We love M&Ms – now it is also time for P&Ps

For decades, the healthcare industry has used perioperative morbidity and mortality reviews (M&Ms) for blunt evaluations, to continuously improve the understanding of and performance in surgical intervention. Since the industry touts Population Health and Patient Engagement as top initiatives, health systems can use the successful process of M&Ms to perform Population Health and Patient Engagement reviews (P&Ps) of individual cases, for determining the extent to which these terms are being fully addressed and realized across the healthcare system.

One impacting factor for successful reviews is establishing the definition of Population Health and Patient Engagement, what do they mean to your staff. And most importantly what is the understanding of the consumer. The industry is not using a universal, concise definition for either. As a result, I wanted to provide a definition for Population Health inclusive of Patient Engagement - for purposes of comparison and measuring success. These two terms are often discussed as separate entities when the question begs to be asked, "How do we achieve Population Health without Patient Engagement?" If the industry does not have a unified definition, how can we educate and engage the population? If the industry views Population Health only as an extension of public health, the focus is on disease management as opposed to being patient centric; or specifically, the focus is not on engagement of the individual consumer.

It is important to review the distinction between patient engagement and the patient experience. Many data sets of success are being tracked through customer questionnaires, which is basically the consumer perception of quality care delivered, with many initiatives being based upon as a top focus within health systems:
• How clean was your room, bathroom?
• Did you have to wait long?
• Was your room quiet, was the noise kept down?
• Did staff communicate well?
• Did you get the meal selections and TV channels you desired?

Hopefully everyone has pleasant encounters while at physician offices or hospitals. But, the questions above would be construed when evaluating the experience for a hotel stay or dining out, with the goal of having customers stay longer and repeatedly come back.

Unlike hotels, healthcare needs to focus on educating their customers to keep them from staying longer or being readmitted because they are engaged in getting and staying healthy. The current patient experience perception is a 'window dressing' review that does not include a detailed evaluation of quality care delivery, or transparent sharing of reported quality indicators (e.g. hand washing, communication between staff, etc.) If we empowered patients to review their medical experiences - not as a hotel or restaurant visit, but viewed as a hospital or physician visit with care delivery - turning the emphasis from the perceived patient experience to patient engagement, the questions would include asking:
• Was your entire stay and care clean? Were you free from cross contamination exposure ensuring you did not receive a hospital acquired infection (HAI)? Did all staff not only properly wash their hands, but they also avoided touching unclean things after washing their hands, before touching you? (Such as: dirty keyboards while documenting, hand radios and stethoscopes around their necks that were not cleaned after touching previous patients?)
• Did staff monitor you closely to avoid alarms going off, and did they not turn off alarms that continued to make noise because they were frustrated with alarm fatigue? Did they explain to you why values or readings were setting off alarms?
• Were you properly triaged and responded to in a timely manner based upon the severity of your condition? Were you provided with the necessary options available to you such as: care management upon admission to ensure proper assigning of inpatient versus outpatient or urgent care center services, advanced directives review, and pre-admission clinical care coordination for establishing baselines of vitals, labs, level of conscious?
• Was the staff well trained and communicative regarding their effective assessments of you, correlated with your lab values, medications and treatments? Was the staff competent in addition to being polite?
• Were you well informed and prepared for discharge with demonstrated care coordination with all clinicians and support personnel for transitioning to home, long term care facility and/or rehab? Did all staff review the plan of care with you? Were you aware of any resources you needed including care management, palliative care, financial advocacy/bill and EMR review?

The following two case examples show the distinction between reviewing the patient experience versus patient engagement as quality care review. One women admitted into the ER and discharged home stated, "they took great care of me, they were so nice." In actuality: there was no care coordinator between her primary care doctor, hematologist, and pain doctor before admission; her baseline labs were not obtained from her primary care physician upon admission even while being within the same health system; she had the wrong discharge diagnosis in her EMR; there was no communication upon discharge between the hospitalists, social worker, family and primary care doctor; she did not receive any admission assessment; her discharge plan was TBD three hours after the discharge order was written and she was ready to go home; and her ER visit and overall hospitalization was unnecessary due to lack of appropriate lab monitoring with her medication regime from her primary care physician. A second well-educated woman stated she received great care because the staff kept coming in and asking how she was and her pain scale with administering of pain medication; however, there was lack of assessment of her lungs and intake and output to make sure she was not being given a hospital acquired condition (such as pulmonary edema, etc.) with onboarding of 10 lbs. of fluid with the diagnosis of hypertension, renal insufficiency, hypokalemia with shortness of breath. The patient experience was the perception of the stay; while patient engagement is the understanding of their condition and the appropriateness in the delivery of care for that condition with thorough communication.

It was recently reported Medical errors are the number three (3) cause of death in the US. Health systems performing P&Ps provide the means to stay on top of ensuring each patient, the patient's family and advocates are engaged with the delivery of quality care across departments, as well as the continuum of home, inpatient, outpatient, post-acute, and community. Increased quality is then facilitated by reducing over-treatment, under-treatment, incorrect treatment, and medical errors.

Using P&Ps for evaluating individual patient encounters ensures sound processes, with the patient experience centered around how well the patient and families were engaged by appropriately trained staff, at all stages. Shifting from a patient-centric to consumer-centric model means transparency, by informing customers of quality practices and quality indicators being reported as part of engaging them, their advocates, families, and caregivers. Being consumer centric also means their understanding of what is care coordination with care planning between environments after discharge, when they are no longer a patient.

Rose Rohloff is a 35-year healthcare veteran with a background in nursing, business and information systems. She has worked with vendors creating industry leading healthcare software, consulting with $MM healthcare improvement engagements, and bringing new business analytics to the industry. Ms. Rohloff has authored for several leading healthcare journals and currently is presenter for Healthcare, we have forgotten someone – the consumer.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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