Dr. Kaylan Baban attended our event on April 3rd at Patient Room 2020 and wrote about it for ZocDoc. This was first published on April 11, 2014 on The Doctor Blog.
By Dr. Kaylan Baban
Last week, I was privileged to attend a very exciting, forward-thinking event hosted by the NYC Health Business Leaders at NXT Health’s Patient Room 2020, called “Redesigning the Patient Experience to Improve Safety and Outcomes.” The panel discussion was really robust (not always the case), the model room thought-provoking, and the energy and creativity of the gathered attendees from across the healthcare spectrum was palpable. In short, it was the kind of event I think we all need more of, and it inspired me to consider how we can most fruitfully direct the modern pursuit of “patient satisfaction” – and why this endeavor is about so much more than beautiful lobbies and hospital rankings.
A Cultural Shift
Until very recently, “successful” or “appropriate” treatment was judged by providers alone and defined very narrowly. Through a more humanistic approach and a great deal of research, it’s accepted now that incising the correct area or prescribing the appropriate drug is not nearly enough. We in healthcare – providers, patients, administrators, advocates – now know and accept what has long been obvious: The patient experience matters to health outcomes. How to meaningfully impact it is now the question.
The Mindful Provider
Two areas I am personally passionate about are digital health innovation and the mindful provision of healthcare. These may seem opposing forces, but I believe they each represent tremendous tools that can be brought to bear in the service of creating the safest and highest-quality patient experiences possible.
Simple anticipatory communication and approachability are important steps towards that goal. As Dr. Yves Duroseau pointed out on last week’s panel, a patient who is told his stitches might come out – and how to manage this – feels very differently about the quality of his healthcare encounter and his own self-efficacy when the sutures loosen than a patient who receives the same technically high-quality care and is sent on his way without that information. This matters to clinical outcomes. Not only will the first patient be able to manage the situation when it arises, but he is also (as patient advocate Ilene Corina cited in her own experience) more likely to ask questions or raise concerns that may lead to crucial case-specific changes in care.
Despite – and increasingly because of – the pressures of the ever-shrinking window of time reserved for the patient encounter, the kind of ease and clarity of communication I described above is critically important. It matters whether a patient feels comfortable asking the questions that may ease her anxiety about taking a new medication, help her understand the importance of keeping a follow-up, know that a minor side effect does not necessitate a trip to the ER, or help her recognize the signs of a serious complication that might not otherwise receive attention until too late. These solutions are not really about taking more time, they are about something much more valuable and intangible than that: being present with your patient. Our patients know when we aren’t all there, and that experience is damaging to the patient-provider relationship, yields worse outcomes, and short-changes us all.
Well-designed, easy-to-use technologies can provide a sense of empowerment, and also help patients feel like people, even during a hospital stay. For instance: Give in-patients a tablet that identifies every member of their healthcare team by name and also photo – as in Dr. Rainu Kaushal’s upcoming pilot at Weill Cornell, addressing the findings that 68 percent of patients cannot identify even one of their hospital physicians at time of discharge. Or, as in NXT Health’s Patient Room 2020, devise strategies to use wireless wearables to limit the psychological sense of being encumbered, and build in teleconference capabilities for patients’ families and advocates to join morning rounds and visit their loved ones remotely.
Access to health records – in a form that is useful – also matters. The proliferation of patient portals and Blue Button are a start. (I know a doctor, though, who is very careful not to abbreviate “shortness of breath” in his documentation any longer, since getting an earful from an irate patient with chronic lung disease who believed he was being called an “SOB.”) Making health records easily available is an important first step, but we should not be willing to stop there. As NYCHBL President Bunny Ellerin so perfectly stated, sharing her own experiences: “I’m an educated person, and I not only didn’t know what the results meant, I didn’t know why the test was done!” This is not acceptable. To borrow from CMS verbiage, this is not sharing patient data in any meaningful way.
Bringing It All Together
Natural language processing to translate these records from “medicalese” to plain language, as called for by Dr. Duroseau, may be the future. Dictation softwares and “smart phrases” that avoid clinical shorthand are up to the challenge now, and should be much more widely employed. In all events, we must ensure that qualified clinicians (preferably the patient’s own) are accessible to explain terminology and results, and to discuss questions that arise. Not only will that patient have a better understanding of and be a stronger champion for his or her health, this kind of communication builds the patient-provider relationship – a known predictor of health outcomes – and boosts the self-efficacy that promotes health and wellness.
At the end of the day, all of us – patients and providers – want the same thing: good outcomes. All too often, however, incomplete definitions of success, systemic challenges, and poor design seem to put us at odds. Approaches that take into account the lived experience of patients and providers, and all the elements critical for us to reach that common goal, offer the opportunity for us to work seamlessly on the same team.
Kaylan Baban, MD, MPH, is a public health physician, educator in digital health and the role of mindfulness in healthcare, and Preventive Medicine resident physician at the Icahn School of Medicine at Mount Sinai. She is also a passionate mobile health developer, consultant, and enthusiast. Follow her on Twitter: @KaylanBaban