My guest today is CEO Don Ford. We begin our conversation talking about coffee. We talk about standards, consistency, choice and customization to meet customer needs. In many coffee shops we are able to fully customize our order e.g. extra large, non-fat, decaffeinated, latte, single shot with no foam. And when we do, our order is made on the spot, to our specifications, and served within quality control feedback loops involving the customer to ensure the right coffee gets to the right person at the right time.

What if a patient could customize their care?

Why can’t they?

What would our system look like if this was an option?

These are questions that we know are increasingly being asked in our system and are driving more organizations to look at how they become more patient/person-centred and patient/person-directed. In our view, this is a logical next step in a transition that has been occurring in healthcare over many years. The system started from a place of doing “to patients,” being very me-as-provider-centric; to doing “for patients,” becoming more aware of bringing the patient’s voice into the room; to doing “with patients,” where the move was to a more inclusive and transparent engagement of the patient although still at the invitation of the provider. Is the next evolution, doing “at the direction of” the patient, where it is the patient who takes the lead in the conversation and the provider who is there to help.

The Ghost of Healthcare Hope appears…

“It is encouraging to think of the possibility that our system would not only allow, but expect, perhaps even demand, that the patient has this leading role in their care. After all, it is for them that we are there in the first place. I know that many places are actively pursuing this model with active attempts to find ways for patients and their caregivers to have voice at all levels of organizations. I know that there is a growing groundswell of being more patient/person-centred or patient/person-directed. Attempts are being made to introduce Patient Based Co-design and other similar models are afoot in many locations. These are hopeful signs that this new way of thinking about how we design and provide healthcare is more than a phase that will pass in time.”

While we tend to bask in what are often very high ratings on patient satisfaction surveys, increasingly we are coming to understand that often the questions asked on these surveys just scratch the surface of the patient experience. Valuable as a first level benchmark, these surveys often do not delve into what really matters to the patient. In general, patients are satisfied with their healthcare experience overall, but taking time to delve more deeply into their experience often reveals important, and at times difficult to hear, details of what their experience was really like.

In a project in the Northumberland Hills part of Ontario, known as the PATH project, a concerted effort was made to meet with and hear the healthcare journey story of several patients with complex health problems. The stories they recounted were clear and compelling. The primary messages were that often they were not heard, not listened to, not respected for what they knew of their particular situation, not provided with the “simple” things that would have made a profound difference in their lives, not able to engage with their providers in a meaningful way and not able to be confident that all those who were engaged in their care were coordinated and together on what was best for them. Those involved in the PATH journey have been able to address many of the issues  raised by challenging and changing locus of control, mindsets, behaviours and by demonstrating empathy.

The Ghost of Healthcare Hope returns…

“It is good to know that, with a concerted effort by everyone from the patient to the caregiver to the myriad of providers, change can occur. It is good to see that time has been taken and allowed to find the right path for many of these changes and that willingness to be open to what may be seen as criticism and not having gotten it right has been a catalyst for change and not an opportunity to find fault and lay blame. But what does this mean for how those who govern our health system and for those who hold responsibility at the highest levels of our system?”

It means deep change.

Changing how we think about and value patients and their caregivers. Embracing that the person who knows most about their situation is the person in the situation as well as those who support them.

Changing how we listen, really listen. Remaining open to hearing the voice of patients and their caregivers. Dr. Jerome Groopman, in his book How Doctors Think, notes that “Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind (of) what’s wrong. And too often, we make what’s called an anchoring mistake – we fix on that original judgment.” We know this tendency to jump in with the answer, while possibly not fully understanding the problem, is not unique to physicians. Direction for governors, senior leaders and everyone in the health system can be found in Stephen Covey’s book The Seven Habits of Highly Effective People where he suggests that we first must learn to listen to ourselves (habits 1-3) to understand our core values and goals, and then listen to others (habits 4-6) to become aware of their values and goals. It is through this active listening that we will find common ground and develop productive relationships.

Changing how we embrace the skills and abilities of everyone in the health system and beyond. Time to move out of our historic silo thinking, stop believing only we have the answer and discounting the value and perspective of the rest of the system. Bringing many new and disparate voices to the table, starting with the patient and/or their caregiver, opens up possibilities that may never have been considered. It is often from these seldom-heard voices that creative and innovative solutions can be found to what, on the surface, may seem to be intractable problems. Governors and senior leaders need to find ways to bring these voices to the tables at which they sit and to the problems with which they deal. After all, it was a product often referred to as “a solution without a problem” that 3M was able to turn into a multi-million-dollar product by thinking about it for a different purpose – the Post-It Note.

Changing how we share our knowledge and spread our new discoveries. Too often good and great ideas don’t find their way into more generalized practice, and patients suffer as a result. With all the technology that is around us every day, it shouldn’t be that difficult to spread an idea and hear from others what has worked and what hasn’t. As governors and senior leaders, it is imperative that we open ourselves to looking outward, both to our colleagues in the health system and to ideas beyond our traditional boundaries. There are lessons to be learned from many sectors that serve the public each day and we should not be afraid of “R&D – Rob and Duplicate.” To steal good ideas shamelessly, improve on them and then hope someone else does the same to you is how we will continuously improve.

The Ghost of Healthcare Hope returns once again:

Relationships are the pathways to the collective wisdom and intelligence from the full continuum of the system. Through relationships, information is created and transformed, the healthcare organization’s identity with the full system expands to include more partners and stakeholders and the organization becomes wiser.

I close with this definition of “organization” from the BusinessDictionary.com…“A social unit of people that is structured and managed to meet a need or to pursue collective goals. All organizations have a management structure that determines relationships between the different activities and the members and subdivides and assigns roles, responsibilities, and authority to carry out different tasks. Organizations are open systems – they affect and are affected by their environment and their customers.”

Next week my guest is Professor Anne Snowdon. We talk about the need to personalize and explore three actions.

See essays in this series.

See essays from series 2

See essays from series 1

Comments

Janice Gilners wrote:

Posted 2015/02/25 at 10:58 AM EST