A recent article (May 20, 2009) by Dr. Diane Rittenhouse and Dr. Stephen Shortell published in the Journal of the American Medical Association was an excellent commentary on a new model of healthcare delivery called the patient-centered medical home. According to these authors, "the fundamental challenge in the United States is to expand access to all U.S. residents, while rapidly reengineering the delivery system to provide consistently high-quality care at lower overall cost. Current reform discussions recognize that success will require a shift in emphasis from fragmentation to coordination and from highly specialized care to primary care and prevention." This is where the the patient centered medical home model comes in to being.
The patient-centered medical home is grounded on four major supporting structures:
1. Primary Care
2. Patient-centered Care
3. New-model Practice
4. Payment Reform.
The importance of primary care is based on years of research demonstrating the role of primary care in producing more positive outcomes at lower costs. Primary care is comprehensive, first-contact, longitudinal and coordinated medical and preventive care delivered by a team of providers spearheaded by the physician.
Patient-centeredness is the tailoring of medical care to meet the needs and preferences of patients. Active participation by the healthcare consumer leads to shared decision-making regarding treatment strategies. Traditional and nontraditional communication (i.e. Internet or virtual office visits) is critical to promoting patient-centeredness.
New-model practice builds on innovations in healthcare delivery: continuous quality improvement, patient safety, transparency and accountability. Evidence-based medicine, population-based healthcare systems, performance measurement and improvement, point-of-care decision support and information technology (i.e., the electronic medical record) are additional areas of concentration promoting the new-model practice.
Payment reform requires, in addition to traditional fee-for-service, additional payment mechanisms to reimburse clinicians for jobs well done. Pay-for-performance and care management are two additional structures being considered to help primary care practitioners in establishing and delivering on the patient-centered medical home.
In reality, what this all means is that when patients have easy access to high quality care that is provided at a lower cost, everybody wins. The U.S. healthcare delivery system is on the brink of a major collapse. It is a distinct possibility that if we continue as we are, our nation will have a national healthcare delivery system much like our neighbors in Canada. This would certainly save money. But would it promote the kind of healthcare that U.S. healthcare consumers have become accustomed to?
According to Rittenhouse and Shortell, marketplace and political realities will necessitate action on healthcare delivery system reform in the U.S. the widely endorsed patient-centered medical home has the potential to increase access and quality and to decrease the rate of growth in costs over time. As healthcare reform gains momentum, this model of healthcare delivery is sure to be tested. The results of this experiment will undoubtedly shape the future of healthcare delivery in our nation for decades to come.
Dr. Dale
Sunday, May 31, 2009
Thursday, May 28, 2009
Sprucing Up the Office
Shortly after arriving in Williston, I had a new patient make an interesting observation about her experience in our office. She said that everything went well from a clinical perspective but she had a real problem with the waiting area. She told me that when she was getting ready to take a seat prior to be called back into the examination area, she looked down at the chairs in the waiting area and noted how dirty they were. Because of this critical observation on her part,she decided to stand until she was called back in order to be seen.
About a month later, another patient who had been to the office made a similar observation. He commented that the medical care he received was excellent but that if we were going to rebuild the family health center, we needed to "spruce up the office".
You might think that people would not necessarily make comments about the decor. They may even look past the aging vinyl chairs and graying tile floor if they received high quality medical care. Apparently not.
Right before our open house in April, our CEO agreed to a makeover for the reception area of the family health center. Painting and patching, pictures and a flat screen television were some of the new changes. The open house was a success but the real comments were about how nice the reception area looked. We just laid the new floor this week and the positive comments about the decor continue.
Our patients really do notice the physical plant. Just the right, soothing colors and no opulence transform an "OK" visit to the office into a more satisfying experience. I have seen this before. In other practices, new waiting room chairs or new carpet and paint show that you really care about the patient experience. It does not go unnoticed. It is actually very much appreciated. We are sprucing up the hospital now. I cannot wait to hear the comments about the new hospital lobby.
Dr. Dale
About a month later, another patient who had been to the office made a similar observation. He commented that the medical care he received was excellent but that if we were going to rebuild the family health center, we needed to "spruce up the office".
You might think that people would not necessarily make comments about the decor. They may even look past the aging vinyl chairs and graying tile floor if they received high quality medical care. Apparently not.
Right before our open house in April, our CEO agreed to a makeover for the reception area of the family health center. Painting and patching, pictures and a flat screen television were some of the new changes. The open house was a success but the real comments were about how nice the reception area looked. We just laid the new floor this week and the positive comments about the decor continue.
Our patients really do notice the physical plant. Just the right, soothing colors and no opulence transform an "OK" visit to the office into a more satisfying experience. I have seen this before. In other practices, new waiting room chairs or new carpet and paint show that you really care about the patient experience. It does not go unnoticed. It is actually very much appreciated. We are sprucing up the hospital now. I cannot wait to hear the comments about the new hospital lobby.
Dr. Dale
Monday, May 25, 2009
Timeliness is next to Godliness
Delays have become the norm within health care delivery today.
Everybody is complaining about waiting.
Delays for an appointment.
Delays in the reception area or in the examination room waiting to see the doctor.
Delays on test results.
Delays for referrals to specialists or diagnostic testing.
Many patients tell me wait times can be as long as 10 hours or more in some local emergency rooms in Gainesville.
Same day appointments in the office are becoming more of a reality. Customer demand is fueling this change.
Why is it that we have become so inpatient when it comes to getting our healthcare?
Unrealistic expectations on the part of patients have created many logjams.
Ask yourself the last time you really needed to be seen in an emergency room. Was it truly an urgent problem? Was it life or death? Could it have been handled in an office setting?
What is an acceptable wait time for receiving medical care? It depends on the acuity of the patient's problem. Even with this identified, no one really has the right answer. It is all about supply and demand. Supply of providers and demands of patients.
It appears that may change as the healthcare industry begins to implement the patient-centered medical home. If healthcare delivery is really about the patient, then getting the patient to the right venue to receive their care is a critical success factor for achieving positive outcomes.
Timeliness is next to godliness in healthcare. Of course, it depends on whether you are on the giving or receiving end of healthcare services. Caveat emptor!
Dr. Dale
Everybody is complaining about waiting.
Delays for an appointment.
Delays in the reception area or in the examination room waiting to see the doctor.
Delays on test results.
Delays for referrals to specialists or diagnostic testing.
Many patients tell me wait times can be as long as 10 hours or more in some local emergency rooms in Gainesville.
Same day appointments in the office are becoming more of a reality. Customer demand is fueling this change.
Why is it that we have become so inpatient when it comes to getting our healthcare?
Unrealistic expectations on the part of patients have created many logjams.
Ask yourself the last time you really needed to be seen in an emergency room. Was it truly an urgent problem? Was it life or death? Could it have been handled in an office setting?
What is an acceptable wait time for receiving medical care? It depends on the acuity of the patient's problem. Even with this identified, no one really has the right answer. It is all about supply and demand. Supply of providers and demands of patients.
It appears that may change as the healthcare industry begins to implement the patient-centered medical home. If healthcare delivery is really about the patient, then getting the patient to the right venue to receive their care is a critical success factor for achieving positive outcomes.
Timeliness is next to godliness in healthcare. Of course, it depends on whether you are on the giving or receiving end of healthcare services. Caveat emptor!
Dr. Dale
Sunday, May 24, 2009
Patient Centeredness
On the American Hospital Association's Quality web page, the real business of health care is about:
1. preventing ill-health
2. caring for people who are sick
3. meeting the needs of people with chronic disease or disability
4. making people in communities healthier.
The Institute of Medicine's Crossing the Quality Chasm report defined patient centeredness as focusing "on the patient's experience of illness and health care and on the systems that work or fail to work to meet individual patients' needs".
Several characteristics of patient-centered care have been identified based on work done by The Picker Institute:
1. respect for patients' values, preference and expressed needs;
2. coordination and integration of care;
3. information, communication and education;
4. physical comfort;
5. emotional support;
6. involvement of family and friends;
7. access.
Patients vary on their desire to be involved in their health care. Patients today are made to feel excluded as partners in the discussion and decisions that affect them and the health care they receive. As a consequence, patients and their families find the health care they receive to be impersonal and incomplete.
At our family health center and in the hospital at Nature Coast, we strive to be all inclusive with patients and family members concerning decisions about choices related to health care needs. It does not take any longer to have a meaningful discussion with a patient and with their family about what to do. I am a big believer in having an open dialogue about the risks and benefits of treatments. I see myself as a coach who guides my patients through the maze of what has become one of the largest bureaucracies in the world, the U.S. healthcare delivery system.
What do I believe is the critical success factor for patient-centeredness? The clinician must develop the skills of being a good listener. When an open-ended question is posed to the patient at the beginning of the encounter, "What can I help you with today?" or "What brings you in to see me today?", when left alone the patient will talk about their issues for around 2 minutes and stop. It is this uninterrupted time that makes the patient feel as though they have had the opportunity to become a partner in their care. This is the most critical time period that begins the cascade of patient-centered decisions and activities.
The number one reason that malpractice suits are brought against most physicians is the perception that there was a significant failure to communicate with the patient.
Making the patient the center of the healthcare universe should be our number one priority as our nation attempts to rebuild the healthcare delivery system.
The patient is the center of our universe at Nature Coast. In just a short while, patient care surveys will be done to check my perception.
Dr. Dale
1. preventing ill-health
2. caring for people who are sick
3. meeting the needs of people with chronic disease or disability
4. making people in communities healthier.
The Institute of Medicine's Crossing the Quality Chasm report defined patient centeredness as focusing "on the patient's experience of illness and health care and on the systems that work or fail to work to meet individual patients' needs".
Several characteristics of patient-centered care have been identified based on work done by The Picker Institute:
1. respect for patients' values, preference and expressed needs;
2. coordination and integration of care;
3. information, communication and education;
4. physical comfort;
5. emotional support;
6. involvement of family and friends;
7. access.
Patients vary on their desire to be involved in their health care. Patients today are made to feel excluded as partners in the discussion and decisions that affect them and the health care they receive. As a consequence, patients and their families find the health care they receive to be impersonal and incomplete.
At our family health center and in the hospital at Nature Coast, we strive to be all inclusive with patients and family members concerning decisions about choices related to health care needs. It does not take any longer to have a meaningful discussion with a patient and with their family about what to do. I am a big believer in having an open dialogue about the risks and benefits of treatments. I see myself as a coach who guides my patients through the maze of what has become one of the largest bureaucracies in the world, the U.S. healthcare delivery system.
What do I believe is the critical success factor for patient-centeredness? The clinician must develop the skills of being a good listener. When an open-ended question is posed to the patient at the beginning of the encounter, "What can I help you with today?" or "What brings you in to see me today?", when left alone the patient will talk about their issues for around 2 minutes and stop. It is this uninterrupted time that makes the patient feel as though they have had the opportunity to become a partner in their care. This is the most critical time period that begins the cascade of patient-centered decisions and activities.
The number one reason that malpractice suits are brought against most physicians is the perception that there was a significant failure to communicate with the patient.
Making the patient the center of the healthcare universe should be our number one priority as our nation attempts to rebuild the healthcare delivery system.
The patient is the center of our universe at Nature Coast. In just a short while, patient care surveys will be done to check my perception.
Dr. Dale
Sunday, May 17, 2009
Are You Getting Effective Medical Care?
As a patient, one must always question whether you are receiving effective medical care. But as a lay person, how would you know?
The Institute of Medicine's Crossing the Quality Chasm report defines effectiveness as "care that is based on the use of systematically acquired evidence to determine whether an intervention, such as preventive service, diagnostic test, or therapy, produces better outcomes than alternatives, including the alternative of doing nothing". This definition serves as the foundation for evidence-based medicine.
I refer to evidence-based medicine as one of my 8-points of change for healthcare.It is one of the backbones for healthcare stewardship. What does it mean to receive evidence-based medicine?
Evidence-based medicine is the melding of three critical factors:
1. Best research evidence derived from laboratory experiments, clinical trials, epidemiological research, and outcomes research.
2. Clinical expertise through which the clinician uses his clinical skills and experience to rapidly evaluate each patient's unique health state, to make a diagnosis, and to recommend treatments based on knowledge of the respective risks and benefits.
3. Patient values which refers to each patient's unique preferences, concerns and expectations that are part of each clinical encounter.
The lay person may ask the question: What care is right? The clinician must be able to explain in lay terms the above three criteria in order to ensure that the care the patient is about to receive will be effective.
This is a new concept for many patients. It is new because these types of medical care help patients learn to manage their own health. It forces a dialogue between the patient and clinician in order to come to an agreement on what care is right for the patient. This is healthcare stewardship. This is what I use with my patients.
Is your doctor using it with you?
Dr. Dale
The Institute of Medicine's Crossing the Quality Chasm report defines effectiveness as "care that is based on the use of systematically acquired evidence to determine whether an intervention, such as preventive service, diagnostic test, or therapy, produces better outcomes than alternatives, including the alternative of doing nothing". This definition serves as the foundation for evidence-based medicine.
I refer to evidence-based medicine as one of my 8-points of change for healthcare.It is one of the backbones for healthcare stewardship. What does it mean to receive evidence-based medicine?
Evidence-based medicine is the melding of three critical factors:
1. Best research evidence derived from laboratory experiments, clinical trials, epidemiological research, and outcomes research.
2. Clinical expertise through which the clinician uses his clinical skills and experience to rapidly evaluate each patient's unique health state, to make a diagnosis, and to recommend treatments based on knowledge of the respective risks and benefits.
3. Patient values which refers to each patient's unique preferences, concerns and expectations that are part of each clinical encounter.
The lay person may ask the question: What care is right? The clinician must be able to explain in lay terms the above three criteria in order to ensure that the care the patient is about to receive will be effective.
This is a new concept for many patients. It is new because these types of medical care help patients learn to manage their own health. It forces a dialogue between the patient and clinician in order to come to an agreement on what care is right for the patient. This is healthcare stewardship. This is what I use with my patients.
Is your doctor using it with you?
Dr. Dale
Saturday, May 16, 2009
Prevention, Prevention, Prevention
This was a particularly difficult week for me. It seems that every patient that was seen in the office was focused on sick care and chronic disease.
I often get this statement from my patients, "If I wasn't sick, I wouldn't need to be here (i.e. doctor's office)". My other favorite, "Just fix me up, doc. I got things to do. I don't have time to be sick."
As you may already know, one of my 8-points for healthcare change is to move from a sick care system to a well care system. So lately, I have been contemplating how to get my point across to patients about preventive health and wellness. I know, as do others in the healthcare professions, that Americans do not follow advice very well about disease prevention and being well. Therefore, you have to become a Madison Avenue marketing executive and design slogans to get your patients attention.
My little wellness ditty goes like this:
Eat a healthy diet,
Move your body,
Rest your body,
Find your inner spirit,
No smoking or tobacco use,
Alcoholic beverages in moderation,
No illicit drug use,
Age-related cancer screening,
Look for the positive each day,
Take control of your health today,
Protect the environment.
Now I know it's not fancy with big words and catchful phraseology. It will probably not replace Dr. Oz's messages on Oprah. But, the message about being healthy and well must be simple. The KISS principle, Keep It Simple Stupid, works well for me. My issue is we are not coaching our patients into being healthy and well. The statistics support my opinion. We are a sick society and getting sicker in mind, body and spirit. I hope this week creates opportunities for Jim and I to work on disease prevention and health promotion. Every opportunity with a patient is an opportunity to get the wellness message out there.
Dr. Dale
I often get this statement from my patients, "If I wasn't sick, I wouldn't need to be here (i.e. doctor's office)". My other favorite, "Just fix me up, doc. I got things to do. I don't have time to be sick."
As you may already know, one of my 8-points for healthcare change is to move from a sick care system to a well care system. So lately, I have been contemplating how to get my point across to patients about preventive health and wellness. I know, as do others in the healthcare professions, that Americans do not follow advice very well about disease prevention and being well. Therefore, you have to become a Madison Avenue marketing executive and design slogans to get your patients attention.
My little wellness ditty goes like this:
Eat a healthy diet,
Move your body,
Rest your body,
Find your inner spirit,
No smoking or tobacco use,
Alcoholic beverages in moderation,
No illicit drug use,
Age-related cancer screening,
Look for the positive each day,
Take control of your health today,
Protect the environment.
Now I know it's not fancy with big words and catchful phraseology. It will probably not replace Dr. Oz's messages on Oprah. But, the message about being healthy and well must be simple. The KISS principle, Keep It Simple Stupid, works well for me. My issue is we are not coaching our patients into being healthy and well. The statistics support my opinion. We are a sick society and getting sicker in mind, body and spirit. I hope this week creates opportunities for Jim and I to work on disease prevention and health promotion. Every opportunity with a patient is an opportunity to get the wellness message out there.
Dr. Dale
Thursday, May 14, 2009
A New Approach to Quality Care
The Institute of Medicine's Crossing the Quality Chasm report described new, more beneficial approaches in providing care to patients. This new approach consists of the following:
1. Care is based on continuous healing relationships.
2. Care is customized according to patient needs and values.
3. The patient is the source of control.
4. Knowledge is shared and information flows freely.
5. Decision-making is evidence-based.
6. Safety is a system priority.
7. Transparency is necessary.
8. Needs are anticipated.
9. Waste is continuously decreased.
10. Cooperation among clinicians is a priority.
It is no longer acceptable for the health professional to control care. Doctors can no longer fly by the seat of their pants when treating patients. Secrecy can no longer be tolerated. The health system can no longer react to needs. Cost reduction over patient care is unacceptable. Is this really happening today?
There is so much going on in Washington, D.C. and all of the states' capitols regarding healthcare reform that you almost need a scorecard to keep track of all the players. What is missing from most of the conversation is this new approach to patient care. Ask yourself whether you can see this new approach being implemented the next time you make a visit to the doctor or hospital.
If you visit our health center in Williston, I can guarantee that this new approach is being adopted in our practice. We are also having an impact on health care delivery in our town.
For example, we have always had same day appointments for our patients. Just the other day, Jim mentioned to me that the doctor's practice across the street had a new sign. "What did it say?", I asked. Same day appointments. Who says you cannot lead by example. Needs of patients are being anticipated.
Dr. Dale
1. Care is based on continuous healing relationships.
2. Care is customized according to patient needs and values.
3. The patient is the source of control.
4. Knowledge is shared and information flows freely.
5. Decision-making is evidence-based.
6. Safety is a system priority.
7. Transparency is necessary.
8. Needs are anticipated.
9. Waste is continuously decreased.
10. Cooperation among clinicians is a priority.
It is no longer acceptable for the health professional to control care. Doctors can no longer fly by the seat of their pants when treating patients. Secrecy can no longer be tolerated. The health system can no longer react to needs. Cost reduction over patient care is unacceptable. Is this really happening today?
There is so much going on in Washington, D.C. and all of the states' capitols regarding healthcare reform that you almost need a scorecard to keep track of all the players. What is missing from most of the conversation is this new approach to patient care. Ask yourself whether you can see this new approach being implemented the next time you make a visit to the doctor or hospital.
If you visit our health center in Williston, I can guarantee that this new approach is being adopted in our practice. We are also having an impact on health care delivery in our town.
For example, we have always had same day appointments for our patients. Just the other day, Jim mentioned to me that the doctor's practice across the street had a new sign. "What did it say?", I asked. Same day appointments. Who says you cannot lead by example. Needs of patients are being anticipated.
Dr. Dale
Monday, May 11, 2009
Six Aims for Quality Transformation of Healthcare Delivery
The Institute of Medicine (IOM), established in 1970 under the charter of the National Academy of Sciences, serves as adviser to the nation to improve the health of all Americans. The Institute provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector and the public.
In 2001, the IOM released a landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century.The report expounded on the needed focus related to specific quality issues and accompanying changes in the U.S. healthcare delivery system that are required. Specifically, the report indicated that all "healthcare organizations...should adopt as their explicit purpose to continually reduce the burden of illness, injury and disability and to improve the health and functioning of the people of the United States".
To close the widening quality chasm in the U.S. healthcare delivery system, the IOM report recommended that healthcare should focus on these six aims: patient safety, effectiveness, patient-centeredness, timeliness, efficiency and equitability. The report notes that focusing on these six aims will begin a transformation in our current national healthcare delivery system. This transformation will require a systematic re-design of current healthcare systems and processes of care.
I am in complete agreement with this report. I have written about the report in my books. In fact, you might say that these six aims of transformation have become my guiding force for clinical activity at Nature Coast Regional Health System. What all the stakeholders in our national healthcare system need to realize is that this report is applicable at all levels of patient care; from the individual practitioner to the largest of all the healthcare delivery systems in this country.It transcends all the local, state, regional and national healthcare bureaucracies because it is all about the patient. If I can adopt the recommendations of this report in a small rural health system, others in a similar situation should be able to do the same. It needs to become a grass roots effort at the smallest level to rise up and create the groundswell for national transformation. I am assuming that President Obama's advisers have read this report. If not, it needs to be brought out again into the mainstream media to shock the consciousness of all Americans.
My next blog will describe the report's new, more beneficial approach to providing patient care.
Dr. Dale
In 2001, the IOM released a landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century.The report expounded on the needed focus related to specific quality issues and accompanying changes in the U.S. healthcare delivery system that are required. Specifically, the report indicated that all "healthcare organizations...should adopt as their explicit purpose to continually reduce the burden of illness, injury and disability and to improve the health and functioning of the people of the United States".
To close the widening quality chasm in the U.S. healthcare delivery system, the IOM report recommended that healthcare should focus on these six aims: patient safety, effectiveness, patient-centeredness, timeliness, efficiency and equitability. The report notes that focusing on these six aims will begin a transformation in our current national healthcare delivery system. This transformation will require a systematic re-design of current healthcare systems and processes of care.
I am in complete agreement with this report. I have written about the report in my books. In fact, you might say that these six aims of transformation have become my guiding force for clinical activity at Nature Coast Regional Health System. What all the stakeholders in our national healthcare system need to realize is that this report is applicable at all levels of patient care; from the individual practitioner to the largest of all the healthcare delivery systems in this country.It transcends all the local, state, regional and national healthcare bureaucracies because it is all about the patient. If I can adopt the recommendations of this report in a small rural health system, others in a similar situation should be able to do the same. It needs to become a grass roots effort at the smallest level to rise up and create the groundswell for national transformation. I am assuming that President Obama's advisers have read this report. If not, it needs to be brought out again into the mainstream media to shock the consciousness of all Americans.
My next blog will describe the report's new, more beneficial approach to providing patient care.
Dr. Dale
Sunday, May 10, 2009
Quality-Driven Healthcare: Doing the right...
Quality-driven healthcare delivery is and will always be a difficult subject to tackle. Everyone has an opinion. Patients, providers, health insurance, government and other stakeholders debate and write on this topic daily.
All of my patients in Williston have their own ideas on what constitutes quality health care. To many, it is really just sitting down and the doctor taking time to hear about what "ails" them. To others, it is more about making the correct diagnosis, initiating the proper treatment, and getting them better. Better to go back to work, better to back to school, and better to go on with their lives.
I guess, the easiest way to describe what is quality-driven healthcare may be summed up in the following way:
Doing the right thing (need);
In the right amount (cost);
At the right time (when needed);
In the right way (appropriate);
Producing the best possible results for the patient (outcome).
I like this the best to describe quality-driven healthcare. It covers everything. However, it is really too simplistic an approach for everyone to agree on as to using it as the driving force for quality-driven healthcare services. In the next several blogs, I will explore and discuss more in depth what has become the accepted approach to quality-driven healthcare in this country.
I wrote about this approach extensively in Healthcare Stewardship. This accepted approach for quality-driven healthcare is what I believe will save healthcare in this country.
But for now, let's all learn about doing the right...
Dr. Dale
All of my patients in Williston have their own ideas on what constitutes quality health care. To many, it is really just sitting down and the doctor taking time to hear about what "ails" them. To others, it is more about making the correct diagnosis, initiating the proper treatment, and getting them better. Better to go back to work, better to back to school, and better to go on with their lives.
I guess, the easiest way to describe what is quality-driven healthcare may be summed up in the following way:
Doing the right thing (need);
In the right amount (cost);
At the right time (when needed);
In the right way (appropriate);
Producing the best possible results for the patient (outcome).
I like this the best to describe quality-driven healthcare. It covers everything. However, it is really too simplistic an approach for everyone to agree on as to using it as the driving force for quality-driven healthcare services. In the next several blogs, I will explore and discuss more in depth what has become the accepted approach to quality-driven healthcare in this country.
I wrote about this approach extensively in Healthcare Stewardship. This accepted approach for quality-driven healthcare is what I believe will save healthcare in this country.
But for now, let's all learn about doing the right...
Dr. Dale
Wednesday, May 6, 2009
A Story to Guide Us All
From time to time, I have opened a lecture or talk with a story I discovered on the Internet many years ago. It has served as my guiding force and helped me create my tag line for my medical consulting company. The story goes like this:
One evening, a health care executive sat reading his company's annual financial report. His young son was not amused. He was bored and wanted his dad's undivided attention. "I've got nothing to do!" he cried. The health care executive tore out the last page of the financial statements from the report. "Here", he said to his son. "Draw on the back of this for a while". His young,eager son grabbed the paper and off he went.
A few minutes later, the boy returned. Proudly, he showed his father the simple stick figure he had just drawn. The executive smiled, but he had hoped the drawing activity would have occupied more of his son's time. "What may I do next?" his son asked.
The father thought to himself. "A puzzle, my son likes to work on puzzles". He turned over his son's drawing to the complicated financial statement. "If I tear this into little pieces, can you put all the numbers back together for me?" he asked his son. His son was just as eager to please his father and agreed to the task. "This should take him at least an hour", the executive thought.
Soon after, his son returned with the page taped together. The executive was amazed. "How did you put all those numbers together so quickly?" he asked. "Simple", said the son. The young boy turned the page over to show the stick figure on the back."I just put the person back together, and those numbers took care of themselves."
How powerful a statement. If you take care of people, the financials will take care of themselves. This has been my company's tag line for years. This is the full embodiment of healthcare stewardship. We must take politics and profitability out of the equation to fix our broken national healthcare delivery system. It is my belief along with many others that we have to get back to taking care of people. I agree with the following: No measure, no manage; no manage, no margin; no margin, no mission. But at what expense? Have we lost are willingness to do the right thing for our fellow man? Are we that myopic a society to have allowed ourselves to focus on the margin and not on our patients in healthcare delivery? My tag line should become our national healthcare mantra. It isn't too late, or is it?
Dr. Dale
One evening, a health care executive sat reading his company's annual financial report. His young son was not amused. He was bored and wanted his dad's undivided attention. "I've got nothing to do!" he cried. The health care executive tore out the last page of the financial statements from the report. "Here", he said to his son. "Draw on the back of this for a while". His young,eager son grabbed the paper and off he went.
A few minutes later, the boy returned. Proudly, he showed his father the simple stick figure he had just drawn. The executive smiled, but he had hoped the drawing activity would have occupied more of his son's time. "What may I do next?" his son asked.
The father thought to himself. "A puzzle, my son likes to work on puzzles". He turned over his son's drawing to the complicated financial statement. "If I tear this into little pieces, can you put all the numbers back together for me?" he asked his son. His son was just as eager to please his father and agreed to the task. "This should take him at least an hour", the executive thought.
Soon after, his son returned with the page taped together. The executive was amazed. "How did you put all those numbers together so quickly?" he asked. "Simple", said the son. The young boy turned the page over to show the stick figure on the back."I just put the person back together, and those numbers took care of themselves."
How powerful a statement. If you take care of people, the financials will take care of themselves. This has been my company's tag line for years. This is the full embodiment of healthcare stewardship. We must take politics and profitability out of the equation to fix our broken national healthcare delivery system. It is my belief along with many others that we have to get back to taking care of people. I agree with the following: No measure, no manage; no manage, no margin; no margin, no mission. But at what expense? Have we lost are willingness to do the right thing for our fellow man? Are we that myopic a society to have allowed ourselves to focus on the margin and not on our patients in healthcare delivery? My tag line should become our national healthcare mantra. It isn't too late, or is it?
Dr. Dale
Monday, May 4, 2009
Providing Health Care as a Family Physician
Family physicians in small towns have a difficult job. You are often the go to person for everything health care related. Even if you cannot help the patient, you are the first one sought out for advice. Our practice in Williston provides so many different functions.
On the patient level, I provide my patients personal health care used in diagnosing and treating illness. My focus is on the patient rather than the disease requiring me to understand patient's goals for health and balancing my treatment plan's intensity with quality of life issues. I try at all times to focus my treatment decisions with the goals of the patient. From a healthcare stewardship perspective, I only order those tests that will enhance my ability to make a diagnosis or treat the patient more effectively. Trust and understanding allows for the development of a continuous healing relationship. All of this is done within the context of the family and the community.
On the health care system level, I serve as the initial point of entry for my patient's evaluation of medical issues. After the triage is performed, I attempt to match my patient's needs with the available resources without trying to over- or undertreat my patient. Coordinating health care services as required allows me to place my patient appropriately in the hands of a specialist when I believe it is required after careful history, physical examination and appropriate testing suggests I cannot care for my patient within the scope of my training and experience. This is my contribution to health care stewardship as it relates to healthcare resource utilization.
On the population level, I direct my patients to appropriate levels of care beyond primary care for secondary and tertiary services such as cardiac catheterization for unstable angina or chemotherapy for cancer. Providing immunizations for my patients helps to stop the spread of communicable disease and assists the public health functions required of all family physicians.
It is not always easy to follow healthcare stewardship principles and practices. Sometimes you just have to say "no" to the request for the MRI of the back with a minor strain or "no" to the prescribing of the antibiotic for a viral illness. I believe patients for the most part respect your judgment as long as you can justify your decisions based on the evidence. Your patients do not need an entire course on anatomy or pathology but a little detail can go along way in helping patients becomes stewards as well.
I had a great day in the office today. Many of the patients received the medical care they needed, not necessarily the medical care they wanted.
Dr. Dale
On the patient level, I provide my patients personal health care used in diagnosing and treating illness. My focus is on the patient rather than the disease requiring me to understand patient's goals for health and balancing my treatment plan's intensity with quality of life issues. I try at all times to focus my treatment decisions with the goals of the patient. From a healthcare stewardship perspective, I only order those tests that will enhance my ability to make a diagnosis or treat the patient more effectively. Trust and understanding allows for the development of a continuous healing relationship. All of this is done within the context of the family and the community.
On the health care system level, I serve as the initial point of entry for my patient's evaluation of medical issues. After the triage is performed, I attempt to match my patient's needs with the available resources without trying to over- or undertreat my patient. Coordinating health care services as required allows me to place my patient appropriately in the hands of a specialist when I believe it is required after careful history, physical examination and appropriate testing suggests I cannot care for my patient within the scope of my training and experience. This is my contribution to health care stewardship as it relates to healthcare resource utilization.
On the population level, I direct my patients to appropriate levels of care beyond primary care for secondary and tertiary services such as cardiac catheterization for unstable angina or chemotherapy for cancer. Providing immunizations for my patients helps to stop the spread of communicable disease and assists the public health functions required of all family physicians.
It is not always easy to follow healthcare stewardship principles and practices. Sometimes you just have to say "no" to the request for the MRI of the back with a minor strain or "no" to the prescribing of the antibiotic for a viral illness. I believe patients for the most part respect your judgment as long as you can justify your decisions based on the evidence. Your patients do not need an entire course on anatomy or pathology but a little detail can go along way in helping patients becomes stewards as well.
I had a great day in the office today. Many of the patients received the medical care they needed, not necessarily the medical care they wanted.
Dr. Dale
Sunday, May 3, 2009
What does a Family Physician do?
What does a family physician do? I am asked this question regularly today. Much more often than 20 years ago. Everyone knows that specialty medicine has been growing for years. Unfortunately, even family physicians have begun to specialize. Hospitalists, sports medicine, urgent care, and ambulatory medicine are just a few of the areas that family physicians have gravitated to over the years. The family doctor is rapidly moving towards extinction. My partner Jim Long, PA-C and I are trying to stop this trend in Williston.
According to the American Academy of Family Medicine (AAFP), the definition of family medicine was updated in 2005 to the following:
A medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
In 2008, the AAFP expanded their definition with the following:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
When I came to Nature Coast Regional Health System, fragmentation of the local healthcare delivery system was evident. Most of the physicians in the area were practicing ambulatory medicine only. Adults were seen in some practices and children went to others. The hospital in Williston had only 1 physician on its medical staff. Admissions to the hospital were far and few between. Patients told me that they were traveling to Gainesville 30 miles away to get their diagnostic studies, labs, and specialty medical care. Williston is a rural community. Where was the family doc?
A great deal is changing at our health system nine months later. Comprehensive, continuous, patient-centered care is becoming the norm. Patients' are happy to get as much of their care by their family doctor (i.e., me and Jim) as can be provided in Williston. Patient admissions to the hospital are up. Patients are getting their labs and diagnostic studies (i.e.,x-ray, ct scan, ultrasound, labs, etc) in our hospital. Specialty medicine has come to Williston (e.g., Orthopedics) to see patients in our family health center. Complementary and alternative medicine is finding its way to Williston, as well, with chiropractic, acupuncture and midwifery setting up shop in our family health center. Unattached patients ( i.e., patients without a family doctor) are joining our practice after admission to the hospital because they understand the value of having "their family doc" attend them regardless of the venue for medical care. This is how following the principles and practices of healthcare stewardship can make a difference with respect to quality, cost and access. Providing evidence-based medicine in a lower cost venue with easy and friendly accessibility to health care services is healthcare stewardship at its best. Healthcare stewardship requires primary care physicians to be able to function at the patient level, health system level and population level. What are the health care functions provided by primary care that will contribute to healthcare stewardship? More on this later in my next blog.
Dr. Dale
According to the American Academy of Family Medicine (AAFP), the definition of family medicine was updated in 2005 to the following:
A medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
In 2008, the AAFP expanded their definition with the following:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
When I came to Nature Coast Regional Health System, fragmentation of the local healthcare delivery system was evident. Most of the physicians in the area were practicing ambulatory medicine only. Adults were seen in some practices and children went to others. The hospital in Williston had only 1 physician on its medical staff. Admissions to the hospital were far and few between. Patients told me that they were traveling to Gainesville 30 miles away to get their diagnostic studies, labs, and specialty medical care. Williston is a rural community. Where was the family doc?
A great deal is changing at our health system nine months later. Comprehensive, continuous, patient-centered care is becoming the norm. Patients' are happy to get as much of their care by their family doctor (i.e., me and Jim) as can be provided in Williston. Patient admissions to the hospital are up. Patients are getting their labs and diagnostic studies (i.e.,x-ray, ct scan, ultrasound, labs, etc) in our hospital. Specialty medicine has come to Williston (e.g., Orthopedics) to see patients in our family health center. Complementary and alternative medicine is finding its way to Williston, as well, with chiropractic, acupuncture and midwifery setting up shop in our family health center. Unattached patients ( i.e., patients without a family doctor) are joining our practice after admission to the hospital because they understand the value of having "their family doc" attend them regardless of the venue for medical care. This is how following the principles and practices of healthcare stewardship can make a difference with respect to quality, cost and access. Providing evidence-based medicine in a lower cost venue with easy and friendly accessibility to health care services is healthcare stewardship at its best. Healthcare stewardship requires primary care physicians to be able to function at the patient level, health system level and population level. What are the health care functions provided by primary care that will contribute to healthcare stewardship? More on this later in my next blog.
Dr. Dale
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