Where does the patient fit in?

Thursday, March 1, 2018 | Jacob Turmell

Where does the patient fit in?

As I was preparing to write this blog post – my first with MedAxiom – I decided to go back through prior blog posts to get a feel for content and perspective. Reading through the blog posts, I kept asking myself: “So, what does this mean for the patient?” I think that we must keep the patient experience at the forefront of what we do. After all, isn’t it the patient we are serving?

Last week, in Lori Walsh’s blog post, she did an excellent job of talking about the need to perform a service line checkup that includes operations, clinical, transformational, and financial assessments. And I completely agree that cardiology practices need to look at these on a yearly or more frequent basis. I would also say, look at your patient experience as part of that clinical evaluation. And this is more than just your patient satisfaction scores. Talk to your patients about their experience when they come to your practice. Was parking easy? How long are they waiting? Are the chairs comfortable? Did someone greet them warmly? Did they have the time with the provider they needed and was the plan clear to them? Did they have their questions answered? These questions can give you invaluable insight on how to better serve your patients. Further, consider creating a Patient and Family Advisory Committee (PFAC) that can give you feedback on the patient experience to help you improve.

Joe Sasson wrote an interesting blog post on the vendor relationship and I thought about how this will impact or benefit the patient. A strong vendor relationship certainly can help to drive down cost. However, vendors are beginning to understand that selling is no longer about a widget or an item; rather, it is about helping organizations achieve their clinical and operational goals. This can lead to improved financials, but ultimately it can result in improved care for the patients. The patient can benefit from care standardization, improved efficiency, and up-to-date clinical pathways. The vendor has a unique perspective of having more of a global view of what other organizations are doing, and what is working and what is not. They can help you develop the care pathways to drive improved outcomes for the patient.

We are living in a world of healthcare mergers and acquisitions, as Anne Beekman pointed out to us a few weeks ago. Any one of us could rattle off multiple reasons why these mergers are happening, what the goals of the mergers are, and whether they have been successful or not. But has the patient benefited them? I would say no and yes. First, patients have enjoyed going to their small community hospital where their caregiver is their neighbor and friend. The provider or nurse lives in the community and has a vested interest in the patients and health of the community. Some patients may feel that when the small community hospital is bought out or the physician practice merges into a health system, the small community feeling can be lost. Also, there is a risk of programs being consolidated, which could lead to clinical services not being available in areas where they once were. I would say that patients have greatly benefited from the mergers and acquisitions as well. Health systems have been able to improve outreach to smaller areas and bring clinical services to areas that did not previously have them. And although consolidation of services could mean that the patient may travel a bit further to get care, the people providing the care are truly experts in what they do just from an increase in sheer volume.

Value-based purchasing (VBP) is probably one of the biggest game changers for healthcare that I have seen over the past 20 years. As Joel Sauer mentioned in his blog post, the shift from a fee-for-service payment model to a value-based payment model was not perfect and still needs refining. It has not been easy for any of us who work in healthcare! But has the patient benefitted from it? Like Joel, I say “Yes.” VBP has forced organizations to think about the value of the care offered to the patient. It is has forced clinical standardization to eliminate errors and waste. I do think over time we will begin to see larger impacts on the quality metrics that we are tracking. All of this benefits the patient.

Lastly, Ginger Biesbrock talked about how to be a successful leader in today’s dynamic healthcare environment. I would further this conversation by saying we are all leaders in healthcare when it comes to managing our patients’ health. Ginger discussed the concept of servant leadership and I believe this is the model we should use when caring for patients. The role of the provider in the provider-patient relationship has moved from that of the benevolent paternalism to more of a patient-centered approach. This fits with the concept of being a servant leader for your patient. The servant leader provider focuses on the needs of the patient over their own needs and empowers the patient to move towards self-management of health behaviors and improvements in overall health.

As you can probably tell, I am passionate about the patient experience and patient perspective. I try to keep it at the center of all I do and I would challenge each of you to do the same. In process improvement events, write “The Patient” on a flip chart or dry erase board to keep everyone focused in driving decisions. Better yet, invite a patient to sit on the improvement event! Consider a PFAC team to get true feedback on how they are experiencing healthcare at your practice. Don’t just rely on your satisfaction scores! I always have believed that if we do what is right for the patient, no one can argue that it is the wrong thing to do, and the other pieces – financial and operational – will fall into place.



Illustration: Lee Sauer

About the Author
Jacob Turmell

Jacob Turmell, DNP, RN, NP-C, ACNS-BC, CCRN-CMC, Vice President, MedAxiom Consulting, is a certified Nurse Practitioner with a strong clinical background combined with years of medical industry experience. While earning his Doctor of Nursing Practice degree, Jacob?s focus on systems leadership gave him expertise in organizational assessment, outcome-driven change management, population health, and public policy. At MedAxiom Consulting, Jacob is focused on care processes redesign and provider team optimization.

To contact, email: jturmell@medaxiom.com

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