Collaboration: A Strategy for Patient Survival

Laura L. Adams, President and CEO Rhode Island Quality Institute

By: Laura L. Adams

It’s no secret that the health care system isn’t performing up to its potential. There are opportunities for preventative care that we don’t seize upon, technology that is available to keep people healthier which we don’t utilize, and the measurement of physical pain but the failure to notice the pain and isolation we may be causing because the system simply isn’t designed treat the whole person. We know that we want fewer medical errors and increased patient quality of life, and we know patient satisfaction could be higher and that patients could feel more empowered to take charge of their own health, yet we have not yet recognized and acted upon many opportunities for innovation that can make this happen.

One of the major issues I see is that we are not engaging in the lives of our patients. The current system is set up so that patients must engage with us, and then only when they’re sick. A patient in congestive heart failure will get care when he shows up in the ED gasping for breath, for example, but we have the ability to be present in the life of that patient and intervene long before he has to arrive at the hospital in the midst of that struggle, desperate for immediate care.

So right now, we’ll take care of a patient when they come to see us, but we don’t yet work collaboratively with others in the community to coordinate and monitor care when they’re outside our four walls. Essentially, the system has been designed to wait for people to get sick instead of intervening and helping them live healthier lives, and that kind of “come and get it care” should be a thing of the past. We must encourage a better understanding of earlier intervention methods, community-wide connection and collaboration, and the leveraging of available technology and predictive analytics.

The system was structured to be an acute care system. But if you think about it, that’s the definition of a “sick care” system, not a health care system. We should really judge the success of health care based on the health of the people within our communities, not the size or number of our hospitals.

If our goal is to create a system that is worthy of a patient’s trust, we need to act collaboratively to create a new definition of health, develop new ways to tell the truth about our performance as health care providers, and recognize that patients are already in control of their health in so many important ways. A true health care system would help people cope with social, emotional and physical challenges throughout their lives, not just rescue them when they are facing a physical crisis. Part of that is enabling patients to manage their own health and capitalizing on their ability to do so.

Most importantly, we need to talk much less and listen much more, because people have important stories to tell about their experiences with the health care system, and that is a data goldmine in terms of inspiration for a new design. They know what works and what doesn’t, what makes them feel isolated and alone as well as connected and comforted, and they can tell us firsthand where the flaws and trouble spots are within the system. If you simply ask, patients and family members will talk about their emotional pain, about not feeling included or properly informed, about not understanding but being too embarrassed or afraid to ask for clarification, about not knowing how to navigate the system, about not knowing how to advocate for themselves or a loved one – and on and on.

The information and inspiration for innovation lies within those honest, desperate stories. But we also have to do our part and be completely transparent about our performance too. Unfortunately medical errors happen, but when we are upfront with patients and family members, they have an opportunity to contribute to ensuring that these errors never, ever happen again, and to become co-creators of a safer design.

Rhode Island is experiencing an opioid crisis of epic proportions. It is, in fact, the worst public health crisis of recent memory, with people in their prime having their promising young lives snuffed out by addiction. We have had incidents in which these patients, in the throes of addiction, will go into treatment and will name their parents as the people to contact in the event of an emergency. Unfortunately, this type of permission isn’t sufficient to comply with the Health Insurance Portability and Accountability Act (HIPAA) law in the US. Thus, parents are experiencing, in the case of one young man, their son going in and out of the ED seven times in just three months for drug overdoses, and three times in the last three months of his life, despite having given permission for his parents to be contacted, should another overdose happen. Busy providers working hard to save his life just don’t have time to dig through the patient record to see if someone should be notified, and if in the case of an adult child, determine whether the parents even had HIPAA-compliant permission to be notified.

Out of tragedies like this came “Designee Alerts,” a service of the Rhode Island Quality Institute that allows a patient to designate anyone of their choosing to receive real-time, electronic alerts any time the patient is admitted to or discharged from a hospital or emergency department in Rhode Island. Had this been in place earlier, these parents would have had multiple opportunities to help save their son’s life. Listening to the anguish of parents whose children have been claimed by addiction is heartbreaking, but listening intently is the only way to inspire innovative changes that ensure that the system never fails like this again.

Join me at HealthAchieve in Toronto on November 7th, where I will be talking more about what’s needed to create a delivery system worthy of patient and family trust, and how collaboration is a critical survival strategy for both patients and providers that can help us develop the kind of health care system that those who depend on it – literally for their lives – truly deserve.

Laura L. Adams is the president and CEO of Rhode Island Quality Institute

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