Clinician to Clinician

Photo: Dr. Wheeler looks forward and smiles. She is wearing a simple, dark suit.

Penny Wheeler, MD, chief clinical officer, Allina Hospitals & Clinics, periodically writes Clinician to Clinician messages to encourage dialog between her office and clinicians throughout Allina and to share perspectives on significant clinical issues facing Allina.

The core of our mission at Allina is to provide exceptional care. We fulfill this mission every day and numerous people benefit. Even while celebrating that work, as caregivers, we also need to ask each day, "How much better could we be?"

Our strategy calls for us to care for patients no matter the need or the setting — from preventative care, to lessening the burden of chronic illness, to acute care services, to compassionate care at the end of life. We aspire to walk with each patient to ensure he or she is continually supported rather than a following the tortuous, disjointed path that is too frequently the patient experience today.

Recently, I heard the story of a woman with a chronically ill child. The child had multiple congenital anomalies and enormous health challenges. The burden of illness for this child and his family was enormous and, sadly, it was compounded by the fragmentation and complexity of the health care system. The child's care team consisted of forty-four providers and the mother had to navigate and coordinate all the care by herself. With such a lack of care coordination, it is simply not possible to provide exceptional care.

In most industries, the customer reigns supreme. In health care, however, the focus is too often on the technical aspects of care and patients are relegated to being passive participants. Ill, infirm or otherwise in vulnerable positions, patients accept long waits, poor communication, and de-personalization as the norm. Outside of health care, such standards would not be tolerated.

While the term 'patient-centered' is often bandied about, what does it really mean? What does 'patient-centered care' look like?

"Patient-centered care" can best be defined as open and complete information sharing with patients, involving patients in medical decision-making, responding to patients' unique needs and values, and coordinating care across providers, settings and conditions.

Evidence is increasing that patient-centered care can improve patients' health. At MCG Health System in Georgia, a neuroscience unit partnered with patients' families to help monitor patients' status in the ICU. Surprise: communication dramatically improved and outcomes soared. The unit decreased medication errors by 62 percent, length of stay fell 50 percent, staff vacancy rates went from 7.5 percent to 0, and patient satisfaction rose from the 10th percentile to the 95th!

Patients receive episodes of remarkable care in our hospitals and clinics each and every day. That being said, overall, people spend a tiny fraction of their life in clinics or hospitals. That means we need to make every visit and every encounter count. In fact, I believe that we will not—we cannot—dramatically improve care until we engage our patients as our partners in care.

Each of us, as physicians, nurses, other caregivers or support staff has a role to play in providing patient-centered care.

My role as a clinical leader for Allina is to help design performance systems and other incentives that reward patient-centered care. It's to define and articulate our vision for patient-centered care and it's to keep our obligation and our commitment to providing this care at the forefront of all aspects of our decision-making at Allina.

Finally, one of the most important roles I can play is to help remove barriers to providing patient-centered care.

I think that most of us understand — intellectually — what patient-centered care is, and why it can be powerful. While we aspire to provide care that is patient-centered to each and every patient, we don't always provide it. Whether it's due to structural barriers—processes or policies that undermine a patient-centered approach, or maybe it's education and training, we understand it conceptually but don't know what it would look like for a particular patient, on a particular floor in a particular clinic or medical center.

I need your input. I want to hear from you. What's your role in providing patient-centered care? What are the barriers you encounter and how can I support you in providing such care? What examples of patient-centered success or challenges have you faced?

E-mail me, call me at 612-262-0605, or stop me when I'm visiting your medical center (I'm trying to get out to an Allina facility every week). I'd love to hear from you. Together, we can create a truly patient-centered experience across Allina.

A patient's view of exceptional care

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