Flip the Clinic: Transforming the Physician-Patient Interaction

Communication is one of the hot topics in healthcare reform these days. It's up there in discussions about readmissions, patient satisfaction and quality of care. Despite some valiant, yet isolated, efforts to improve communication in healthcare settings, most of what's floating around seems to emphasize what's lacking, how poor communication contributes to less-than-exemplary care and how healthcare providers have completely lost touch with what patients can understand.

Thomas Goetz, entrepreneur-in-residence at the Robert Wood Johnson Foundation and former executive editor of Wired, has set out to change all that. His newest project, Flip the Clinic, is an ambitious pioneering effort directed at improving the literal moment of the healthcare experience. That moment is about 15 minutes on average; it's the brief window during which physicians and patients have face-time.

What's the flipping deal?
It's a funny image and a catchy phrase, but what does it actually mean to Flip the Clinic? In the abstract, the idea refers to shifting the major intents, responsibilities and roles in the physician-patient relationship so that the patient can become an expert in his or her own care. The physician takes on a role of synthesizer, a reference point off of which patients might bounce ideas about their health.

The purpose of this flip is to engage patients and optimize the expertise of care providers so that they might once again do what they're best suited to do: Provide care. It's how the Flip the Clinic team imagines the physician-patient relationship should be delivered in practice.

This is a big goal. Mr. Goetz hopes to get the ball rolling by attaching the Flip the Clinic name to a website functioning as an innovation hub, highlighting some of the most interesting and promising tools in healthcare communication. By placing metaphorical neon signs on the best tools of the bunch, Mr. Goetz hopes it'll become easier for healthcare participants to find them and take them for a (successful) spin.

Flip the Clinic has already made progress on creating this toolkit. Mr. Goetz, along with a team from RWJF — consisting of policy makers, entrepreneurs, nurses, physicians and, of course, patients — designed the website content as a front line for gathering ideas. It's a friendly orange-and-white affair that lays out the basics of the Flip the Clinic in plain language. The thorough descriptions and questions-and-answers lead to a simple "contact us" page where it's possible to share your thoughts on improving the care interaction — as a patient, as a physician and as anyone somewhere in between. In the end, the website will feature perhaps 20 or 30 pockets of innovation, drawing on initiatives that have already improved the communication problem somewhere in the healthcare universe.

According to Mr. Goetz, a number of companies and entrepreneurs are engaging with the effort to point Flip the Clinic toward people who are working on the premise of the project. "There are lots of organizations stepping up and saying they've been working on this in some way or another but haven't quite found the vehicle that helps their colleagues understand what's going on," he says. Indeed, while the think-tank team is just where the main idea genesis is located, Mr. Goetz notes the number of organizations with a sense for the needs in healthcare is much larger.

The idea of creating a resource for transforming the physician visit experience has its roots in many places. First, it's inspired by open-source software GitHub. For the uninitiated, this is a website that exists for sharing various tools and open-source code among web developers and the tech-savvy so all may benefit from one user's clever innovations.

It's also modeled off of another innovation, Flip the Classroom, a project that works to optimize the teacher-student interaction by offering online instruction and allocating classroom time for individualized student-teacher interaction.

Flip the Clinic's modus operandi also borrows from the tech industry, where things are conceived, built and brought to production as soon as possible. Mr. Goetz indicates that part of the uniqueness of Flip the Clinic comes from the fact that it's planned to be almost twice as fast as the traditional intervention model, no mean feat in an industry where progress has traditionally been slow. "What we're doing here is taking some quick-and-dirty technology piloting techniques and bringing them to a new area," he says.

The project also attempts to take on the problem of customizing innovation. The flip strips tools to their basic principles, marrying those that are essential to a tool's function with those that will make it successful in any setting. Essentially, the flip is the all-terrain vehicle of interventions. It's fast, pragmatic and adaptable. It capitalizes on the best expertise of both parties, the patient in his or her health, and the physician in providing synthesis of ideas and care. And it seems like it has the resilience it takes to make some serious headway.

The innovations
The exact nature of the innovations is still in progress. Mr. Goetz imagines something as simple as creating mutual guidelines for patients and physicians for that 15-minute conversation, cheat-sheets for both parties to get the most out of the limited time they have together. Or, interventions could be as complex as reincorporating house calls into the physician-patient relationship.

The Flip the Clinic team is in the process of compiling a list of ideas, cutting it down to 10 or 15 and field testing them, not to a clinical level, but well enough so that by January the website will be populated with tools for clinics and hospitals to attempt their own flips. "What we produce in January is hopefully the beginning of a broader discussion and a more specific and precise articulation of an opportunity," says Mr. Goetz.

Of course, as in any enterprise, there are uncertainties. Although Flip the Clinic encourages innovative ideas, many of which have been pipe dreams until now, not all of these ideas will be able to make the jump from the drawing board into the real world. Predicting which ideas will survive is anyone's guess.

Another consideration: Although the project optimistically says that it doesn't expect Flip the Clinic to require extra resources — interventions are designed to run as leanly as possible — the truth is that no one really knows yet if this is true. The redesign of healthcare is a totally new frontier. But this shouldn't be a deterrent, says Mr. Goetz: "It's trial-and-error, but it's the kind of thing we think we should try: To draw up the incentives and free up the resources in the right way."

Permission to flip
The inherent uncertainties of the project are what make it both exciting and unusual. Mr. Goetz says he is thrilled with the willingness of the RWJF to take a risk on the project, which runs in a very different way than other projects with similar missions.

It's a risk that could be well worth it. After all, as Mr. Goetz points out, at its worst, Flip the Clinic starts important conversations that get the ball rolling in that direction. At its best, Flip the Clinic may spawn systemic changes that revolutionize healthcare in a meaningful way. "There's a big spectrum between those two, so we'll see where it's going. We're designing it to scale up, so hopefully it will be able to take on a life of its own," says Mr. Goetz.

In fact, that's what he would consider the greatest success of the project. He'd like people to feel that Flip the Clinic gives them permission to do things differently, and he hopes "it resonates even more broadly than we might imagine and seems to reverberate as a landmark for people across the country." Kind of a tall order, but with the adaptable mindset and willingness to listen Flip the Clinic has shown thus far, nothing seems impossible.

"It's about reminding people why they're in [healthcare] and reminding each other the virtues of the other side. We're trying to take advantage of the tools and technologies that might give them some room to do that," he adds.

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