Recognizing relationships within the community of care is critical in this expanding context of accountability in healthcare.  I use the word community not just to represent a city or geographic region, but rather all of that and those relationships with peers and referral partners that have grown over time.  Too often the view of competition for the independent physician is quickly defined as that increasingly ominous hospital system in their same zip code.  But the more appropriate view is to recognize the reality of that view of competition with regard to a real continuum of care for the patient.  The independent physician has never had control of the entire facility and resources of a hospital system, so it is appropriate to recognize the continuum of care for her patient population and how she can participate with her guidance and reputation with the community.

There is so much value in the patient experience with the independent physician, from accessibility to affordability when compared to the hospital experience.  What’s more, when the independent physician recognizes the value of the patient experience that she and her fully engaged clinic staff can and have provided for the patient over time, the ominous nature of hospital competition may not seem quite as ominous.  This is a time in healthcare when competition and collaboration in healthcare are not mutually exclusive concerns.  Recognizing key relationships in a continuum of care is something that is well known within the hospital, which is one reason why those practice acquisitions look so attractive.  The trust from the patient often begins in that small clinic with the accessible independent physician.

Some additional reading:

Independent doctors unite to fight national trend toward hospitals buying physician groups:  http://bit.ly/11JRer5

How could cost prevent health IT from driving patient engagement:  http://bit.ly/UMhhNx

However, it begins with the realization that while physicians’ qualifications are clearly important within the purpose of the clinic, that purpose must also persuade people to reach out to the clinic based on something that is happening or important to them.  The leverage that the clinic has in this scenario is the ability to be swift in both defining the purpose and creating a sustained dialogue among the entire staff. This dialogue can easily be started through questions like:

• What are the typical questions that people have when they call the clinic for the first time?

   

• Do the people who accept those calls know the answers to those questions and have a genuine interest in talking about the experience within the clinic.

   

• Does that person sitting at the reception desk really only care about just what’s happening in front of them in the waiting area?

   

• Do those staff members have an awareness of what patient education means to new and existing patients in terms of helping them ask better questions during their visit?

   

• How could the website for the clinic be utilized to share the purpose of the clinic within the continuum of care for the patient by extending the reach and value of the physicians?

   

• What dialogue could be added to the clinic website for the benefit of patient education and further, what makes for an “ideal patient” for the clinic?

   

• How could those clinic staff members and clinic website communicate consistently in creating awareness for new patients about certain conditions and underlying causes?

   

• How easy is it for anyone to find the clinic website without knowing any of the physicians or the name of the clinic? 

The dialogue that begins with these questions serves to define the clinic within the community it serves, every person’s relevance as an employee within the clinic, and why a person should choose this clinic.  Incidentally, with this dialogue well underway, the dialogue with an EHR vendor who will be a true partner in supporting the purpose and sustainability of the clinic will become clear in terms of what each person on staff needs to do their job without interruption or workarounds, providing base content for educating patients, accessibility for patients, and collaboration among other clinics as appropriate for the continuum of care.

For her, remembering recent information has become a challenge.  She uses a small notebook/calender to keep track of conversations, upcoming events with friends, and other appointments.  We shared some time during her recent appointment for an eye exam that represents the typical approach to patient engagement in the clinic.  Its a story that represents both competent medical care an missed opportunities for client care by also being present in the moment.

The check-in process was just what you would expect as described by the medical billing consultant.  Before we sat down the receptionist made copies of the insurance cards and collected the copay for the exam.  So the diligent documentation was now complete, since we had completed the HPI info online a few weeks in advance.  With the mechanical aspect of this patient engagement check-in event complete, it was time for us to take a seat and wait.  We struck up a conversation with another patient who was waiting for the eyedrops to take effect to dilate his eyes.  As we were talking, I tried to include either of the two receptionists who were sitting only a few feet away at crescent shaped desk waiting for the next patient to walk-in.  No sliding window in front of them to act as a shield toward the patients, and yet no interest in interacting us either.

Then stage one of the exam began, and we proceed down the hall for the initial screening and imaging of the eyes.  All goes well and we’re continuing down to the exam room where all the information will finally come together with the doctor.  A bit more of wait in the exam room before the doctor walks in, but that’s how it goes.  The doctor comes into the exam room and begins interpreting the results of that preliminary exam.  He does a great job of translating the medical terminology into layman’s terms and, after conducting his own exam, gives reason to change the script from the current lenses.

Dilation of the eyes was an afterthought to this part of the exam.  Of course there is reason to be thorough so we decided to add this to the visit and go back to the reception area to wait for the dilation to be complete.  After we complete another stop in the exam room with the doctor, we proceed back to the reception desk where we are introduced to the staff member who specializes in the eyeglass sales.  At this point, the duration of our visit in the clinic is nearly 90 minutes.  As the salesperson talks about the features of the current lenses and how those would apply to the cost of new lenses, I ask her how much of the cost would be covered by the patient’s private insurance.  Her response was that she did not know but we could always try to submit a claim later and see what, if anything, is covered.

This patient engagement event lasted about 90 minutes, and yet with the insurance information in hand within the first minute of the visit no one thought that it might be worthwhile to use that information as an advocate to understand out of pocket and covered costs for the patient.  This is the opportunity of real patient engagement that can separate one clinic from another in the community.  The competent and complete exam by the doctor was certainly at the core of this experience.  But in terms of the engagement from the patient’s perspective, this is the minimum expectation for someone seeking this service from a doctor.  The face time with the doctor lasted about 20 minutes.  However, in the remaining 70 minutes worth of time all of us, including the reception/eyeglass staff, were waiting for the doctor.

People who approach the patient experience from either side of the reception area in the clinic know that healthcare costs can be both confusing and intimidating at times.  When the patient experience is defined by those minimum expectations for competent care by a doctor, there is plenty of reason for patients to shop around before that next visit.  This competent care, that in this story represented less than 30 percent of the time in the clinic, can easily be viewed as a commodity by a patient.  Too often, patient engagement is viewed as an event that is limited to the doctor’s time, in this case 30 percent, with the patient.  The remaining time, other people in the clinic who could do something to contribute to this experience are too busy trying to stay out of the way.  Being social in the medical clinic is about recognizing how to appropriately participate in the patient experience.  A great starting point might just be helping those reception staff in the clinic understand that their job has more to do with patient than documenting their current insurance coverage.  A fully engaged staff who can confidently participate appropriately in a social interaction will prove to patients that their engagement is not just an event, but rather a process of inspiration and education with reason to talk again soon and maybe even sell more services.

That concept of who is willing to take on the responsibility for making the next pot of coffee seems like a menial task, and yet that last cup sits as people who enjoy coffee defer their enjoyment because of the commitment of the next steps.  The opportunity to enjoy that cup of coffee right now is at your fingertips, but who is willing to take that cup of coffee and brew the next full pot?  It may not be the same person as it was yesterday, and for some there may be some training involved, but the endless pot of coffee happens with the purposeful recognition and appropriate action of those who witness the need.  The continuum of care within a patient’s experience can be complicated, but meaningful participation along the way with a fully engaged staff might just be as simple as brewing that next pot of coffee.

Read more here:

http://ehrintelligence.com/2013/01/09/how-could-cost-prevent-health-it-from-driving-patient-engagement/

For about the last 20 years I have remembered the words of Jim Valvano during his experience with cancer.  He was someone who did have my attention back in 1993 when he shared some genuine thoughts that still resonate with me today.  Many people might remember the words at the end of his speech, “Don’t give up…Don’t ever give up.”  I also remember his advice earlier in that speech about three things that you should do everyday.  Those three things were to make time for: laughing everyday, thinking, and allowing yourself to cry.  I have not experienced cancer, but my aunt did a few years ago. What I learn from her is the journey that she continues to experience everyday.  Its a journey that I’ve tried to understand through her words and emotions along with that thought-provoking advice from Jim Valvano.  Here is a link to the original speech to reflect on your own terms: http://www.youtube.com/watch?v=HuoVM9nm42E.

Its all to common to look for the latest book or some other form of presentation as a source for the answers to the challenges that we face in healthcare or any other context.  But perhaps there is more value in setting aside some time to think and allow those thought-provoking questions to arise.  That’s what Jim Valvano’s words mean to me everyday – not a recipe for success with all of the answers but a willingness to engage in my own journey everyday with people I care about.  We often look to sports to identify role models for behaviors or even for a cause.  What is interesting is how Lance Armstrong is currently attracting so much publicity while having so little to offer with his words.  In contrast, Jim Valvano with just a few words remains such a great inspiration for making time to experience emotions and engage in thought.  Answers to some of those thought-provoking questions may come in time, especially when you recognize that they take time and a genuine commitment.

I’ve learned a lot from her about her experience, but I’ll never know it all regardless of how much I listen.  What she knows is that her memory skills are not what they used to be.  The recent neurological examination was a difficult one for her and we’ve talked about it during and after the event.  This is a journey that only she will truly know, but I and others in my family can be there by being present and helping to sustain all those things that represent the better aspects of daily life with an awareness it’s different now.  It’s frustrating for her and she shares these feelings with us everyday.  We can’t always do everything, but we do what we can together.

I wanted to share another story from someone who has been helpful to me and become a friend along the way too.  Christine Miserandino is known by many people in the online community, and her ‘spoon theory’ is a great one that everyone should read:  http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/.  For those who are apprehensive about interacting in online communities of any kind, this is just as relevant in all of those ‘offline’ interactions as well.  It’s been valuable for me as much in trying to help as a caregiver as it has in making sure not to try to help too much.  Thanks Christine!

While there are certainly people who have been eager to be personal about their healthcare experiences and points of view in this context, it hardly describes a mastery level that is easily translated to so many other people who are not participating in this environment.  It is not a matter of just having the HIT resources to make this personal interaction suddenly possible or even better.  It is the opportunity to realize a meaningful dialogue among those people in the clinic setting regarding small steps to define a new culture that is not only possible but sustainable with a fully engaged staff.  Small steps because many people have not only had little training in the appropriate use of these virtual tools in the healthcare conversation, but in the nature of an open conversation whatever the setting.

The dialogue among clinic staff and patients has been a difficult one for many valid reasons.  The personal nature of the physician-patient interaction that builds trust is also one that represents a barrier of getting too personal.  So as we look at the myriad of resources and tools in the new normal of digital healthcare, lets remember that every interaction matters.  The opportunity to engage patients has always been available with every patient waiting in the reception area or calling by telephone.  Engaging patients begins with a culture of care that includes full and concise participation of everyone on staff, without exception.  It may feel like trying to convince someone who hates vegetables to opt for carrots as a healthy snack option.  It is certainly a process of change and presenting it the same way to different people will likely result in failure.

We’re all patients at some point, and as we hold ourselves accountable for our care we also know that with good health and proactive care there will be less need for us to think about going to the hospital.  Community healthcare may seem a lot bigger these days for a patient with access to so many resources and connections to people in many different places, but it still happens in the community where we live.  Reaching out into the community is a new conversation for many in the clinic setting, because this is not about generic educational pamphlets and marketing materials.  This is about clearly responsive and proactive conversations between people, and that does not mean simply filling the queue for the physicians with a myriad of notes and messages.  Everyone has a role in this patient experience, and for staff its a matter of participating in care versus just sitting in a chair.  What’s more, this is conversation that truly matters at the local level in the clinic’s community as the outpatient experience continues to evolve even more ‘out’.