Unleashing Patient’s Power in Improving Health and Care

Unleashing Patient’s Power in
Improving Health and Care

© 2018 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Patient’s Power to Improve Health and Care
Across the world, we’re facing significant financial
constraints in healthcare, an aging population,
and the increasing burden of chronic disease.
We need to move to the Institute for Healthcare
Improvement’s Triple Aim Initiative of better care
for individuals, better health for populations,
and lower per capita costs.
We also need to unleash patient’s power
if we truly want to transform healthcare.
We need new solutions and new ways
of thinking if we want to be successful.

How to Flip Our Thinking in Healthcare
Years ago there was a New York Times article about
a teacher who turned education upside down by
“flipping” his classroom.
When he was teaching during the day,
he would give a lecture, use slides
or overheads, and then gave students
homework to do on their own.
The students would go home and
struggle alone as they tried to figure
out how to incorporate the day’s
lesson into their assignment.

As an athletic coach, he realized he went about that
role in a completely different way.
When coaching, he would bring all the athletes
together for training and observed their strengths
and weaknesses.
Before they came to practice each day, he would
give them videos to watch at home. The learning
took place at home and then he could actually
watch them practice.
He started thinking about why he taught one
way and coached another.

He decided to flip his classroom, giving students
videos to watch at home.
Then, when they were in class, they worked together.
He could see how each child was absorbing
information and where the barriers were.
What he found is that when he changed his
teaching to be more like his coaching, the
results flipped in every grade.
Failure rates dropped, graduation rates
rose, and class attendance improved.

This change helped him identify what he called
“silent failers”–the kids who were struggling but
slipping through the cracks in his old way of teaching.
This flipped classroom model is described as moving
the “sage on the stage” to “guide on the side.”
When I read that line, I thought:
“That’s exactly what we need in healthcare.”

Our ability to sit and write prescriptions or give patients recommendations in
a one-way conversation isn’t cutting it. We’re seeing our health rates in the
United States drop as our costs rise.
If healthcare practitioners can begin thinking and
acting like the “guide on the side,” we can make
progress towards the triple aim:
• Improving health
• Creating better experiences of care
• Reducing per-capita costs

What Matters in Healthcare
Another article that shows a new way to see our professional roles.
This New England Journal of Medicine (NEJM)
article by Susan Edgman-Levitan and Michael
Barry called “Shared Decision Making-The New
Pinnacle for Patient-Centered Care” has one
challenge that I took to heart and shared globally.
In this article, the authors said,
We can’t only ask, ‘What’s the matter?’ We
also have to ask, ‘What matters to you?'”

This question transforms the interaction from
a conversation about clinical symptoms,
problems and prescriptions to a partnered
discussion on getting to the most important
goals in a person’s life, using all the
knowledge of the health care professionals
and all of the assets of the patient and family.

I hope that everyone reading this takes as a
homework assignment this idea that we need
to ask, “What matters to you?”
This idea has spread worldwide with countries
around the world celebrating on June 6th
every year:
“What matters to you day?”
This event prompts an outpouring of
stories from both patients and healthcare
practitioners sharing their experiences
of moving from a focus on disease to a
focus on health.
JUNE
6

Patient Engagement as the Next Blockbuster Drug
Years ago, I was teaching with Susan Dentzer
and we were talking about the power of patient
engagement as the next blockbuster drug.
You may have seen the research
from a coordinated study of cardiac
care where patients were engaged
in the design of their care plans and
carrying out their everyday life
through the perspective of
engagement.
The results are dramatic.

Patients had an 88 percent reduced risk
of dying of a cardiac-related cause when
enrolled within 90 days of a heart attack
compared to those not in a program.
Clinical care teams reduced overall
mortality by 76 percent and cardiac
mortality by 73 percent.

A line from the research study summarizes
the feelings about patient engagement:
Imagine what the headlines would be
if a new cardiac drug proved this kind
of effectiveness. It would be
malpractice not to use it.”
When patients are involved in their own care,
the results are so effective that we have an
obligation to pursue patient engagement.

Trevor Torres, Empowered Patient
There are a few examples I want to share
that illustrate just how effective patient
engagement can be.
The first is a young man, Trevor Torres, who
is a self-described “diabetes evangelist.”
He has multiple chronic diseases and yet
feels empowered when he’s able to engage
in his own care.
Photo:epatientdave.com
Trevor Torres

Trevor’s clinicians told him,
Photo:epatientdave.com
Trevor Torres
There are two ways to think about giving
yourself insulin. You can either take the same
dose every day and adjust your diet, or if you
know you’re going to be eating something
different, then you can adjust your dose.”
Trevor’s responded by asking,
“Why don’t I just create an algorithm that deals with both variables?”

The cost of diabetes is incredibly
expensive in human terms, in
disability terms, in dollar terms, and
in hospital utilization.
We can work with patients like
Trevor and make dramatic
improvements toward the Triple Aim
of health and care improvement.

Changing the Balance of Power
Another example illustrates how changing
the balance of power in medicine can yield
incredible results.
There is an academic medical center in
Jönköping, Sweden that looks very different
than anything I had ever seen in a hospital:
The patient self-dialysis wing
I know patients do their own hemodialysis
and their own peritoneal dialysis, but I had
never seen a wing of an academic medical
center totally designed and run by patients
providing their own care.

So how did it happen that a CEO decided to
build a wing for patients to care for themselves?
I met Christian Farman, a young mechanic who
was diagnosed with glomerulonephritis and was
admitted for dialysis.
Christian quickly became interested in how the
dialysis worked. After a few weeks, he asked his
nurse to teach him how to do his own dialysis.
Then, the 73-year-old woman in the next bed
said she also wanted to learn. Pretty soon,
many of the patients in the unit were curious
and asking about taking on their own care.

Now they have a dialysis unit where up to 70
percent of the patients do their own dialysis.
They’re operating at about one half the cost
per patient, have evidence of better outcomes,
and far fewer complications and infections.
Here the patients are happy, healthy and
taking care of themselves in a way that
demonstrates the power patients have in
their own care and the importance of social
support in managing a chronic illness.

Changing the balance of power is not just
about improvements in the healthcare system.
The power of patient engagement has a
profound effect on a patient’s personal life.
There’s an app called, “My Life, My Dialysis
Choice,” that walks patients through lifestyle
values and options when they find out that
they may need dialysis.
Photo: Medical Education Institute

The app asks questions such as:
• Do you have a dog?
• Would you rather sleep at night or dialyze at night?
• Are you afraid of needles?
Once they fill out these questions, the app
gives them recommendations about peritoneal
versus hemodialysis, in-center versus at
home, daily versus nocturnal, etc., and what
these patients are then having discussions
with their clinician about these choices.

Patients feel like they’re co-designing their
care and they’re getting better results.
If we start to think about this idea of flipping
from, “I’ll take care of you,” to “How do I work
with you?” we see dramatic improvements in
results all across the Triple Aim.

Flipping the Discharge Model
One of IHI’s Fellows, a physician from
Sheffield, England was struggling with length
of stay and the hospital discharge process.
He began thinking of ways to flip the
discharge process.
Rather than doing physical therapy in the
hospital and then discharging patients to
a home, he thought,
Why don’t we discharge patients as soon as
they are clinically able and have the home
health team assess them and prepare them
for their care at home?”

Flipping the Discharge Model
They started trying it and found that the flipped
discharge process works really well.
As soon as patients are clinically stable, they
are discharged. Then occupational therapists,
physical therapists, and community nurses
work with them in their home.
What they found is that patients that were
scared in the hospital, became more
confident and empowered as soon as they
were in their home environment.
The results were incredible: 10,000 patients
got home three to four days faster in one year,
saving as many as 40,000 hospital bed days.

Reablement
Another innovative model of care that
produces better outcomes at a lower
cost is reablement.
It’s a multi-professional team working
to achieve the patient’s goals in a
collaborative way and a different tempo
that seen in many health systems.
This different approach enables frail and
elderly patients to thrive in their home
settings and to get back to health and
what matters to them.

The Importance of Curiosity
When I first became the CEO of hospital, I was 34
years old. I was young, and believed that my job
was to hire the most intelligent people and that
was how we were going to provide great care.
As soon as I started doing rounds and
talking to staff and patients, I realized
that EQ, emotional quotient or empathy,
was just as important as IQ.
Since then, I’ve also come to realize
how critically important CQ is–curiosity
quotient. I think some people are
naturally curious, but I believe you
can build your CQ.

One way I do this is whenever I’m in a new
healthcare organization, whether it’s an outpatient
clinic or a hospital, I say, “Take me to the place
you are proudest of.”
I’ve seen places I never would have thought to ask
about, and I have learned amazing things this way.
I saw a 30-bed dementia unit where the staff was
able to go 861 days without any patients in restraints
by putting book case covers over the doors so that
patients weren’t constantly seeing doors opening
and getting out of bed.
The staff used quality improvement methods to ask
why, test changes, and improve care for every patient.

It’s the curiosity piece that helps us innovate
and discover new models of care.
We need to design and share new processes
and new models like the examples shown.
In each example, the idea started with one
clinician or one patient running one Plan-
Do-Study-Act cycle and then using quality
improvement to build models that work
for a population.

My challenge is, how do we:
Flip the balance of care –
from the hospital to the community?
Flip the balance of delivery –
from individual providers to care teams?
Flip the balance of power –
from the provider to the patient and family?
Flip the balance of costs –
from treatment to prevention and co-production?
Flip the balance of emphasis –
from volume to value; and from healthcare to health?
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Taking on challenges one step at a time in order to transform
policy and change resource allocation can have a profound
effect on the Triple Aim and an increased joy in work.
If we can flip care to coordinate all aspects of
care—physical, social, functional, emotional,
and safety—we can prevent hospitalizations,
improve the quality of life for millions, save
millions, and build joy in our everyday work lives.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
Six Steps to Managing an Infection Control Breach
Improve Patient Engagement with Five Public Health-Inspired Principles
Maggie O'Keefe, Product Line Director, Operations and Performance Management; Marie Dunn
The Top Five Recommendations for Improving the Patient Experience
Anne Marie Bickmore; Kathleen Merkley, DNP, APRN, FNP, Sr. VP of Professional Services
Why a Patient-centric Approach Is Best: Stories from a Physician
Dr. Bill Knowles
How Patient-Centered Care Turns Patients Into Leaders
Kathleen Merkley, DNP, APRN, FNP, Sr. VP of Professional Services
Quality Data Is Essential for Doctors Concerned with Patient Engagement
Dr. Ed Corbett

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Maureen was the former IHI President and CEO for five years, after serving as Executive
Vice President and COO for 15 years. She is a prominent authority on improving health care
systems, whose expertise has been recognized by her elected membership to the National
Academy of Medicine (IOM), among other distinctions.
Ms. Bisognano advises health care leaders around the world, is a frequent speaker at major health
care conferences on quality improvement, and is a tireless advocate for change.
Maureen Bisognano

Unleashing Patient’s Power in Improving Health and Care

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