Producing Peace of Mind: How Hospitals Can Identify and Reduce Patient Suffering

Last week, Thomas Lee, MD, who practices primary care at Brigham and Women's Hospital in Boston, saw a patient for a follow-up appointment after surgery. Dr. Lee says he made sure to email the patient's surgeon, Atul Gawande, MD, in front of her, so she could see he was updating Dr. Gawande on her case.

That gesture was part of an effort Dr. Lee and his colleagues are making to show patients they're communicating and working together. Dr. Lee — who is also CMO for Press Ganey, a company focused on improving the patient experience— says Brigham and Women's, in its quest to provide cutting-edge care, often ends up getting a lot of clinicians involved in a case. That approach brings together a considerable amount of brainpower but can also make coordinating a patient's treatment a bit chaotic. As a result, patients worry that the clinicians treating them aren't working well together, Dr. Lee says.

"We're actively trying to attack that fear and take additional steps to make it obvious to the patient," he says.

Dr LeeThat line of attack is part of a larger battle to alleviate patient suffering (physical pain, fear, anxiety and other discomfort), a goal Dr. Lee says should become the focal point for the healthcare system. He says healthcare organizations need to aim not just to avoid harming their patients but to actively label, detect and reduce patients' suffering.

"Of course, everyone in healthcare has always been against suffering," he says. "What we're hoping is we're helping to accelerate the change of healthcare’s structure. There's clearly a change underway toward being organized around patients' needs."

In recent years, as clinicians have increasingly narrowed their focus within certain specialties, they often get so caught up in the technical details of care that they overlook patients' suffering, or they don't know how to respond to it, according to Dr. Lee. In a November 2013 Harvard Business Review blog entry, he and a colleague wrote the healthcare industry has systematically avoided acknowledging the existence of patient suffering, or at least using the term to describe it as such.

"The time has come to deconstruct suffering — break it down into meaningful categories that reflect the experience of patients and help caregivers identify opportunities to reduce it," they wrote. "Those that can accurately categorize, measure and mitigate their patients' suffering most effectively will be rewarded with greater market share as well as the loyalty and retention of clinicians and other personnel."

Dr. Lee and his colleagues break suffering down into two main categories: avoidable and unavoidable. Unavoidable suffering, which providers should seek to mitigate, is associated with the symptoms of the patient's condition and the side effects of treatment. In contrast, avoidable suffering arises from dysfunction within the delivery system, which providers need to recognize and eliminate, Dr. Lee says. Many hospitals already have programs in place to reduce hospital-acquired infections and other avoidable sources of physical pain. However, Dr. Lee says providers need to go further and find ways to prevent avoidable fear and anxiety — common forms of suffering among patients.  

"I like to think of this is as a logical extension of organizing care around patients' needs and a logical extension of the safety culture," he says. "That avoidable suffering that is organization derived…identifying it as such and labeling it as such, I think that people in healthcare will respond to that challenge. That's why we're in healthcare, after all: to relieve suffering."

Lessening or eliminating suffering starts with gathering feedback from patients about their experiences navigating the healthcare system. "That collection of data should be a part of care, the way taking people's blood pressure is a part of care," he says.

Once providers have gathered enough data on patient experiences, they can analyze it to find the source of problems. For instance, Dr. Lee says, providers can examine feedback on staff communications skills broken down by categories (for example, looking specifically at how well nurses, doctors and others communicate with patients), to detect problem areas.

Overall, Dr. Lee says healthcare providers need to act to define suffering and reduce it. "One of my colleagues at Brigham and Women's put it this way …peace of mind is where we are supposed to produce," he says. "We have to work to create that peace of mind. We can't just assume it is going to happen otherwise."

More Articles on Care Improvement:
Video Game Technology Identifies Patient Falls, Helps Improve Quality
Do Checklists Work in Healthcare? Patient Safety, Behaviors and Organizational Culture
5 Tips for Measuring Patient Safety Data 

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