As cost and care supply fashions shift in the United States from episodic, charge-for-service care towards inhabitants health and worth-based mostly reimbursement, health care leaders are targeted greater than ever on affected person engagement as a key to driving down prices and enhancing outcomes. And but, as so many people know who’ve tried to handle our personal care or are likely to sick relations, the U.S. health care system not often feels prefer it’s been set as much as assist us succeed.
What’s wanted is a elementary redesign of the affected person’s position — from that of a passive recipient of care to an lively participant charged with outlined duties, outfitted to dispatch them, and accountable for the outcomes. In different phrases, we have to view the affected person’s position as a job after which design that job in such a means as to drive the perfect health outcomes potential.
The Patient’s “Burden of Treatment”
Patient advocates and others who’ve studied the U.S. health care system have catalogued the diploma of “unpaid,” and unsupported, work sufferers tackle in service of their very own care. The common, low-danger affected person should comply with up on referrals to specialists, fill and handle drugs, and adjust to bodily remedy and different regimes. With legacy, pre-web software program techniques nonetheless the norm in most hospital environments, sufferers additionally turn out to be unpaid couriers, shuttling crucial health knowledge from one supplier to the subsequent.
According to a 2015 survey on the patient experience, almost 30% of sufferers bodily carry x-rays, check outcomes, and different important health knowledge from one supplier’s workplace to the subsequent. And 55% say their medical historical past is lacking or incomplete once they go to their physician.
For sufferers that suffer from persistent or complicated circumstances, as a Mayo Clinic paper recently argued, the “burden of treatment” have to be shouldered alongside the “burden of illness.” A 2012 research cited by the research’s authors estimated that the self-administration of a persistent sickness calls for, on common, two hours of affected person work every day — work that’s typically poorly supported, annoying, and irritating in nature.
For all of the articles advocating for “patient-centered care,” that is the change that we finally have to be prepared to make: Rather than having sufferers as passive recipients of care, they have to be lively producers of their care, in partnership and coordination with physicians and medical employees. So what are the necessities for attending to that finish state?
Account for Patient Work Across the Full Care Journey
First, we have to acknowledge and account for all of the affected person work that now goes unrecognized and unsupported. This means grappling with the complexity of duties sufferers tackle as they search care throughout an ever-increasing variety of settings — work that varies extensively relying on acuity degree, illness state, demographics, insurance coverage sort, socioeconomic circumstances, and so forth.
For years, hospitals and medical teams, trying to transfer the needle on affected person satisfaction, have targeted largely on managing and optimizing remoted episodes of care. CAHPS surveys, for instance, which function the business commonplace for measuring the affected person expertise, give attention to affected person satisfaction with particular person encounters inside a single establishment.
But the best way we entry and expertise care has modified. Where we used to have a lifelong relationship with a household physician, we now change docs incessantly because of scheduling points, modifications in insurance coverage protection, and different elements. We’re additionally extra more likely to search care outdoors the partitions of health methods or the boundaries of particular networks — whether or not it’s by way of pressing care visits, digital consults, or various therapies. And we all know that a lot of what impacts our health, for higher or worse, occurs between visits. Who is accountable for measuring the affected person expertise over time and throughout all of those disparate care settings?
As we shift towards inhabitants health, with supplier reimbursements tied on to improved outcomes, we have to transfer from managing episodes of care to managing your complete affected person journey throughout the complete ecosystem of care. The affected person journey turns into the operational backdrop towards which sufferers, physicians, and different employees and caregivers should play their respective elements.
Intentionally Design the Patient’s Job into the System
If the affected person is to have a job in the care-delivery course of, we should apply the identical rules of intentional work design to their jobs as we do to these of physicians and medical employees. In a current Physician Leadership and Engagement Survey carried out by athenahealth with 2,000 docs, we discovered that solely 20% of docs surveyed reported excessive ranges of engagement in their jobs. Those who have been extremely engaged, nevertheless, pointed to some key drivers: belief in management and the system, open communication and suggestions, and an operationally efficient work setting that permits them to ship excessive-high quality affected person care. It’s not a stretch to recommend that sufferers can be engaged and motivated by the identical drivers.
We know from basic administration concept (e.g., the work of J. Richard Hackman and Greg R. Oldham) utilized and examined in different service-business contexts what good job design seems like. Well-designed jobs, for instance, give people a clearly outlined position to play with adequate autonomy and common efficiency suggestions constructed in. This not solely permits individuals to execute duties successfully but in addition provides them a way of which means and satisfaction in their work by seeing the connection between their efforts and outcomes.
In distinction to this excellent work state of affairs, the roles and obligations of sufferers at present are virtually by no means clearly outlined or absolutely supported. Patients routinely tackle irritating duties, such because the switch of important info from one supplier to a different, that know-how must be designed to deal with. They wrestle to get entry to the knowledge they should are likely to their very own care, and get little suggestions or satisfaction from seeing their actions transfer the needle on outcomes. For sufferers to be glad with care, motivated to play their half, attentive to required screenings, and compliant with care, they want the help of a system designed to assist them do their jobs successfully.
Support the Patient by means of Network-Enabled Technology
Saying that the affected person has a job to do doesn’t in any method recommend that sufferers should shoulder the burden of their obligations unsupported. Technology is the important thing enabler of sufferers’ success, offering the knowledge, visibility, and suggestions they have to do their jobs.
So what does this seem like? As a part of its analysis and improvement efforts round inhabitants health administration, athenahealth has begun the work of mapping out a collection of affected person journeys tied to distinct affected person varieties. The objective is to know all the important thing factors of engagement which are wanted in order to help the affected person earlier than, throughout, and between visits. Naturally, the affected person journey and factors of engagement look very totally different for a healthy 28-year-previous than they do for a 55-year-previous smoker with diabetes and hypertension. But each have jobs to try this can solely be achieved successfully with the help of surrounding know-how.
For instance, knowledge aggregated from a mess of sources — from digital health data to insurance coverage knowledge — can be utilized to color an entire image of the affected person. Smart scheduling methods and affected person portals assist sufferers entry care on demand. Reminders by way of textual content and different modes assist the affected person arrive on time and ready. Open knowledge trade permits private health info to journey from one supplier or encounter to the subsequent so the affected person isn’t enjoying courier.
For excessive-danger sufferers, wearable units and care administration apps assist them keep compliant and related to care groups 24/7. Technology can’t do sufferers’ job for them. They nonetheless have to embrace conduct change and take accountability for their very own care. But it will probably make their job simpler to do, extra more likely to be efficient, and extra satisfying and rewarding.
It’s extensively accepted that we’ll by no means understand the objectives of health care’s Triple Aim — decreasing prices, enhancing the health of populations, and enhancing the affected person expertise — with out placing sufferers on the middle of their care. To do that successfully, nevertheless, health care leaders should do greater than retool previous mission statements or retrain physicians and frontline employees. They might want to reorient their considering to acknowledge the essential job of the affected person, design it thoughtfully into new operational frameworks, and make investments in the networked know-how required to help all of it. Only when sufferers, physicians, and employees are all working collectively, absolutely engaged and enabled to do what every does greatest, will we obtain the medical and monetary outcomes we’re all aiming for.