Introduction to Patient Centered Care IHI Open School PFC 101

Agenda Review IHI Lesson Model Exercise Discussion of Patients and Providers as Partners Wrap Up

milestones PCP #3 Reduce unnecessary hospitalizations PCP #4 Encourage patients and families to collaborate in goal setting, decision making, and self-management (#5 Incorporating pt and family feedback, #7 Continuity between pt and care team, #8 Pt empanelment, #17 Provider availability 24/7, #22 Technology for scheduling and communication options, etc.)

Models of the Patient-Provider Relationship Paternalistic: physician or provider is viewed as an expert authority on health care Informative: provider is a technical expert who simply provides information to the patient, and the patient holds the decision-making power about his or her care Interpretive/deliberative: provider serves in the role of a counselor, advisor, friend, or teacher

The Partnership Model Health is determined by more than health care. Clinical care makes up only about 20 percent of any person’s health outcomes. To address disparities, providers must seek to address the social determinants of health as well. Patients are diverse individuals who are active agents in their own health. Providers play the role of facilitators who help patients achieve their own health goals.

What’s wrong with the traditional model? Patients always have a choice to take medical advice. Patients have assets to contribute to their own care. Social conditions place limits on what patients can do for their health.

A Note about Trust The Tuskegee study (1930s‒1972) Internet Many patients have had life experiences that lead them to distrust providers

Model Experiences Tell about an experience you had or shared with someone using a traditional model that did or did not result in optimal care. We will list the reasons you believed you had this care from each group on the board.

Patients as Partners There are always two experts in the room The one who does not have expertise in medicine is an expert in: Their life experiences Their abilities Their willingness Their culture Recommendations stop at the middle of the room It is ultimately the patient who will live with care decisions

Providers/Patients as People Agency Bias – thinking of people’s actions as primary cause of an outcome Cultural Competence – ability of a system to provide care to patients who are diverse and tailor delivery of the system Implicit Bias – unconscious and unintentional discrimination Health Disparities – unfair differences in health due to inequitable social conditions

So What moves us forward Using Shared Decision Making - a conversation based on respect and dignity information sharing participation collaboration HCT Taking Steps - any provider can take steps such as pausing to notice implicit bias empathize by understanding without judging practicing humility by acknowledging what you don’t know

Rethinking Compliance Health care systems may label patients as “non-compliant” when patients don’t follow through with a plan of care. It may have been developed without their input or be possible in the context of their lives. Who is failing? Dr. Martin Bataldin – health care should be seen as a service that is co-produced by patients and providers.

Ask Me 3 registered IHI and the National Patient Safety Foundation – May 2017 Ask Me 3 is an educational program that encourages pts and families to ask three specific questions of their providers to better understand their health conditions and what they need to do to stay healthy. 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

conclusion Patient-Provider models need change There are a number of barriers for both providers (bias) and patients (literacy) to overcome Ultimately patient centered care is up to the HCT to develop and direct

Communication is Key