Seeing From the Other Side
Thinking about incorporating the patient perspective into your practice decision-making? Here's how to get started.
Hospital X was a newly remodeled facility advertised as the height of patient care.
Upon entering the lobby, patients encountered beautiful sculptures, shiny floors, and brightly colored art from local artists. The food court was advertised as serving better food than the restaurants around it.
And yet, patients weren't happy. Patients coming out of surgery had to recover in semi-private rooms and felt unable to heal in peace. Many also worried about the risk of infection due to the presence of a roommate and other guests. Although millions of dollars had been spent on the new renovations, Hospital X missed an important factor in patient care.
Hospital X doesn't technically exist, but it is based on a real hospital that encountered the same issue. Although administrators sought to provide a better patient experience, they did not solicit the opinions of actual patients. This hospital would likely have benefited from working with patient advocates or the input of a patient advisory council.
The Business Case
Understanding the patient experience is important. As the health care climate continues to shift toward value-based payments, understanding the patient perspective is vital for practices to remain profitable. Patient experience is an important tenet of the new MACRA legislation (read more at MACRA at bit.ly/JUL_BUL). MACRA identifies patient experience as one of its four priority areas, and its emphasis underlies an increasing awareness of patients as consumers with greater knowledge about their care and higher expectations of their providers.
"Patients are always seeing the situation from the other side," says C. Matthew Hawkins, MD, assistant professor pediatric radiology at Emory University School of Medicine in Atlanta and chair of the ACR Commission on Patient- and Family-Centered Care (PFCC) Quality Experience Committee. "Including patients is providing another perspective that is very difficult for physicians to see." Adds James V. Rawson, MF, FACR, chair of the ACR PFCC Commission and chair of radiology at Augusta University Health, in Augusta, Ga., "Patients will always be the expert in their experience. And if you want to improve the experience, then you're going to have to ask the patient what was good about the experience and what was bad — and how you can make it better. We won't be able to significantly improve the patient experience without involving the patient."
Furthermore, health centers that have made effort to improve patient care and include patient input have seen multiple improvements. These include shorter average lengths of stay, higher than average satisfaction scores, and growth in patient volume.
Starting to involve patients in your practice can seem daunting, but it doesn't have to be. Bernard Roberson, patient advocate and corporate director for service excellence at Phoebe Putney Health System in Albany, Ga., recommends that physicians start small. "You don't have to immediately create a committee or organization. The more you try to formalize committees in a hurry, the harder it is to actually get it started," he says. "Start by talking to the patients seeking care at your facility and building relationships that way. Ask what they like about the facility or what they don't like. You make a huge difference by showing interest in a patient's opinions."
Starting small is a good way to begin changing a culture that might not be receptive to including patient input on big projects or committees. "There tends to be a lot of misconceptions and barriers to having patients and families as part of a team," says Roberson. "People may be worried about HIPAA or that the patients will get in the way and not understand how things work on the physician side. So start slowly."
Ian A. Weissman, DO, radiologist at the Milwaukee VA Medical Center and member of the ACR PFCC Commission, recommends helping to change your culture by introducing patients to administration and staff members. "See if you can get permission from a patient to come speak at one of your staff meetings," he says. "People start to change when they hear stories in person. It's amazing to watch some of the reactions from people in the room as patients with strong voices tell their story."
Roadmap for the Future
Hawkins adds that individuals in governance tend to be more receptive when you have at least a tentative plan in place. Decide whether you're going to propose that patients serve on specific committees or projects, and have an idea of the patients you'd like to ask to participate. Rawson adds that putting patients on specific projects helps introduce the concept to other staff. "A patient advisory board tends to operate outside of operation teams or governance structures. They give input rather than make the final decision," says Rawson. "As a result, you risk the board being marginalized or ignored. To get around that, you can introduce patient advisors to staff and integrate them more fully in your processes."
The Right Candidates
So your practice or department is ready to begin including patients. How do you find them? Start by looking at the relationships you already have, says Weissman. Are there patients who have given you good ideas in the past? Have you encountered individuals in your community you feel might be a good it? You can also look for recommendations by getting on the agenda at staff meetings, including notices in employee newsletters, or asking for input in materials for patients and families served by your practice or organization.
While you're looking for patients, evaluate whether or not the group you're putting together fairly represent your population base, advises Hawkins. Make sure you have a fairly heterogeneous group, both ethnically and socioeconomically. He notes that advisory councils tend to include disproportionately upper class patients who have the time and resources to get involved. And while having those patients is good, it's not necessarily a fair representation of the needs of all your patients.
Roberson comments, "In my experience, minority patients have tended to be more hesitant in participating in advisory groups. Some feel that their inclusion is simply organizations checking a box and that their opinions won't really be listened to." At Augusta University Medical Center, the organization created a separate patient advisory council that specifically catered to promoting diversity and soliciting diverse opinions. The council was made up of individuals from ethnic, sexual, and socioeconomic minorities. Roberson adds, "Once they began to see that we took their comments seriously, these members began branching out into our other patient councils."
Rawson also suggests recognizing that each patient will have a different schedule and commitments. In order to accommodate those advisors who work full time, you may have to have your meetings at night. "You have to be really flexible," he says. "Otherwise you'll end up with only the people who can afford the time."
Ultimately, Rawson says that the best way to begin working with advisory councils is to just start doing it. "Working toward patient-centered care is not a single project — there's no endpoint, so you can continually work at your process. My advice is to start now, not later," he says. Roberson reiterates, "Just ask patients what they see and what you can do to make things better. How can radiology become the number one service in your area? Trust me, they'll tell you."
By Meghan Edwards, digital content editor for the ACR Bulletin