Ideas That Shift the Power to Patients and Improve Outcomes

Donald Berwick, MD, a former CMS administrator, shares eight ways for doctors to let patients share the lead in their care and reap the benefits.

Patient engagement — the active involvement of a patient and family members in his or her health and health care — has been shown to improve patient outcomes and reduce costs.1 But achieving greater patient engagement has been a challenge for most health care organizations.

Donald Berwick

To that end, Donald Berwick, MD, MPP, co-founder of the Institute for Healthcare Improvement, proposes an effective lever for increasing patient engagement: shifting power from clinicians to patients.

It’s the first of 10 New Rules for Radical Redesign in Health Care the institute has crafted — and perhaps the most significant, because it strongly emphasizes the notion of patient-centered care.

Speaking at the institute’s annual forum in December 2016, Berwick illustrated its benefits by using photographs, videos and live participation of patients who were empowered in their own care.

• At Parkland Memorial Hospital in Dallas, the primary teaching hospital for the University of Texas Southwestern Medical Center, patients who require long-term intravenous antibiotics are infusing the medications at home on their own. Over the course of the four-year project, the hospital has saved $40 million and almost 28,000 hospital admission days.

• Zak Wolf, a child with Crohn’s disease, learned to insert his daily nasogastric tube on his own — and created a video that walks other children through the technique.

• At Alder Hey Children’s Hospital in Liverpool, England, chefs and support staff provide patients with “food on demand” — what they want, in the amount they want, at the time they want. Patient nutrition and patient and family satisfaction have improved, and food costs have decreased substantially from reductions in food waste.

• Bellin Health, an integrated health system in Wisconsin, has joined with local schools, community agencies, employers and government agencies to form the Live Algoma Coalition. Its aim is to improve the health of high-risk populations through community-driven initiatives, such as assisting high school students to coach younger students about healthy lifestyle choices.

• At Ryhov Hospital in Jönköping, Sweden, patients with renal failure have the option of self-dialysis. That began in 2005 after a patient asked if he could perform his own dialysis. Staff considered the request and decided to try it. The dialysis nurse said she saw “possibility, not the problems,” while another patient said, “I gain all the freedom.” The hospital since has hired him to coach others.

• Likewise, a nephrology practice in Texas has begun to test self-dialysis, and the new process has reduced hospitalization and mortality rates.

What can health care leaders do to increase patient engagement by shifting the power dynamic between clinicians and patients?

Berwick, a former administrator for the Centers for Medicare & Medicaid Services, offers eight suggestions:

1. Use what the patient and family bring. Accept their gifts.

2. Talk less. Ask more. “What matters to you?”

3. Make transparency limitless. Share information and knowledge.

4. Protect privacy; but improve privacy laws. “We have … overinvested in stupid privacy rules that don’t help anyone at all,” he says.

5. Equip homes and communities to replace institutions. Moving care from the inpatient setting to the home goes a long way in shifting power.

6. Share decision making. Use decision support, online tools and new technology to engage patients in decisions about their care.

7. Do not design core systems around hard cases. “Good rules for the very few are bad rules for the many,” he says.

8. N=1 care. In other words, customize care and respect that each patient is an individual.

REFERENCE

1. James, J. (2013) “Health Policy Brief: Patient Engagement,” Health Affairs, Feb. 14, 2013. Retrieved Dec. 22, 2016, from http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf .