A Health Care System Tailor-Made For Patients

By Haydn Bush	December 12, 2011
What will a patient-influenced care delivery system look like?

Incorporating patient perspectives into the design of health care delivery was one of the major themes of the recently concluded Institute for Healthcare Improvement 2011 National Forum in Orlando. The meeting marked the first time patients were on the IHI faculty, and session after session featured patients and advocates describing their firsthand experiences to an audience of hospital administrators and clinicians.

Of course, excellent patient care has always been the desired end result in health care ? the hard part is delivering on that promise, and an emerging school of thought suggests that listening to patients is an essential part of achieving excellent outcomes. During a press briefing at IHI, Gary Kaplan, M.D., chairman and CEO of Virginia Mason Medical Center in Seattle, noted that his system puts patients at the top of its care "pyramid," and emphasizes listening to their stories as one way of meeting that goal.

"We asked [patients], how did it feel lying on stretcher outside the operating room?" Kaplan said.

Another featured speaker at the briefing, Jeff Thompson, M.D., CEO of Gundersen Lutheran Health System in Lacrosse, Wis., made a similar point about end-of-life care. For over two decades, the system has embraced an advanced-care planning program that helps patients create advanced directives. For Thompson, that strategy relates to an overall emphasis on empowering patients to participate in their own care.

"It's more than a document," he said. "It's a system of care."

But I got the best sense of what a patient-influenced system might look like in practice when I spoke with Anthony DiGioia, M.D., an orthopedic surgeon at Magee-Womens Hospital in Pittsburgh, who was at IHI to discuss his hospital's Patient- and Family-Centered Care Methodology and Practice program. During an effort to redesign discharges for knee replacement surgery patients, DiGioia and his colleagues found out that many of the patients were apprehensive about going home, in part due to the region's topography.

"In Pittsburgh, there are lots of hills, and lots of steps," DiGioia said.

As a result, patients worried about tasks as mundane as walking from their cars to their homes ? a process that might take as little as 18 steps. In addition to a new strength conditioning regimen, the care team simulate their patients' challenges, purchasing a small car, now housed in the hospital's gym, for patients to practice getting in and out of, and having patients practice walking up and down the hospital's stairwells.

The results? The program boasts the lowest length of stay for knee replacement patients in western Pennsylvania, and 90 to 92 percent of patients return home without going to a skilled nursing facility, DiGioia said.

"One of the basic premises of our methodology and practice is that we have to view care through the eyes of patients and families," DiGioia said. " ? We have to be able to look at the full cycle of care, and the only common denominator throughout our entire system to examine that is patients and their families."

Haydn Bush is senior online editor for Hospitals & Health Networks magazine.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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