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“She was shocked. ‘How could it be?’”
As I sipped my iced green tea the other morning, an incredible woman who has now become a good friend shared with me the following story:
“To say that Dr. Jankowski [name changed] was absolutely floored when the findings were shared would be an understatement. She was also disheartened and hurt and asked me, ‘how could this be?’”
My good friend continued:
“Dr. J had been charged with instilling a patient-centered care culture within the large healthcare system. She had been working day and night with her team to manifest the needed change and the new focus. She felt good about the effort, and yet the progress was not what she had hoped for or expected. Yes, the healthcare system’s marketing and communications highlighted patient-centered care, and yet she knew if you pulled back the curtain the reality was not congruent with the branding.”
Honor knows no statute of limitations. ~ Samuel E. Moffat
The bar was dark, loud and smokeless.
The table set with a glass of pinot noir and a non-alcoholic fruity beverage.
The voices of the two healthcare quality leaders were hushed but steady.
“Once we have a financial model in place, our ability to improve healthcare provision will be much more attainable.”
“It requires a financial model to be in place prior to doing the right thing? We cannot wait. Patients are being wounded. Families are being harmed. Communities are being hurt. Over 50 percent of inpatient adverse events are preventable. The harm rate in healthcare is staggering. Yes, a financial model aligned with our aims is important, but doing the right thing should not be dependent on it. We need to identify those people who truly value patient safety--those people who are not reliant on a new financial incentive to do what is right, those people who truly care--and ensure they are positioned to both lead and serve in an effort to improve the healthcare system. A financial model is important. It is also a technical fix to an adaptive challenge. We cannot wait.”
Over the past few years I have written a number of “patient non-compliance” pieces for Hospital Impact, and apparently the posts have struck a chord with readers.
Today I am sharing brilliant feedback from a local healthcare leader and a story that highlights the impact to patients, families, communities and the costs of not improving the system to better address this challenge.
First the feedback.
After having read and reflecting on a 2014 Hospital Impact post, “Lessons on Patient-centered care,” a local healthcare leader shared:
A number of years ago, I wrote the post for Hospital Impact titled, "The bane of many physicians: The 'non-compliant' patient," in which I highlighted:
“We must lose the ego that exists in the system, lose the hierarchical approach to healing, and truly engage with and help patients get well.”
More recently for the Arnold P. Gold Foundation, I wrote the piece, "Non-compliance explained ... and what healthcare leaders can do about it," and noted:
“In too many cases, women and men who are considered “non-compliant” by the traditional medical system were victims of abuse as children. For example, experiencing sexual abuse as a child can lead a person to have an insecure relationship with their body and thus with food. Those who have been bullied by coaches and others during youth sports may end up with severe distaste for exercise. But physicians rarely hear about these experiences, and do not understand these barriers in their patients’ way.”
Back in the early 1990s, while working for Harvard Community Health Plan (later Harvard Pilgrim Health Care), I was involved in the implementation of quality-based incentive programs (now called pay-for-performance or P4P programs) where we incentivized physicians and medical practices to do certain things such as improve patient satisfaction and adhere to a drug formulary.
Some years later, while at Martin’s Point Health Care, I developed these incentive models and oversaw their use and impact. And over time I learned a great deal about controllable outcomes, unintended consequences and the direct and indirect impacts of such models.
Now 15 to 20 years later, as we continue to move from productivity-based reimbursement to quality-based reimbursement via the accountable care organization and other payment reform models, a large caution sign is illuminated before me.
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