Making Patient-Centered Care Reliable

Abstract

Multiple reports have concluded that healthcare does not reliably meet patient needs and can even cause harm. The Institute for Healthcare Improvement (IHI) has adapted reliability principles and methods from other industries and applied them in healthcare with promising results in hospital settings. This article describes how one outpatient system successfully applied the IHI reliability methods to multiple clinical and administrative processes. How the application may differ in outpatient environments is also discussed. In particular, the patient role is much more central, and a strong collaborative engagement with the patient is likely necessary to achieve high reliability. Applying reliability principles to patient-centered processes is a critical and undeveloped area.

Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

“…Meets quarterlyMission statement: “To establish a patient advocate forum to gain quality experiences, observations, and suggestions for improvement”Activities: review practice improvement project for depression care management; provide insights on scaling patient action group to entire Rochester, MN primary care practiceProduced more patient-centered, personal-handoff process and associated provider scripting (e.g., from “someone will call you” to “the care manager is an RN who works with me”). Enrollment of patients diagnosed with depression into care management intervention was 96.5% Baker et al [29]US CareSouth outpatient clinicsEducational material design around body mass index after negative initial feedback regarding topic approach; revised pain assessment“A strong collaborative engagement with the patient is likely necessary to achieve high reliability” Bitton et al [27]Hospital- and community-based primary care teaching practices affiliated with Harvard Medical SchoolClinic “transformation teams” encouraged to include patients as core members“Trainees and patients can be agents of change, and their presence provides added motivation for academic faculty to create and support change” Coulter and Elwyn [20]UK policy efforts to involve public in healthcare processesCommunity-health councils, proposed statutory patient forums and commission for patient and public involvement and health, patient advisory and liaison services in each trust, annual patient surveyNo empirical findings reported DiGioia et al [23]University of Pittsburgh Medical Center, US6-step patient- and family-centered care methodology including using Codesign Toolkit and Improvement Team to close gaps between current and ideal care experiences“Refocuses existing resources around the patient and family rather than fitting patients and families around the physician and system. It makes it possible to take any current state and move the care experience toward the ideal—as defined by patients and families” Fontaine et al [28]Minnesota primary care practicesState PCMH certification standard development included patient-advocacy representatives; published standards include “continuous improvement process that included a quality-improvement committee with active patient recruitment and participation”Patient’s positive experiences with PCMH increased practice leaders’ job satisfaction and trust in the processProcess for using patients as PCMH advisors/getting input on PCMH changes from patient partners on change team all correlated significantly ( P  ≤ 0.01) with practice system change (but not clinical outcomes) [33] Karazivan et al [24]Direction of Collaboration and Patient Partnership at the University of Montreal: Implemented by two primary care teams as of 2014<...>…”

“…Many articles reported that patient/family partnerships resulted in process improvements, including staff trainings [22, 26], service redesign [16, 17, 21, 27, 28], and patient materials (e.g., for self-management or new patient orientation) [18, 29–31]. Several articles said patient/family involvement catalyzed practice improvement through “influential stories,” “different perspectives” [26] or “experiential knowledge” [32].…”

A Framework for Making Patient-Centered Care Front and Center

“…Can the patient trust that the environment in which s/he is receiving care is safe and committed to errorfree care? 17 Can the patient and clinician trust that someone is looking out for the patient's interests as s/he transitions between health care settings? Can the patient trust the skills of the medical assistant who is inserting an intravenous catheter?…”

Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods

“…Typical operationalizations of safety are (serious) safety events, 21,22 mortality, 23 and catheter-associated infections, 24,25 whereas some studies rely on established patient safety indicators (e.g., central line-associated bloodstream infection 26,27 ). With regard to the goal of effectiveness, studies aim for context-specific operationalizations such as the body mass index and Hemoglobin A1C rate in the case of patients with diabetes 28 or, more generally, the rate of patients who receive the recommended care. 29,30 With regard to the goal of patient centeredness, we find that it is measured by the degree of patient satisfaction.…”