Patient-Centered Health Sites Improve Patient Outcomes and Physician Satisfaction
Is your healthcare site patient-centered? If you think it is, how do you know? Have you measured what your patients (clients) think? Being patient-centered seems to be a hot topic in the healthcare field over the last 6 or 7 years. I first read about it in the Institute of Medicine's report "Crossing the Quality Chasm." It appears a multitude of times in articles and websites about the Patient-Centered Medical Home for primary care providers. Dr. Carolyn Clancy, director of the Agency for Healthcare Quality, recently authored an article on this topic for "Patient Safety and Quality Healthcare." Why is this such a prominent topic at this time? Dr. Clancy states in her article that "patients are the best source of information about their own bodies and about how they prefer to be treated. They should be active participants in decisions about their treatment...When patients play an active role in their healthcare, they are more likely to comply with their treatment-and enjoy safer care." From her point of view, the patient enjoys many benefits. From my point of view, this is also a win for the healthcare site. For one, if the patient has a chronic disease, then the primary care physician will be much more successful in treating the patient. Instead of the patient coming in every month or so to "put out a fire," the well-managed chronic care patient can come in twice a year or so for a checkup and encouragement. Many physicians would rejoice at such success. After all, that is why most became physicians. The office manager at the primary care site may see it as a loss of income. This is not likely to be so as pay-for-performance rewards will help offset the income and most offices will better be able to meet the needs of all their patients. Also, according to a 2005 article by Truls Ostbye in the Annals of Family Medicine, most primary care physicians don't have enough time in a day to handle the needs of their chronically ill patients, much less those with acute problems. Hence, time not used in "putting out fires" can be devoted to the needs of other patients who may not have been receiving the amount of care necessary. The physician's day will still be full. For hospitals, as noted in another article in the March/April edition of "Patient Safety and Quality Healthcare," there will be lower costs in risk management. In other words, there will be fewer suits, lower insurance costs and improved patient loyalty. One local hospital used the approach to satisfying patients and families needs and concerns to rise to the top quartile of national hospitals in patient satisfaction. In fact, this year this same hospital was ranked by "Modern Healthcare" as one of the top 100 hospitals in the United States. I have used the client-centered model to increase the number of clients that I serve and the number of sources of clients. For instance, just this month one of my satisfied clients referred me to a university to work with students seeking their Ph.D.s to help with their data analysis. I have already picked up two new clients. Further, this same client referred me to a medical research office at a local hospital where I will be helping with their data needs. If this isn't enough to convince you that being patient-centered is a win for all involved then let me report the most important findings of a survey that I recently analyzed for a healthcare system. The survey of employees found that the most important characteristics they wanted in a physician were physician courtesy, staff courtesy, and physician reputation. An office with these characteristics will improve patient loyalty and thus improve outcomes for the office. Client loyalty is a key of any business (and healthcare is a business!); it improves profits since it is easier to serve repeat clients than to develop new ones. How do you know if you are patient-centered in your practice or at your site? Is it enough to think that you are because you are offering services that articles focusing on the patient-centered services say are necessary, such as email visits and other IT solutions. I don't think that implementing services such as these will be enough. The only way to really know is to ask your patients; this approach, in fact, fits the patient-centered model. Should you just ask a patient outright about important qualities identified in the relevant literature? No. The best approach is to use a survey. Dr. Clancy notes in her article that fewer than 33% of primary sites use surveys to gauge their success in providing services. Hospitals are much better as CMS vigorously promotes surveys now. Good surveys are developed by professionals, such as statisticians, with the help of the healthcare site employees. Developing your own survey with the help of a professional will yield results that provide a better fit and analysis of your site. For instance, suppose you want to measure courteousness of staff and physicians at your site. Just asking "Are the staff and physicians at this site courteous?" won't do, even if you use a 10 point scale. If the answer by the patient is generally negative, the question as asked won't provide you with any clue as to how to proceed to improve courteousness. However, if you develop a survey on-site, you will probably come up with more pointed questions, such as "Are you greeted by the receptionist when you come to the office?", "Do you feel comfortable asking questions of nurses aides?", and "Does the physician answer your questions in such a way that you are satisfied with the answers?". Using a survey occasionally at your site will give you a benchmark to start with and track your success over time. With improved success you will see better patient outcomes and improved patient loyalty and word-of-mouth referrals, which will improve your income. I believe that current literature is correct in emphasizing patient-centeredness. Emphasis on this topic will continue and more payees will base rewards on it. Adopting good businesses practices that use this approach (often termed Voice of the Customer) in continuous quality improvement models and Lean Quality Improvement models will yield excellent results. For many sites the journey towards patient-centeredness will require much effort and time. A good starting point is using professionally developed and analyzed surveys.