Patient loyalty and healthcare stewardship

Practicing in a small rural community is challenging. Word spreads quickly regarding the quality of medical care available in the community.Williston,Florida is no exception.
Teddy Roosevelt is famous for this unforgettable saying,"Speak softly and carry a big stick". I have tried to obey this edict for years but I really trusted it beginning with my very first day at Nature Coast Regional Hospital. It was my hope to come to the hospital with very little fanfare. Many physicians had come and gone before me and the perception in our community of the hospital and family health center (aka, the clinic) was poor regarding the quality of medical care available.
I started out working several shifts each week in our emergency department. I admitted patients to our hospital and followed them on the floor during their stay. I offered to be their family physician upon discharge in our family health center. Most importantly, I did this under the cover of silence. My goal was to allow word of mouth to spread about the new doctor in town and the quality of care being delivered.
Patient loyalty is much different than patient satisfaction. When patients are satisfied, they are happy with their medical care but they really wouldn't go to the ends of the earth to see "the physician". When patients become loyal, the physician becomes "their physician" and they would travel great distances just to have that one-on-one interaction because there is no other.
Dr. Joe Inguanzo in a recent article on customer loyalty in Hospitals and Health Networks , stated that over the last 25 years, an average of 80 percent of consumers have consistently laid claim to a hospital they would call their "own." More than half of the top 10 reasons consumers prefer a certain hospital center on some form of loyalty: they have always gone there; there is a strong perception of personalized care; a doctor recommended the hospital; perceptions of overall reputation are positive; they or a friend or relative works there; patients' experiences with staff are memorable.
Patient loyalty is a critical element for establishing healthcare stewardship. When patients become loyal, there willingness to buy into the process of healthcare stewardship is much easier. They can be molded into more respectful consumers of healthcare goods and services. Preventive care and wellness become the focus of office visits with fewer and fewer visits for sick care. Emergency room visits go down dramatically and are replaced with many more outpatient encounters. The patient-centered medical home becomes a reality for the busy practitioner.
Nine months have passed since I arrived at Nature Coast Regional Health System.
We are starting to act like a health system and not a fragmented hospital with a dysfunctional "clinic". My partner Jim Long, PA-C, and I are constantly amazed at how quickly we have developed patient loyalty. This month, we will have surpassed over 800 encounters in our family health center. Our average daily census grows in the hospital. We see an average of 20 patients at our local nursing home each week. People are no longer driving away from Williston but they are driving to our community to get their health care. Quality, cost and access are being followed closely and Jim and I are winning the war. Hard work, dedicated staff, caring and kindness are becoming the norm in our health system. Healthcare Stewardship is alive and thriving in Williston.
Dr. Dale

Healthcare Stewardship: An Eight Point Plan for Change

What is stewardship?
The notion of stewardship is an ethically-driven responsibility for protecting and developing one's limited resources. There is no real ownership of the resources by stakeholders, just borrowing. Therefore, stewardship is the careful and responsible management of borrowed resources that promote people's well being.
What is a steward?
A steward must provide the necessary leadership to establish the rules by which all stakeholders behave in ways that reflect the interests of both public and private sectors. Stewards must then ensure corrective action when behavior by stakeholders becomes aberrant and potentially harmful to the population served.
What is the main goal of Stewardship?
Finally, stewardship's main goal is to help the population being served achieve positive outcomes whilst carefully managing the limited resources available.
Applying stewardship to health care delivery systems.
Applying the concepts of stewardship to present-day issues facing health care delivery systems today creates the careful, well-constructed opportunity of managing borrowed and limited health care resources in a transparent, socially responsible manner. It is with this in mind and using the concept of stewardship as my guiding principle , that I have created an 8-point plan for health care change for our U.S. healthcare delivery system.

My 8-point plan consists of the following:

• Establish a basic healthcare package for all Americans
  

• Move from a sick-care system to a well-care system

• Use evidence-based medicine

• Require insurance companies to put patients first

• Encourage physicians and patients to use healthcare resources wisely

• Get doctors in the trenches involved

• Establish a national database for healthcare information
  

• Create a national agency to promote transparency and accountability regarding healthcare outcomes
  

•

–

I am aware that these are lofty goals. They are all applicable to the current crisis that confronts all the stakeholders of the U.S. healthcare delivery system. Now is the time for a major paradigm shift in healthcare delivery at all levels. It is not too late. It will be too late if we do not change now. After all, it really is about the patient.
Dr. Dale

•

•

–

–

Rural Medicine Crisis, 2009

Jon Bailey of The Center for Rural Affairs in Lyons, Nebraska, recently highlighted in the center's newsletter this past February a top 10 list of health care issues facing rural America today.
This list is not an all inclusive identification of issues but I must say it is right on the mark. Many of the issues I have been managing for the last 9 months at Nature Coast Regional Health System are related to Bailey's list.
The top 10 list is as follows:

1. An economy based on self-employment and small businesses
2. A growing dependence on and need for public health insurance plans
3. A stressed rural health care delivery system
4. A healthcare provider and workforce shortage
5. An aging rural population
6. A sicker and more at risk population
7. A need for disease prevention, health promotion and wellness resources
8. A lack of mental health services
   
9. A rising dependency on health technology
10. An effective emergency medical system

My days as the chief medical officer for our health system in Williston, Florida are spent managing all of these issues and more. Healthcare Stewardship is my attempt to bring the classroom to the shop floor and improve health care delivery in a small rural community.
I remind everybody who works on our team that "it is what it is". We must work smarter and not necessarily harder in order to provide our patients with the patient-centered medical home they so readily deserve. The patient is our center of the universe and our focus on the patient cannot waiver even during the most trying of times.
Dr. Dale

Welcome to Healthcare Stewardship

Welcome to my blog about healthcare stewardship.
It is my hope to introduce many to the concept of healthcare stewardship. We are entering into a very exciting time in healthcare delivery. I decided about 18 months ago to write a book on this topic. What I thought would be a textbook, Healthcare Stewardship, actually evolved into a potential script for shaping healthcare delivery in the United States. I have taken many of my ideas, supported by others who have written before me, and began applying them in a small rural hospital in Williston, Florida. As the days continue, I hope to be able to chronicle how we are saving this small rural hospital from extinction just like the many that are going away as we speak. Stay with me on my journey and provide me with your thoughts. May we all become healthcare stewards.
Dr. Dale