Developing a Workforce Strategy for Patient-Centered Care: 6 Key Steps

Environmentalist Paul Hawken once said, "All is connected. No one thing can change by itself." The idea certainly strikes a chord for hospitals, which are complex ecosystems of their own. To deliver patient-centered and coordinated care, hospitals need to operate under a clear vision and strategic plan that is upheld throughout the entire organization.

This strategic plan needs to be carried out in every role and department within the hospital, from nurses at the bedside to human resources in the interview process. It should be broken into feasible steps that caregivers can embed into their daily routines, and formally embedded into the organization through governance structures, reward programs and professional roles.

But before delving into workforce strategy, it's helpful to define what "patient-centered care" is by what it isn't. The term is so widely used throughout healthcare that it is sometimes easy to forget what "patient non-centered" care looks like. Hospital leaders, physicians and employees should constantly be keeping an eye out for ways their organization can improve.  

Allan Khoury, MD, senior health management consultant with Towers Watson, says examples of patient non-centered care run the gamut. Patients' confusion about medications, discharge procedures that result in readmissions, patients taking it upon themselves to convey medical information from their specialists to their surgeons, or patients not knowing which provider to follow up with — these are all symptoms of a non-centered experience.

The repercussions of this type of experience, which stems from poor communication and care coordination, are extensive. It affects patient satisfaction, safety and quality of care, not to mention the financial and operational aspects of the hospital.

Rick Sherwood, senior consultant with Towers Watson in the Chicago office, says poor care coordination can occur at every point of along the spectrum, even weeks after the patient has been discharged from the hospital. For instance, a patient returning home to five different medical bills for charges they find incomprehensible is not a sign of patient-centered care, even though the event occurs outside the hospital facility.

The following six steps can help hospitals strengthen their workforce strategy for patient-centered and coordinated care.

1. Devote hospital governance structures to the patient experience. Patient and family advisory councils are a sound indication of a hospital's commitment to patient-centered care. These governing bodies provide perspective and feedback about the patient experience, including whether patients feel safe, whether patients' individual needs were identified and met, whether patients' questions were appropriately answered, and whether clinical information was thoroughly shared and understood. Mr. Sherwood says he's seen a proliferation of these committees in the past few years, and he finds them to be "a great way to engage patients in their care and in the larger community of the hospital."  

Cleveland Clinic has more than 15 governing bodies called Voice of the Patient Advisory Councils. These groups, comprised of employees and patients, are part of Cleveland Clinic's Office of Patient Experience. They meet regularly to discuss a range of issues and challenges that affect patients and family members, including hospital policies. For instance, the council can incorporate patient, family and employee feedback to influence hospital management's decisions about things like visitation policies.

2. Include "patient champions" throughout the hospital workforce. Many more hospitals are also creating formal roles within the hospital and system workforces that focus on patient-centeredness. For instance, patient navigators act as "quarterbacks" who oversee a patient's care coordination, from the time of admission to discharge to follow-up. These individuals make healthcare more patient-friendly and accessible, eliminating any barriers or interferences that may hurt their care. "He or she is a single point of contact for patients," says Mr. Sherwood. "This role I'm seeing more of is definitely a good one."

Roles like patient navigators vary throughout the organizational hierarchy, from chief experience officers to patient advocates, but they share the same broad goal: Bring the patient to the forefront of the care experience. Some hospitals and health systems have even established offices or departments to oversee these initiatives, such as Massachusetts General Hospital in Boston.

Massachusetts General has its office of patient advocacy, which serves as a liaison between patients and the hospital. The office has streamlined and standardized processes for patient feedback, ensuring compliments and complaints drive improvements throughout the organization.

Patients and their family members are encouraged to contact the office with compliments, which will be shared with the appropriate person, recorded in a database and responded to promptly, or a complaint. If the office receives a complaint, it will ask the patient for permission to begin an investigation, talk to the person named in the complaint and collaborate with the patient for a possible resolution to the issue. Ideally, the entire process takes no more than 30 days.

3. Ensure each component of the workforce understands its role in meeting goals for patient-centered care. No hospital department or employee is immune from the call to provide patient-centered care. When developing a strategy, hospital leaders must take clinical or operational goals, such as lowering readmission rates, and connect them to every facet of the organization. How does human resources affect readmissions? How can that department help ensure readmission rates are low? How can employees be trained differently to support low readmission rates?

Questions like these are worth answering. "Everyone should have a role in these goals," says Mr. Sherwood. "These goals should also be more precise than, 'We want to offer good patient care.'"

At Cleveland Clinic, more than 40,000 employees attended half-day training programs on how to improve the patient experience. The training was designed for every employee — from cardiologists to parking attendants. During those sessions, James Merlino, MD, Cleveland Clinic's chief experience officer, gave an example of how a patient-centered organization should operate. "Imagine there was a puddle on the floor," he said. "In the past environment, 10 employees would just step over it. Now, we've created a culture of ownership where regardless of your role, you wipe up the puddle," Dr. Merlino said, according to a Plain Dealer report.

4. Approach patient-centered care goals with as much intent and structure as other core measures. Core quality measures have reinforced hospitals' need for care processes that promote timeliness, efficiency and patient-centeredness. "[These measures] really force care to be coordinated," says Dr. Khoury. "You need the whole team to reengineer their processes."

A hospital's strategy to improve performance on a core measure illustrates the type of strategy the organization should implement for other goals that may not be part of HCAHPS or the federal Value-Based Purchasing Program. As an example, look at how providers' approach to pneumonia has evolved since it became a standardized core measure.

"At academic medical centers in the old days, to receive treatment for pneumonia, patients were seen by a medical student, then interns and residents. It took a long time to get antibiotics," says Dr. Khoury. This process has since been reengineered at hospitals, especially since CMS incorporated pneumonia care processes into its core measures. Hospitals are now rated on whether adults with pneumonia received their first dose of antibiotics within six hours of their arrival to the hospital. Hospitals may want to approach other patient-centered goals with as much structure, focus and system-wide vigor as they do CMS' core quality measures.

5. Find a happy medium for checklists. Many hospitals are deploying checklists and scripting devices as tools to drive evidence- and team-based care delivery, but these tools need to be used with caution. Relying too heavily on checklists and scripts can rob the provider-patient relationship of authenticity and emotional intelligence, says Mr. Sherwood. "Discharge scripts, rounding scripts and checklists — there is a lot of evidence they lead to better patient care. But the other side of it is they become too mechanical. Make sure you still have flexibility, so there is still a human element."

Physicians' and caretakers' bedside manner should embody the values of patient-centered care. This includes key nonverbal behaviors, such as sitting near the patient during discussion and making consistent eye contact. Some organizations use physician performance measures that support these behaviors. While scripts and checklists can ensure consistency, they tools should treated as resources that accompany compassionate and respectful care from hospital providers.  

6. Acknowledge and reward employees for their contributions. Whether it's an employee recognition program or financial incentives, hospitals should continually acknowledge employees' contributions in creating a patient-centered organization.

"One of the things we're talking to hospital systems about is [creating] better ties between pay and these goals," says Mr. Sherwood. "And not just at the top levels of the hospital and system, but in the lower levels of the organization." One hospital Mr. Sherwood has worked with is planning to offer matching contributions to employees' 403(b) plans if the hospital meets its patient-centered goals. "It puts some teeth in it. It says, 'We really mean this. If you do this, you'll be rewarded,'" says Mr. Sherwood.

Regular recognition programs can also help employees keep their eye on patient-centered goals. For instance, each fall, Cleveland Clinic selects 12 employees — physicians and staff, based on patient and peer nominations — for recognition as part of its Exceptional Healing Partners program. The program honors employees who have embraced patients' mental, physical and spiritual needs, and consistently anticipated and exceeded patients' and families' expectations.   

More Articles on Patient-Centered Care:

Patient Care Coordination: Strategies and Leading Practices
35 Best Practices for Physician Communication
Study: Patient-Centered Care Plans Improve Health Outcomes



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