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Ruth Tarentine - Toward patient-centered care

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Better outcomes in the United States can result when patients are active partners in health-care decisions and routinely offer providers their opinions on the quality of their care. In this type of patient-centered care, physicians collaborate rather than control, which requires asking what the patient prefers and considering the answers.
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Better outcomes in the United States can result when patients are active partners in health-care decisions and routinely offer providers their opinions on the quality of their care. In this type of patient-centered care, physicians collaborate rather than control, which requires asking what the patient prefers and considering the answers.
Guest writer Ruth Tarantine serves as chair of and nursing faculty and online nursing graduate programs at a private university. With 25 years of nursing experience, she holds a doctorate of nursing practice from Chatham University.
Guest writer Ruth Tarantine serves as chair of and nursing faculty and online nursing graduate programs at a private university. With 25 years of nursing experience, she holds a doctorate of nursing practice from Chatham University.

While the U.S. has unrivaled status in many areas, health care is not one of them.

In 2000, the World Health Organization (WHO) ranked our country 37th in health care quality in the world. In the years 2004, 2006, 2007 and 2010, the independent Commonwealth Fund compared the United States with six other industrialized countries: Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. Health system performance was measured in five categories: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.

Despite spending the most money on health care, the United States ranks dead last. The most significant way the U.S. differs from other countries is our absence of universal health care coverage.

But even when access and equity are not considered, the U.S. ranks behind the majority of the other countries on most measures.

As a result, governing bodies are insisting that hospitals improve by moving toward patient-centered care and taking other quality improvement measures.

Surveys you receive after visiting doctors or medical facilities are designed to measure patient satisfaction and the level of patient-centered care. Increasingly, medical provider reimbursement will be based on these scores.

Accordingly, everyone in health care is talking about patient-centered care. Here’s a simple definition: “Nothing about me without me” (Delbanco et al, 2001).

A landmark report, “Crossing the Quality Chasm: A New Health System for the 21st Century” by the Institute of Medicine, however, complicates the definition a bit more. The report defines patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values and assures that patient values guide all clinical decisions.”

According to the Institute, patient-centeredness is one of six aims for quality improvement in health care. The others are safety, timeliness, effectiveness, efficiency, and equity.

Although foreign to long-standing practice in U.S. health care, research shows that patient-centered care yields better results:

  • Patients who participate in decisions about their care have better outcomes overall.
  • Patients are more likely to follow a plan of care when they help design the plan.
  • Patients who receive patient-centered care report higher patient satisfaction scores.

Unfortunately, for most patients, patient-centered care is an anomaly.

Hospitals are rapidly trying to change their cultures to one of patient-centered care. Even so, they often miss the mark.

A great deal of money is spent on educating hospital staff on the definition of patient-centered care. The problem, however, isn’t a lack of understanding.

The problem is putting patient-centered care into practice. The culture of control is so ingrained in U.S. health care that a major shift in thinking is needed.

Patient-centered care is a dynamic human interaction among patients (and advocates) and health care providers.

Because each person is unique, each patient will have different ideas and preferences. It is the provider’s job to integrate the patient’s desires into the plan to achieve optimal results.

You might think of patient-centered care as returning to the Golden Rule of treating others the way you want to be treated. Unfortunately, the way you want to be treated isn’t necessarily the way someone else wants to be treated.

Care that assumes the provider knows what the patient wants is still provider-centered. Patient-centered care requires providers to ask the patient or family what the patient prefers.

Patient-centered care depends on patients playing two roles: partner and evaluator.

To function as a partner, patients (or advocates) work in collaboration with physicians and staff. As health care providers help manage a patient’s care, the patient will be involved in decision-making. Collaborating helps physicians assure that care plans will be based on the individual patient’s needs, values and priorities. Active participation is required for successful outcomes.

In addition to acting as health care partners, patients (and their advocates) should offer essential feedback to the medical team. A patient’s perspective provides unique information to providers, helping gauge the effectiveness of care as well as the performance of the provider or organization. Patient surveys provide helpful disclosures after the fact, but no one should wait for a survey to communicate.

Providers naturally look at things through the lens of a physician or nurse rather than the eyes of the patient. If you are unhappy with your care or see an opportunity to improve it, speak up. This is your obligation.

Providers can’t fix a problem until they know they have one. They can’t make a course correction after the fact. Your appraisal may be crucial to successful future outcomes.

In many cases, you won’t receive patient-centered care unless you relentlessly pursue it. With perseverance, however, you can influence decisions, perhaps obtaining exceptions to hospital and insurance practices, or customizing care for yourself or your loved one, with the goal of improved quality of life.

Be present. Ask questions. Speak up. Keep good records. Learn to think beyond how it is always done, and to speak in dollars and sense. Refuse to be intimidated.

Most importantly, don’t give up.

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We’re paying top dollar for care right now; we should be collecting commensurate benefits.

When patient-centered care becomes the norm rather than the exception in the United States, our health care system should result in better quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives. 

 

Guest writer Ruth Tarantine serves as chair of and nursing faculty and online nursing graduate programs at a private university. With 25 years of nursing experience, she holds a doctorate of nursing practice from Chatham University.

 

10 ways to participate in your own care, reduce errors

  • Speak up! Never be afraid to speak up, ask a question, or challenge something that doesn’t look right. Odds are, if something doesn’t look right, it isn’t right.
  • Be informed. Use the internet to perform your own research. Read the info packet given to you at the hospital. Know your rights as a patient; they must be posted on every floor in the hospital.
  • Be flexible. Be aware of which health issues are life-threatening and those that are not. Acknowledge that the goal is always quality care.
  • Know the name of each provider. Know the role that provider plays (attending, resident or intern). Know who the decision makers are in your care (besides you).
  • Ask for a copy of the results of any procedure and diagnostic test and keep it in your own medical file or binder.
  • Know your medications and dosages. Always have a list in your wallet. Question new medications, a change in dosage, or a pill that looks different from what you usually take.
  • Demand to be included in the patient plan of care. This includes being informed of any changes to the plan prior to the change. Remember the definition of patient-centered care: Nothing about me, without me.
  • Demand that all providers check the patient ID band before giving any medication, procedure, or patient interaction.
  • Demand that all providers wash their hands.
  • Be present for your loved one or have a loved one with you if you are the patient. This is the Number One way you can ensure better care.
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