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Why isn't patient-centered care a fact instead of just an effort?

November 24th, 2008

by Christopher Cornue

My colleague, Nick Jacobs, recently wrote about patient centered care gaining momentum. I couldn't agree more. At a meeting I recently attended with international leaders for healthcare, this was an major topic.

Each year when the International Society for Quality in Healthcare (ISQua) meeting convenes, there is always a focus in patient-centered care. Up until this year, one of the fathers of patient centered care, Harvey Picker (who passed away earlier this year) was always present, and gave us his insight, motivation and charge to "make a difference" at our respective organizations. This session normally culminated with recognition of leaders in the industry making change happen toward a safer environment for our patients.

[More:]

This year, James B. Conway, among others, was recognized, but it was his specific recognition that most significantly impacted me. Conway took over the role as EVP/COO at the Dana-Farber Cancer Institute immediately after it received attention for a patient who was provided a lethal overdose. The stories Conway told and the actions he took to publicly express what had happened was--and still is--a testament to all of us leading healthcare institutions.

He (and the board) made a bold and, at that time, unusual move that ensured the hospital owned up to its mistake, while at the same time committing to sweeping changes. Those actions are why both he and the Dana-Farber Cancer Institute are recognized nationally for their efforts in the area of patient-centered care.

Over the past few years, several situations have occurred that have caused people to be both horrified at our industry, and proud of the leaders who take positive stands against such situations. So what can we do to make sure that patient-centered care is a normal part of our daily business?

In the coming weeks, I'll be writing about a this effort. Until then, please reflect about what we can do; my sincerest thanks to James B. Conway, among others, for his leadership in these efforts.

9 comments

Comments, Pingbacks:

Comment from: Scott Holmes [Visitor]

With preventable medical errors costing hospitals over 20% to fix these mistakes, one would think this huge ROI would drive industry to develop and market aggressively, and encourage payers to share in the savings.

Maybe GE's new strategy will result in this.

11/25/08 @ 15:33

Comment from: Myron Pulier, MD [Visitor] · http://www.umdnj.edu/~pulierml/

A patient-centered approach could do much toward restoring people's respect for scientific medicine and confidence in their personal physicians. One way to break the current logjam is to train primary care physicians in patient-centered (AKA motivational) interview style in a package that supports a first step towards (modestly) re-engineering the practice toward supporting patient-centered care. I'd love to discuss implementing such a package (I have a concrete proposal in the works).

11/25/08 @ 16:48

Comment from: Bob [Visitor]

Patient centered care will remain an initiative rather than a fact as long as we have payer centered care.

11/26/08 @ 08:48

Comment from: Jill [Visitor]

Agree with Bob. Patient centered care is not a possibility when care is dictated by profit-driven companies.

11/26/08 @ 10:07

Comment from: Dantes [Visitor]

Non sequitur that with profit, patient centered care impossible, as is the assertion payer centered care makes it an initiative.

Medical care is an economic service. If the provider of the service is rewarded for providing good care, then there will be an incentive to keep providing it.

Unfortunately, payors are the middleman...and so are hospitals...often working at odds with the physician. The move to employ physicians means the patient no longer employs the doctor.

Frankly, there are so many meddlers and middlemen involved in hospital care now, it is defocused. The nurses want to make rounds. The pharmacists, the social worker, the dietician, the physical therapist.

One cannot pick up a chart without seeing a half dozen other uninvited "hospital employed guests" on the chart.

It's not patient centered caree anymore because its turned into caregiver centered care, with disastrous results.

11/26/08 @ 18:36

Comment from: Scott Hodson [Visitor] · http://mavhc.com

I agree with Dantes that fragmentation and lack of aligned incentives pose significant barriers to the achievement of patinet centered care. However, my firm has found that it is very possible to implement the sort of "sweeping change" that Christopher mentions in his article to dramatically improve the quality of patient care provided while reducing waste and cost inefficiencies.

However, hospitals are frequently burdened with an overabundance of uncoordinated improvement initiatives that create a "flavor of the month" approach to change. Predictably, this results in incremental improvement at best.

Development of a comprehensive Quality Improvement Strategy that addresses the processes, infrastructure, organization and culture change is the first step in achieving breakthrough improvement in quality, patient safety, and cost efficiency.

11/30/08 @ 14:28

Comment from: Ed Howe [Visitor] · http://actionforbetterhealthcare.com/

Both the medical care and hospital sides are trained and incented to provide acute care. As long as we have a la cart pricing rather than bundled pricing we are creating an environment that stifles innovation and the coordination of care.
Providing integrated care with a focus on early detection of problems, adopting strict protocols for managing chronic diseases, and rewarding doctors for providing chronic care would go along way toward improving American healthcare.
Encouraging the formation of integrated delivery systems to provide such care is essential. Only such systems can provide the information systems, discipline and leadership to rapidly improve results.
Two suggestions: first, let’s have a trial reimbursement pilot that bundles prices and share the rewards with the providers and the government; second, let’s involve the patient in his care and make him partially accountable for both the cost and quality of care.
No doubt we should demand better results at a better cost, but we surely have proven by now that a top-down, regulated approach that tries to control how and where care is delivered does not work. It does not mater if the controlling agent is the government, an insurance company, or hospital executive. Our system delivers just exactly what it is designed to do. Let’s change the design.

12/10/08 @ 11:55

Comment from: additive fuel [Visitor]

Excellent post a very interesting read...
additive fuel

08/17/10 @ 03:03

Comment from: soksana [Visitor] · http://www.seksizlesene.net

One way to break the current logjam is to train primary care physicians in patient-centered (AKA motivational) interview style in a package that supports a first step towards (modestly)sex re-engineering the practice toward supporting patient-centered care. I'd love to discuss implementing such a package (I have a concrete proposal in the works).

08/31/10 @ 18:40