Patient-Centered Care Redistributes Responsibility

Betty A. Marton for HealthLeaders Media , May 8, 2012

Additional benefits and opportunities
Self-administration has also opened up opportunities for physicians, nurses, and respiratory therapists to reeducate their patients on how to use their medications—and some of those patients may think they're doing it correctly, but have fallen into bad habits over the years.

"I had one patient who kept getting readmitted and always said ‘yes' when I asked him about his medications," Cohen says. "But when I had the opportunity to see him self-administer in the hospital, I could see what he was doing wrong. From that I learned how to ask more specific questions and work with them to get better adherence."

Having dramatically reduced the time it takes to provide the care CF patients need has reduced the average length of stay in the hospital for CF patients to seven days from 11. The success of self-administration is also reflected in patient and professional satisfaction surveys: Satisfaction rates for both groups rose from less than 20% before the intervention to above 95%.

"There's no one-size-fits-all model when trying to build patient-centered care," says Boal, "but studies show that the more control patients have in the hospital, the better the outcomes. The way the culture changed around the care of CF patients is teaching us how to let patients with chronic illnesses be the experts they are."

The group, with most of its original members, continues to meet weekly and apply the clinical microsystems process to a range of other issues to perfect the care LIJ Medical Center delivers to its CF patients. This includes the self-administration of insulin for those patients with CF-related diabetes and helping residents use the redesigned order set with new EMRs. The group is also focusing on improving the transition of patients from pediatrics to the adult hospital and has turned its attention to how the staff can improve end-of-life care for patients and their families.

"What's remarkable is that this sophisticated work can only be done at ground level," explains Jaffrey. "People who do the day-to-day work can get through these issues with so much velocity. When we empower them to be the change agents, we're leveraging the largest untapped resource we have in healthcare."

This article appears in the April 2012 issue of HealthLeaders magazine.

Reprint HLR0412-9

Betty A. Marton is a contributing writer for HealthLeaders Media.

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5 comments on "Patient-Centered Care Redistributes Responsibility"

Steve Wilkins (5/21/2012 at 10:12 AM)
Let's be very clear here...patient centered care does not mean giving the patient information or teach tjem self care skills. Patient centered care begings with providers tailoring what they say and do to the patient's health perspective, e.g., health beliefs, concerns, experiences, etc. Patient-Centered Care Begins With High Quality Doctor-Patient Communications

John Burik (5/15/2012 at 7:53 AM)
I'm very much for client- or patient-centered care. The potential downside is when the corporate types begin seeing the profit in this and start cutting appropriately trained and licensed staff with the rationale that we're "empowering" patients.

Deb (5/10/2012 at 8:52 PM)
This is an interesting article, well beyond CF. With all the talk about wanting more "enagaged" patients (which typically means people who do what a provider tells them to do); as this article points out when patients are "enaged" and know what they need for their well-being, they're met with resistence. What if instead of "engagement" we were seeking more of a partnership?




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