Becker's Hospital Review

43 patients and their families to serve on governing bodies that work alongside hospital staff and leadership to influence policies, programs and protocol. Several conversation participants said they see meaningful results and input from these trusted advisories. "Our patient advisory group is extremely engaged and active," said the vice president of quality man- agement at a 245-bed hospital in the Northeast. e group was established seven years ago and sees a lot of community involvement. "ey want our hospital to stay as their community hospital, even though we are now part of a larger system." Another aspect of patient engagement that emerged was helping patients become active participants in their own health, and act as part- ners with their physicians in making healthcare decisions. "If patients are not actively taking care of themselves, they won't have good outcomes, so it's about making sure you meet the patients where they are," said the chief diversity officer at an international organization. "Patient engage- ment is also about understanding the socioeco- nomic components [of a patient's condition]," she said. Healthcare leaders agreed this version of patient engagement requires providers to approach care management holistically rather than episodically, as they have in the past. Leaders said their orga- nizations are finding new ways of getting patients engaged in managing their health between check- ups. e CNO of a 240-bed hospital in the Mid- west said her nurse navigators are now expected to engage readmitted patients in conversation and investigate the social, economic or demographic factors that could be responsible for their read- mission. To learn this, nurse navigators ask patients a se- ries of questions. "Did we not give them enough information? Do they not have the resources to get what they need?" asked the CNO. "Did we not help them understand how important it is to fol- low-up on the things we asked you to do? at's what we're doing differently to help us engage with our patients to understand what failed." ese straightforward, one-on-one conversa- tions have yielded powerful qualitative data and narratives for care teams to address specific pa- tient needs. Previously, using clinical data or close-ended questionnaires, clinicians had diffi- culty identifying core reasons for a patient's re- admission. Sometimes the trigger for readmission is not found in an EHR or spreadsheet, as these discussions have shown. "We had a patient readmitted with out-of-control diabetes," said the CNO. "We were trying to figure out why she was not taking her insulin. She was taking it, but she didn't have a refrigerator to store it in because it broke." Armed with this new information, and knowing that the temperature of insulin influences its effi- cacy, the hospital bought the patient a new refrig- erator to safely store her medication. Aerward, she only arrived to the hospital for scheduled ap- pointments versus ER visits or readmission. Time to challenge the status quo Healthcare is a highly regulated industry rife with red tape, protocol and policy. Yet to better engage patients, several executives underscored the need for care teams to challenge the rules. e example of a hospital purchasing a patient a refrigerator is one example of an unconvention- al action that resulted in big benefits for both the patient and hospital. Leaders said patients have a lot to gain when healthcare professionals are en- couraged to think creatively and question the way things are "always" done. "We have a lot of processes set up because that's the way it's been for a really long time," said the vice president of nursing and patient care at a 34- bed rural hospital in the Midwest. "It's time to take a step back and say, 'Well, why do we have that in place? How can we break it so it works better for this patient?' Removing those barriers helps the patient see what you've done and become more involved." Some organiza- tions are working to make "unconven- tional thinking" a key part of how the system approaches patient care. For ex- ample, one hospital executive said his system is working to create advisory groups of families — but with a loose interpretation of the term. "Not just the family as you see it, but as the patient sees it — which could be their neighbors or friends. It's more about the customer: Who is their family?" Executives also emphasized the need to challenge their own assumptions and view each patient as an individual with unique fears, preferences and needs. "It's about shiing the way we as healthcare pro- viders or a healthcare system view the patient and disease," said the vice president of quality man- agement at a 245-bed hospital in the Northeast. "We're so used to it. We hear it and see it every day. But it's new for this person — it's important to remember that even though we've been prac- ticing for 20, 30 or 40 years, it's new for them. It's a game-changer." Empower care teams with multicultural education and awareness Many leaders are encouraging their teams to chal- lenge assumptions while also building a stronger understanding of their multicultural commu- nities. Cultural competency was an important theme of the conversation that took place be- tween the 13 healthcare leaders. Several noted how, for years, hospitals have operated on cultural as- sumptions or were oblivious to how routine offerings or interactions were per- ceived by individuals from diverse backgrounds. is includes everything from a physician greet- ing a patient on a first-name basis, to offering ice chips as fluids for hydration, to assuming hetero- sexuality on paperwork or questionnaires offered at OB-GYN appointments. In certain cultures, the lack of a courtesy title is perceived as rude, fluids are preferred at room temperature and suppress- ing one's sexual orientation is an offensive breach of patient-provider trust and a contributing factor to inadequate medical care. It is difficult, if not impossible, to build engage- ment among patients if hospitals and healthcare providers do not embrace and respond to cultur- al and demographic differences. e senior vice president of pharmacy services for a 15-hospital system in the Southeast said his organization has a chief diversity and inclusion officer, and it also taps advice and perspectives from "business re- source groups." Similar in function to patient advisory boards, these business resource groups are made up of volunteers from the community who organize based on shared race or ethnicity. "We run our pa- tient-centric care models through those business resource groups to truly segment the populations to make sure we're delivering the care in a way that meets people where they are," said the senior vice president. Leaders agreed: Teaching clinicians about multi- cultural awareness is valuable to their organiza- tion. However, limited resources and physician time make implementing these initiatives chal- lenging, they said. As is, patient-provider interac- tions already take a great deal of emotional intel- ligence, and properly addressing the nuances or subtleties of multicultural relationships can be a challenge. "Navigating those situations is extremely diffi- cult," said the CEO of a 429-bed children's hospi- tal in the Midwest. He said it is one of the less ex- plored aspects of medicine. "ese are profound differences. I had to completely rewire my con- versation style when I moved north. We have to decide what kind of society we are. If we continue to be a multicultural society, it will be critical to understand the fundamental differences between us." e September and October issues of Becker's Hospital Review will feature Part II and III of the conversation, which focus on quality improve- ment, value-based care and system integration. n

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