US Surgeon General Regina Benjamin, MD |
So what were the
opportunities/marching orders we came up with for 2013?
1) Patients can help fix health care. Use them.
2) Hospital C-suite types are still worried disclosing
medical harm to patients will lead to lawsuits. Please get over it. It just isn’t so.
3) Many hospitals (you know who you are) aren’t trying hard enough to reach
performance goals (PfP goals are to reduce hospital readmissions by 20 % and
healthcare-acquired conditions by 40 % by the end of 2013). You need to step
up. If you can’t do it, one patient
advocate has a simple solution for you. (It’s at the end of this post).
Sitting in the audience, I
loved much of what I heard. There was Jessie Gruman, a multiple
cancer survivor, offering her take on the big buzz-phrase in health care:
“patient engagement”. As she rightly points out, the millions of dollars
invested in her various treatments are dependent on HER engaging to find the
right doctors, choose the best treatments, manage surgeries, drug treatment and
care delivery. Never mind the medical, lifestyle, emotional and spiritual
gauntlet she has to manage in between. In the absence of electronic health
records (still not ready for prime time in many respects), the smooth operation
and integration of one’s care REQUIRES the patient to engage. In other words,
patient engagement isn’t a pleasing option, like sour cream with your baked
potato. Without patient engagement, the potato doesn’t get cooked.
Few people have earned
their stripes on this topic as much as Gruman. Founder and President of the
non-profit Center for Advancing Health,
she’s beat back five life-threatening illnesses, including stomach cancer diagnosed
just two years ago.
Three of her most
Tweet-worthy points:
- “We (patients) know mostly nothing about health
care. We don't want to know. We approach on a need-to-know basis.”
(Gruman has 11 physicians she has to see twice a year, so she needs to
know a lot). Not one physician, she says, has ever communicated with
another. “This is not a good
idea.”
2. Despite all the hoopla over IT, “there is no ‘killer app’ that will make us [patients] engage”.
3. “Engagement is not compliance". (Love that one.)
Virna Elly then told us
what it was like to have lived with type 1 diabetes and chronic kidney disease for most of her life, and a successful kidney-pancreas transplant
eleven years ago. “I was a Medicare and Medicaid beneficiary by age 32.” Her plea:
“We need more than a line at the end of a conversation or pamphlet telling us
to ‘ask questions’. We need time to process and absorb, then ask questions. Why don’t you ever ask ‘what do you
think of the information we gave you’? Why don’t you follow up? You need to
meet patients at their level, how they need [information], when they need it.”
Poised and articulate,
business suits mostly covering their accumulated battle scars, these were just
a couple of the well-chosen patient presenters whose presence, learnings and good sense were warmly received by a receptive audience. By all
means, let’s work on developing this partnership in 2013.
Tim McDonald of UIC talks "transparency" |
The plea I’ve heard from
patients echoes the findings of a bunch of studies: Often, all an injured patient and
family may really want is to know what happened and why, perhaps an apology, and to receive a reasonable monetary award (see story on the Malizzo family, below). In an effort to achieve that,
dozens of states have passed what are called “I’m Sorry” laws. They allow a
physician to discuss openly an adverse outcome with a patient and express
empathy. The University of Michigan Health System pioneered this approach back
in 2001. When medical harm happens (and it does, everywhere), they investigate,
notify patients, and offer compensation when employees are found at fault. The
health system says it’s had fewer lawsuits, lower liability costs and faster
resolution of medical-error cases since the policy was implemented.
Yay! Results! Some HENS (Hospital Engagement Networks, contracted to deliver on PfP results) and hospitals presented data that show they are doing good work, able to put aside conflicting agendas to work together and deliver results that save lives. How great is that? We applaud the hard work it takes and celebrate this success. Not just for the lives saved, but because it proves it can be done.
There was much
celebration of successfully instituting “hard stops” to early elective
deliveries (EEDs, in the medical acronym lexicon). A good thing indeed, but
described in some circles as “low-hanging fruit”. (No disrespect, but simply
ending elective deliveries prior to 39 weeks’ gestation doesn't require as much
teamwork, nuance or organizational culture change as, say, making sure patients
leave the hospital prepared and equipped to manage their care
post-discharge.)
Fact is, as some
grumble, some hospitals are resisting the PfP
objectives. They have no results to show. They haven’t joined the “patient
engagement” bandwagon, either too frozen, too uncertain, or worse, too arrogant
to dig in and do the work. Heck, they’re hoping the bandwagon will go the way
of the stage coach: a product of its time, but merely a transient chapter in
history. (And what, exactly, happens when the PfP contract expires at the end
of 2013? No one is sure.)
Barb & Bob Malizzo at QualityNet2012 |
I sat with Bob and Barb
at the end of day two of the conference. They are a warm, sincere and engaging
couple, though their grief over losing their daughter is never more than a word
or gesture away. “What did you think?” Bob asked me of the last two days’
events. “Well”, I began, “it’s great that the patient perspective is such a big
part of this.” Bob looked pointedly at me. “What about the hospitals that
aren’t stepping up?” he said. “For every one that’s working on getting better,
a bunch of ‘em are dragging their feet.”
I looked at him. “You
have a point.” It was clear he had something in mind. “You’ve been a business
owner,” I said. “You’ve even been mayor of your city. What would you do?”
He leaned in. “When
people don’t perform, when they don’t do the job they’ve been hired to do,
there’s only one way to go.” He beckoned me closer. “You fire their ass.”
Ah yes, there's that.
Is this little-mentioned
option really an option? Do you want the board of your hospital considering
such decisive measures? If so, maybe you should let them know.
Or-- what are your best
ideas to achieve the PfP goals within the next twelve—now eleven-plus-- months?
Because the clock, as they say,
is ticking.