Patient-Centered Care

Last month, my father-in-law fainted in a restaurant, and we thought he might be having a stroke. He required an ambulance drive over to one of the local hospitals. The police were great, the EMT was great, and the fire department was great, as were the admitting people in the emergency department and every one of the people over at the hospital. The amount of workup he received was unbelievable for someone who was probably just fainting.

He had an emergent CAT scan, an MRI and a chest X-ray. Eventually he stayed overnight to get a echocardiogram plus more lab tests. All in all he was probably somewhat dehydrated that morning, took his antihypertensive pills, dropped his blood pressure, had a drink and pretty much keeled over.

I’m not here to discuss the amount of resources used, because, of course it was my father-in-law — and it didn’t help that besides me, his other son-in-law was an internist in the same hospital and his three daughters are a psychologist, an epidemiologist and an occupational therapist. Everybody in the ED room was so health-oriented, I think the ED felt they had to do everything possible.

What I really thought about during this episode was not so much the great care they all gave, but rather the claim that hospitals have that they are patient-centered.  The attending physician, after receiving the handoff from the ED physician via electronic medical record (I was very impressed), came into the room and explained the results of the CT scan. This very bright woman explained to my father-in-law, who is not medically oriented, the findings of the CT scan. She used so many medical terms that I had to ask her to stop and tell her that “he has no clue what you are talking about. Speak in layman’s terms.” Sometimes we get so caught up in trying to tell patients technical things that we forget that unless you speak their language, it is difficult to understand.

I’ve been reading much lately by Dr. Charles Denham and, of course, Dr. Donald Berwick about being patient centered extremists. They believe that patient and family involvement starts with educating patients and families and ends with listening to them and taking them seriously.  Patient-centered care means that patient and family input is emphatically built into systems of performance improvement and if patients and families are taken seriously as real experts, and are respected for their valuable perspective of how care can be improved, then organizations can improve at improving.

Denham would say, “leaders drive values, values drive behaviors, and behaviors drive performance.” Engaged leaders need to provide the resources necessary to ensure that the systems are in place.  They need to guarantee that vital patient and family input are built into the practices adopted, leadership resources and systems.

We as leaders need to constantly remind staff and each other that the people whose lives we are guests in deserve us to speak in languages they understand.  Safe, high-quality health care is neither accidental nor static, according to Denham. Rather, it is the result of deliberate actions by dedicated people, including active listening, planning, implementation, and evaluation by organizational leaders and providers of care within their healthcare enterprise.”

Denham also says the culture is the collective behaviors of an organization, or what some have described as “what people do when no one else is looking.” It reflects the operational values of the organization, which may not necessarily be those espoused in brochures or walls in the lobby.

We’re doing better, but we can do much better. The final icing on the cake has to do with us treating patients and families respectfully, using their knowledge, and speaking to them in languages that they can understand.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

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