- On the journey toward more value-based care, healthcare professionals must use team-based strategies to appropriately allocate resources, prevent provider burnout, and deliver on quality metrics. Organizations must create both provider and patient engagement to truly deliver value and ensure both stakeholders are meaningful members of the care team.
At the Value-Based Care Summit held in Boston, a panel of patient engagement experts agreed that healthcare professionals need to determine what true engagement means to patients. Efforts to put patients at the center of care will be for naught if the care and outcomes are not of value to patients.
This means that patient satisfaction does not always represent value and it certainly doesn’t necessarily equate to engagement.
“Patient satisfaction almost has a negative connotation when you start to think about it in terms of the medical setting. It’s the focus of making patients happy,” said Alison Lemay, the associate vice president of patient and family experience at UMass Memorial Medical Center.
“We’re trying to turn the vision on that,” Lemay continued. “It’s not about making patients happy. It’s about their experience in their healthcare journey which goes beyond the four walls of the medical center that we work in. It’s about looking at their experience and what we can do as care providers to add to their experience that helps them become better engaged patients in our organization.”
Deborah Blazey-Martin, MD, MPH, a primary care physician and the chief of Internal Medicine and Adult Primary Care at Tufts Medical Center, agreed. Patient satisfaction focuses primarily on the cosmetic part of healthcare, such as the shiny floors and the comfortable amenities.
“When I think about engagement, it’s about those relationship-building issues,” Blazey-Martin said. “It’s about the patients feeling like there is someone in their practice that they can ask questions of, that they feel like they have someone that they can trust. Engagement is about feeling a part of your healthcare.”
Understanding how to build those patient-provider relationships will require clinicians to know their patients as people and know patients’ wants and needs, said Terrie Enis, PT, MSPT, director of Rehabilitation Services and The Dr. Robert C. Cantu Concussion Center at Emerson Hospital.
“It’s about what matters to the patient, but what matters to a patient on a Tuesday might not be the same as on Thursday,” Enis noted. “We need to switch the paradigm of being directive to helping the patient lead us to what matters to them. When we hit that sweet spot, we have engaged patients.”
Neglecting to ask the patient what she wants out of her care comes with a considerable risk, Lemay added. When providers don’t know what patients want or need during a care encounter, a chasm forms between patient expectations and what is delivered. Dissatisfaction arises when providers don’t meet patient expectations.
But much of this work on patient centricity and engagement is happening within the backdrop of value-based care. Risk-based contracts, accountable care organizations, and bundled payments require practices meet a set of quality metrics that should reflect value.
However, efforts to meet these quality reporting requirements can take away from patient-provider communication and relationships that are at the heart of quality care.
The key to overcoming that barrier is primarily focusing on those quality metrics that relate to the overarching goal of the practice and its patient populations, the panelists explained.
“I have a tee shirt rule that every time I buy a tee shirt, I have to get rid of an old one,” Enis said. “I relate that to our policies and procedures and the way we treat our patients.”
At Enis’ rehab center, she and her teams have had issues with the Joint Commission in that the team was not reporting enough about pain management. This caused Enis and her team to reallocate their resources to deal with pain management quality reporting, even though as a rehabilitation team they aren’t necessarily concerned with pain management.
“In a rehab world it’s about function,” Enis asserted. “When we start making these rules, you need to think about what your patient population really wants to accomplish here. If we start making more rules saying it’s for value, let’s make sure it’s meaningful for patients.”
Focusing quality metrics on what is important for specific patient populations will ensure patients have a quality experience that meets their expectations, the panelists agreed. It will also free up time for providers to experience some job satisfaction and to truly engage with patients in a meaningful way, Blazey-Martin said.
“If your staff is unhappy, it’s unlikely that you will be able to engage your patients,” she stated. “If you add one more onerous, burdensome thing to do, you should take something off the back end if you can.”
Creating provider buy-in and engagement will require organizations to consult providers from the get-go when designing overhauling practice changes and improvement projects. Although UMass Memorial sometimes creates sweeping overhauls to facilitate better patient experience, these overhauls are manageable because they engage the frontline stakeholders, such as patients and providers.
“When you start designing a new system, start with the people who are going to be using it every day,” UMass’s Lemay instructed. “Don’t start with the people at the top, and realize that when you implement at the bottom that the system won’t work and nobody believes in it.”
Blazey-Martin agreed. Often, broad institutional changes take a top-down approach, engaging first those who don’t have much interaction with patients. Although well-intentioned, these methods don’t usually yield great results.
“There are many genuinely compassionate people at the top who want to help people, but it just never works out right when you start a new initiative that’s going to make more work for people,” Blazey-Martin said. “You can’t really fix things for the patients if you don’t know what patients think. You need to ask patients, providers, the frontline staff. Ask them what bugs them when they come in, what is inefficient or how we can make things better.”
Enis added, “taking it from an ‘I have to,’ to, ‘I want to,’ is key.”
Ultimately, reframing quality requirements can better align care team members in the journey toward patient-centricity.
It’s not necessarily about who is driving the care toward patient wellness, but instead about making sure that car is headed where the patient wants, Enis said. That will require patient outreach and giving patients the opportunity to be the arbiters of their own wellness.
“It always comes down to asking the patient about what works for them and what their needs are. It’s going to be different for every patient,” Lemay asserted. “But then you need to empower patients in their healthcare journey. Not every patient is going to become empowered, there might be generational gaps. But putting it out there and making sure that patients have the resources and education that they need is important.”
Removing the computer and the checkboxes from the equation is the best solution for patient engagement, the trio remarked. Although quality metrics are essential for shaping and delivering value-based care, providers will also need moments away from the computer to conduct meaningful patient outreach. As a result, providers will be able to deliver care that is meaningful to patients.
“The only way you can get to patient engagement is by having engaged providers and teams, and it always comes back to morale,” Blazey-Martin concluded. “How do we get those who are on the frontlines to be able to take their hands off the computer and ask patients about their lives? How can we expect our caregivers to be compassionate when the system isn’t being compassionate to them?”
“It’s about trust, it’s about respect, but it’s also about people having time to breathe and being able to care about each other.”