As a hospital patient, I had an earache and trouble sleeping. "We'll get you some medication," the nurse said.
I looked at the capsules in my hand. Then a dose of reality hit me. I remembered I was allergic to that particular over-the-counter cold medicine. They knew that. Didn't they?
Patient-error, avoided, thanks to the patient: me.
At that moment, I was a responsible patient, an easy catch. But of course, that's not always the case, with me or any other patient. Now, healthcare leaders are trying to catch up with the idea that patients have a responsibility to take care of their own health, whether it's being on top of their medications, getting more exercise, or eating right.
But providers have a role, too. It's not hand-holding, but initiating electronic systems and other educational approaches to help patients become partners in their care.
As I report in this month's HealthLeaders Magazine, Peter Pronovost, MD, senior vice president at Johns Hopkins Medicine and the Armstrong Institute for Patient Safety and Quality in Baltimore, says health systems have a ways to go to help empower patients in the health care process. Most education that patients receive in hospitals is "completely inadequate," he says. "More and more, the private sector is working on educational tools for patients," he says.
Johns Hopkins has produced a video to encourage patient involvement, and is working on plans to make videos for patients to elaborate on their stories and needs.
Patients are the fuel that makes hospitals run, and why they exist. Patients are also a headache for the C-suite.
That is certainly reflected in the HealthLeaders Media 2011 Industry Survey, in which leaders cite patient noncompliance and lack of responsibility as the fifth-greatest driver of healthcare costs at their organizations. A quarter of respondents cited patients as among the top three cost drivers, ahead of health plan overhead, medical devices, pharmaceuticals and malpractice litigation.
The lack of communication between patients and primary care physicians when a patient is discharged from the hospital, for instance, can compromise patient safety, and lead to a return visit to the ED or hospital.
Easing patients' concerns can improve Hospital Consumer Assessment of Healthcare Providers and System scores.
Hospitals are investing in programs to promote patient involvement in their own care, saying speed is crucial. Strictly on a health basis, more young people are facing weight issues, and more young people are facing diabetes, while others confront chronic conditions that are adding to patient care issues as well as costs.
Industry stakeholders are also under pressure to adapt behaviors to improve outcomes and contain costs, and none is more integral to the process than patients, says Susan Frampton, president of the Planetree Institute, Derby, CT, a network of hospitals that support patient-centered care.
"Everyone is focusing on patient engagement because it's going to be necessary," says Frampton. "It's the only way we can execute on the concepts of Accountable Care Organizations, or other healthcare initiatives. You can't go very far on any of that without having an engaged, empowered patient. I think the irony is we are struggling to retrofit a system that was set up to disempower patients."
For example, medical records were once sealed from patients like secret CIA documents. Even now, patients admitted to hospitals see their possessions put in little bags, and removed, "like you are in jail," Frampton says.
At the same time "we are looking at patients and families and challenging them to be better partners in their care," Frampton says. It's not going to be easy, she concedes.
To help ease transitions of care, Planetree initiated Patient-Centered Lean, a spin-off of the Lean production process for improved efficiencies that health systems have used, modeled after the Toyota system. The patient centered approach aims to involve patients and their families throughout the process of their care, from meetings with physicians and staff to evaluating care post-hospitalization, Frampton says.
The idea, as Planetree notes in planning documents, is about "improving "patient satisfaction, quality and experiences of care, and improving the caregiver workplace satisfaction and engagement."
While hospitals focus on improving patient involvement in their care, so are physicians. Ultimately, patients must become partners with their physicians and lay out a care framework.
Too many primary care physicians don't press patients to take care of themselves, says William H. Bestermann Jr., MD, medical director for medical home quality at the Holston Medical Group in Kingston, TN. Generally, "primary care physicians mean well and don't do well," Bestermann says. "If you talk to doctors and ask why they don't achieve these things they'll say, "My patients aren't compliant enough and they don't do anything I tell them."
Bestermann and other physicians at the Holston Medical Group have rearranged workdays to help patients become more involved in their care, he says. They changed visiting hours to be more flexible for patients, to get a better sense of their needs, and to learn what more they can do for themselves.
While technological improvements have helped patients, not all of them are the be-all-or-end-all to initiate patient involvement, says Roberta Schwartz, MHS, senior vice president of operations for the 864-bed Methodist Hospital, Houston, TX.
"One of the most important things is for patients to take the time to understand what is going on with their care, and recognize they have a right to get every question answered," Schwartz says.
Methodist Hospital offers free programs for weight management and diabetes that answer questions and help physicians and nurses work with patients to prepare for upcoming procedures or manage chronic conditions.
The idea, Schwartz says, is for patients to "take control" of their health.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
