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I recently participated in a rich discussion of payment reform and its potential impact on care delivery, and I was all set to blog about the pros and cons of the myriad of reimbursement strategies tried (and tried again but with slight modifications and new names) to improve the healthcare value proposition ... but something didn't feel quite right. I couldn't put my finger on it but for some reason I knew reimbursement strategy was not what I should be writing about at this time.
While I processed this "writer's block," I began to receive a number of blog posts, articles, studies, and stories with a similar relationship-centered theme.
- The blog post, "To connect with patients is key," by Dr. Craig Koniver
"If we are unable to connect with our patients, then it will not matter what prescriptions we write or supplements we recommend. Most of us pay this no attention. We go into the exam room and out again in a matter of minutes with prescriptions already printed."
- The study, "Understanding Healing Relationships in Primary Care," from the Annals of Family Medicine
The purpose: "Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained. "
The conclusion: "Healing relationships have an underlying structure and lead to important patient-centered outcomes."
- An email from a dear friend and true leader working on the front-lines of the healthcare system
(Paraphrased) "Staff are not positioned to support the families in ways they should leading up to death. Families of dying loved ones are scared; they think that if they can just keep the persons heart beating they won't have to feel the pain of loss. The nurses know what is coming, but the system fails the patients when nurses are not positioned to sit and share time with patients and/or families through the sadness of the dying process and talk with them about the fear and the unknown."
- The blog post, "Compassionate care is a crucial component of care," by Joyce Hyam
"We must reinforce the importance of providing compassionate care as it does make a positive impact on all of our lives."
These are all brilliant stories, so poignant, so impactful, so connected to the important things in healthcare ... and in life. And yet still to this day, these messages are not the norm when thinking about how to improve the healthcare system.
When was the last time you heard a healthcare leader say: "Let's improve the healthcare system by increasing the opportunities for healthcare providers (doctors, nurses, therapists, etc.) to truly connect with their patients"? Or "Let's invest in training our healthcare providers on how best to make an authentic connection, to establish relationship, to be emotionally intelligent, to be truly present, to listen, to engage, to empathize"?
Interestingly, the same rich conversation about payment reform mentioned above also netted fascinating data points that linked very nicely to the healthcare relationship stories I received. For instance, 10 percent of health outcomes is due to actual healthcare. The other 90 percent is due to health behaviors, socioeconomic factors, and the physical environment.
Digging into the numbers even deeper ... of the 10 percent of health outcomes due to healthcare, 90 percent of what physicians do involves connecting with patients and 10 percent involves the science, as taught in medical schools 30 years ago and highlighted in Dr. Craig Koniver's blog post.
Fascinating, I thought, and loving numbers I calculated further ...
Based on these data, 1 percent of health outcomes is due to the science of medicine, 9 percent of health outcomes is due to practitioners connecting with their patients, 10 percent is due to the patients' physical environment, 40 percent is related to socioeconomic factors, and 40 percent comes from health behaviors.
Payment reform or the importance of relationships to healing ... clearly my heart chose the latter (for this week).
If these data are correct (or even in the ballpark), it is even more imperative that healthcare system improvements (be they in care provision, delivery system changes, and/or reimbursement strategies) are in line with bringing relationship and connection back into the healing process. Electronic health records, the latest pharmaceutical drug, a new surgical technique are all important to optimal healing. But they are not more important than the connection between a healthcare worker and a patient.
Don't believe me? Just look at the numbers.
Thomas H. Dahlborg, M.S.M., is Vice President for Strategy and Project Director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being by improving the systems responsible for the delivery of children's healthcare. He has 23 years of experience leading collaboratively, creating optimal healing environments, analyzing and addressing practitioner and patient needs and expectations, and developing and implementing focused and aligned strategic plans.
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