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Patient-centered care about more than just financial gains

July 24th, 2014

by Thomas Dahlborg

This week my intention was to follow up my recent post highlighting kindness, compassion and patient-centered care with additional positive signs of a healthcare transformation where patients and families are engaged, care teams are healthy and whole and positioned to honor their patients, and patient preferences, patient safety and healthcare outcomes are all being optimized.

And then two things happened.

The first was a discussion within the Robert Wood Johnson Foundation (RWFJ) Leadership Network LinkedIn forum. I asked a question relative to patient engagement, tools, lessons learned and best practices, and during the ensuing interchange an individual with much passion and who is also part of a team doing great work in this area used the phrase "... engagement and activation and collaboration have definitely reached buzzword status." That got me thinking. A buzzword--could it be that patient-centered care was simply "fashionable" at this particular time and that in actuality there is no longevity to this movement? Is patient-centered care simply another flavor of the month?

[More:]

Of course not, I thought.

Then I learned of a prestigious network of physicians seeking to increase its market share in a large metropolitan area and their strategy to do so was "patient-centeredness," which became strictly a means to an end to generate revenue via the quality contracts in place and soon to be negotiated. And how the scores became the end goal and not the lives of the patients they served. It was the very thing I warned about (and which causes great harm to our patients and communities) in the post "Examining patient satisfaction incentives through different lenses."

They reinforced patient-centered care as a tool to a financial end in each presentation throughout the organization, as well as by the very means they implemented to evaluate the output of their "patient-centered" efforts (all financially driven rather than patient driven).

As I processed this information I then heard the following story:

Linda was scheduled for a hysterectomy due to severe pain caused by fibroids and endometriosis. After three C-sections she was hesitant, but was losing so much blood her quality of life grew worse.

Linda had an insurance plan that required her to meet a co-payment for surgeries. A hospital admissions representative called her and did the pre-admission registration over the telephone and a payment plan was agreed upon for the co-payment.

Linda had the surgery and it was successful.

Post-surgery, while heavily medicated and still in post-recovery on a GYN floor, Linda received a call in her room from the hospital billing department. They informed her she needed to pay her co-payment in full before she was discharged.

Linda tried to explain that she had made prior arrangements for a payment plan but the billing person disagreed and reiterated payment is due prior to discharge.

Reminder: Linda is in the hospital and in recovery after major surgery and on the same day as the surgery receiving a call from the hospital billing department.

Now Linda's post surgical stress elevated and she cried just as her nurse walked in. "Are you okay?" she asked Linda.

"NO! I AM NOT OKAY!" Linda began to tell the nurse what happened.

The nurse offered Linda pain medication as she could see her stress and pain increased with this phone call. She also contacted a patient advocate.

The advocate came to Linda's room, talked in length about what was happened, met with the billing department and eventually Linda was discharged with the originally agreed to payment plan.

Patient-centered care? I think not. Linda was grateful for her nurse and patient advocate, but clearly this should have never happened in the first place. Patient-centered care must transcend the entire organization, and all staff must understand the positive impact of patient-centered care, along with the adverse impact of not doing so.

As healthcare leaders we cannot allow patient-centered care to simply be a "buzzword." Patient-centered care must become the fabric of our healthcare system. Patient-centered care must permeate throughout the system (yes even into the billing department). It must resonate deeply from the president and CEO office throughout the organization and back again.

Even though it has the potential to do so, patient-centered care is not simply a tool to gain market share and to improve revenues. Patient-centered care is a commitment each and every one of us within the healthcare system must choose to honor, to provide and to hold dear just as we should our patients, our families, our communities and one another.

As leaders we must position our teams to honor our commitment to patient centered care. What is the very next thing you will do to ensure this commitment is being honored within your organization?

Thomas H. Dahlborg, M.S.M., is chief financial officer and vice president of strategy for NICHQ (National Institute for Children's Health Quality), where he focuses on improving child health and well-being.

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