It’s the Patient, Stupid.
By David Sandman, President and CEO, New York State Health Foundation
Published in the Huffington Post on September 26, 2016
In 1992, the other Clinton—Bill—successfully ran for President using the key message, “It’s the economy, stupid.” The phrase was coined by his campaign team to remind themselves and voters that the key to victory lay in focusing on the weak economy. It was a clever slogan. More importantly, it was a simple and potent reminder of what actually mattered to people.
When people talk about “patient-centered care” like it’s a radical, revolutionary idea, I have a similar reaction (“It’s the patient, stupid”). Who else but the patient should be at the center of the care system? Organizing the health care enterprise around the patient should be an obvious no-brainer.
And yet, the reality is that too often the patient is an afterthought. The patient winds up being secondary to the needs of providers, insurers, drug companies…everyone else with a stake in our health care system. Purchasers, providers, and payers are usually part of decision-making, but the most important “p”—the patient—is generally excluded.
I had a vivid reminder of this recently when a family member was hospitalized. I could fill this post with a long list of things that went wrong and instances when she—the patient—was treated almost like an inconvenience. I’ll share just a few:
- After being admitted through the emergency department, she spent nearly 24 hours lying on a gurney in a hallway while waiting to be placed in a room.
- She wasn’t fed dinner or breakfast.
- When she complained about a malfunctioning machine that constantly clanged and kept her awake, a nurse angrily told her, “It’s your heart, darling.”
- When she finally got a room, she couldn’t get a decent night’s rest because she was awakened for things like yet another blood pressure reading.
- A doctor appeared to check whether her medications matched what she’d been taking at home. He never reappeared and there was no communication about results.
- When she was being discharged, there was a problem obtaining the prescribed pain medications through the pharmacy. Instead of paging a doctor or addressing the medication issue, the head nurse said, “You don’t need them. Take a Tylenol.”
These are not examples of life-threatening adverse events. They don’t constitute malpractice. But they illustrate how often the patient is neglected and mistreated, rather than being treated like the center of the health care enterprise. What’s really shocking about them is they aren’t shocking, that patient-centered care isn’t the norm. I bet you all have own stories just like these (and I invite you to share them in the comments. It might be therapeutic to get it out of your system).
Although the imperative for patient-centered care seems so obvious, maybe it will take a revolution to get there. It will require a cultural shift in our health care system that makes it unthinkable to leave a patient in a hallway overnight without food, sleep, or information. And it goes beyond the inpatient experience: a truly patient-centered system will prioritize patients at each touch point, and will include patient and family input and shared decision-making that reflect patients’ own values and preferences.
We have a new roadmap to move in that direction. The Health Care Transformation Task Force recently released a framework of six guiding principles to ensure that patients’ and consumers’ priorities are addressed when providers consider payment and delivery reforms. The principles are:
- Include patients/consumers as partners in decision-making at all levels of care
- Deliver person-centered care
- Design alternative payment mechanisms that benefit consumers
- Drive continuous quality improvement
- Accelerate use of person-centered health information technology
- Promote health equity for all
Those are big ideas, but the framework also includes operational questions to help providers identify concrete and practical steps to develop a person-centered model of care (summarized nicely in a Health Affairs blog post).
The language of this movement matters: a “person” includes both patients and consumers. That may sound like I’m splitting hairs, but we interact with the health care system in very different ways, depending on our specific circumstances at the time.
If you’re having a heart attack, you’re not in a position to shop around for the highest-value health care. In a medical emergency, you’re surely more of a patient than a consumer. When you’re a patient, you’re at your most vulnerable: you’re sick, and you’re probably scared. The system is supposed to help make you better, to treat you, to prevent further illness, to do no harm.
But if you are newly pregnant? You can be an engaged consumer; you’re in a perfect position to research and plan out your maternity care. Facing a joint replacement? Same thing: consumer.
Consumers want and expect some level of choice, control, and convenience. They want options with clearly explained risks and benefits. They want price transparency, so they can compare costs and know upfront what their bills might be. They want meaningful and understandable measures of quality to assess value for money. They want to be assured of safety and to receive clear instructions and information. They want empathy, to feel cared about instead of ignored. They want a good health outcome and they want a good customer experience; they shouldn’t have to choose one or the other.
It was relatively easy for Bill Clinton’s team to remind themselves and voters that the economy should come first. Actually fixing the economy was a lot harder. The same dynamic applies here. We can spout rhetoric about person-centered care, but making it come true will be harder. Change begins with self-awareness. With patients engaged as full partners, it’s time that our health care system recognizes that, yes, it’s the patient, stupid—and places that patient right where she belongs: at the center.
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