change involves more than three people or three process steps, patient input is required.
Something else that would help: provide training to patient-family improvement partners. The EIN study said most of these partners get limited or no training to help them succeed.
Many patients and family members truly want to be helpful, for altruistic reasons. The ones who are assisting hospitals said in the survey that they do it to: contribute to their community, make care better for themselves and/or their loved ones, give back to the system that provided them and/or their loved ones with care, create some good out of their illness or experience and “fix a broken system.”
Hospitals and hospital physicians: don’t heal thyself; let patients and family members help you mend your medical systems.