The Patient, The Person at the Center of my Care

Maria - Richard's Favorite Nurse

Richard

By Maria McClatchie, RN

In October, I will be running the Chicago marathon.  I'm not a runner, but was inspired by my friend, Richard, to join the SCIS (Spinal Cord Injury Sucks) team and commit to raise money for spinal cord injury cure research, as well as awareness of the devastation that spinal cord injuries can cause.

Unfortunately, I am running not only in honor of Richard, but in memory of him, as Richard passed from complications of quadriplegia last February.

I was part of the care team who got to know Richard during the months he spent at OU Medical center following a spinal cord injury which left him paralysed from the chest down.  He shared with me  the things he loved before his injury, how he lived an active and full life while teaching others to do the same. 

I’d like to share with you this short story about Richard and what may be learned from the patient who is  at the center of our care.

Richard was admitted to the Trauma ICU May 5th 2010 following a bike accident which fractured his neck and injured his spinal cord. I remember the first two days with him very clearly. Naturally he was scared, unsure, distraught, but behind the anxiety was an active, health conscious person who, despite the stress of the situation, made sure his mother was bringing him tilapia and protein shakes rather than having to eat the cafeteria food. I remember being amused by this, as I was almost seven months pregnant and jumped at any chance to eat unhealthy! At the end of his second day, the swelling in his spinal cord had begun to supress Richard's ability to breath and, as a result, he was sedated and placed on a ventilator. This was the last time I saw Richard for almost two months.  

That night, as I was leaving, I went into premature labor and was placed on bedrest. 

I returned to work on July 5th and was surprised to see Richard still on the unit.  He was still ventilator dependant and communication was difficult because we rely on lip reading to communicate with ventilated patients (another skill Richard helped me with). Each day I spent caring for Richard (and his mother, Sharon, who was there everyday) I learned a bit more about him and all the things he enjoyed in life. I used his expertise as a personal trainer to begin losing my pregnancy weight and in September when a group of nurses on the unit started a weight loss competition, Richard created a personal workout regimen for me, cheered me on, and made sure I gave up my 3 Coke Zero a day habit. While I didn't win the competion, I lost by 1/2 a pound Sharon and Richard had a special workout shirt made for me that read proudly, "Body By Dick".

I had the pleasure of spending nine months with Richard and Sharon and the rest of the family. I came to love Richard for who he had been and who he was becoming. He may not have meant to, but he taught me that I am not caring for a spinal cord injury, I am caring for a person with a spinal cord injury.   I am a better person and definitely a better nurse because of Richard .   I am now trying to "pay it forward" by raising money for spinal cord injury research, and I feel it’s important to share his story.

Spinal cord injuries are, unfortunately, a very common injury and devastate those injured as well as their family and friends.   It’s difficult as a health care provider. As a nurse in a level one trauma unit,  we can often feel we are fighting a losing battle.  We have to remember we are caring for a person, not an injury.  And often the people who need our care the most is the family of the patient whose life we touch, even if for a short time.  There are some patients who we just can not physically save. But providing patient centered care means we know each patient is a person, each family unique and regardless of the outcome, we can rest assured, at the end of the day we have truly cared for our patients. 

Richard will not be there, at the finish line, to celebrate my run.  But the impact he had on my life will live on forever. ◦

The Patient, The Person at the Center of my Care

PCMH: New Directions in Care

What is PCMH by ImageThink!

When I introduce myself as the Kansas Patient Centered Medical Home (PCMH) Initiative Coordinator people often respond with “What is PCMH?” And “Why should I care?”

Okay, maybe they don’t ask the second question aloud, but I sense it’s what they are thinking.

So, how do I respond to hospital, long-term care, and nursing administrators as well as optometrists, family physicians, specialists, and other health providers in a simple manner that is meaningful?  How do I respond to you?

I share my elevator speech… “The Kansas PCMH initiative can connect you with the resources you need to survive health care transformation.” 

What are the key words they’ll remember? Perhaps it’s “survival” or “resources.”  And with my elevator speech I have begun collecting stories of transformation and successful health outcomes that can be shared and used across our entire health care continuum. So, I’ll not only have “speeches” but also compelling stories. And we know that stories often paint a better picture.

What’s happening in Kansas

Kansas, not unlike many other states in the U.S., began demonstrating this model in limited format in July of 2011.  The goal was to discover what does and does not work in the transformation in care delivery and to share those findings across the health spectrum.  In Kansas, and through the Kansas PCMH Initiative, we are trying to learn specifically how staff, operations, finance, and culture is impacted by this shift in delivery.  We want to uncover where costs savings can be realized and cost-neutral changes can be made in quality improvement.  We want to deliver the tools for successful patient-centered care to patients and providers alike. 

We know that by creating a learning community we will not only positively impact health care outcomes, but create more viable and sustainable models for the delivery of health in our state.  Our goal is not to reduce competition but instead to enhance and grow free-market competition.  We are taking an interdisciplinary approach to the Kansas PCMH community and have expanded our initial pilot into support for a broader Health 3.0 emphasis which I am pleased to say that Health Facilities Group, Merck, Bank of Kansas, Health Care Real Estate Group, and Concergent as well as other health-related entities play a vital part.

The PCMH model of care delivery

So what is the patient-centered medical home, or PCMH?  PCMH is a health care delivery model based on the relationship between a patient and their personal primary care physician. The physician leads a health care delivery team dedicated to providing comprehensive and continuous care. The physician and their team is also responsible for facilitating effective communication between themselves and other health care providers – communication centered around better care, improve safety, and improved outcomes – for the patient.

With this model patients are held at a much higher level of responsibility for their own health.  Community outreach plays a key role in behavior change and support. Family physicians and their teams will be expected to facilitate a higher level of communication with home health, hospice, long-term care, dentistry, mental health, hospitals, and other health providers that care for patients.  We expect family physicians to work with employers to co-create health management opportunities for population health via registries and other educational opportunities. 

For administrators and human resource directors in our health care facilities, PCMH means a shift in organizational structure that while worth it in the long-run for providers and patients alike, won’t be without its bumps and bruises along the way.  Some employees will get on the bus. Some will leave at the next stop. And it will be challenging, as change always is. And this is one of the key roles that Kansas PCMHI can play in supporting transformation.

In short, PCMH has high expectations that can be met. But the change is not a little one.  With PCMH we are changing a lot.

Financial impact

The thought process simply is that with PCMH and across the entire health care system, patients receive the right care at the right time, lowering their health care costs and improving overall health. Employers pay less for health care as their employees spend fewer hours out of the office. Physicians are paid appropriately for providing coordinated, on-going care.

Currently there is no “standard” model for PCMH.  Thus we are using this window of opportunity to not only test models that are in demonstration in other states, but to refine what a sustainable, viable model focused on health outcomes can look like while reducing or containing costs.  Some PCMH models reflect increased fee-for-service payments from payers during the demonstration phase to offset additional costs including staffing changes, training, and IT upgrades.  Some models reflect a three-pronged approach including the increased fee-for-service, increased per member per month care coordinator fees, and rewards based on health outcomes.  And with these demonstrations come opportunities for increased reimbursements for EMR implementation via Meaningful Use and accreditation (NCQA, PPC-PCMH, Joint Commission, etc.). 

In Conclusion

Remember when I said that “The Kansas PCMH initiative can connect you with the resources you need to survive health care transformation.”?  This is so very true.  The Kansas Health Foundation, United Methodist Health Ministries, and the Sunflower Foundation have all led the way to create an initiative that can support you, health care providers, while helping you, health care consumers, with resources to do what we all want to do…survive.

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PCMH: New Directions in Care

The double-edged sword of information

Ah, information, how I love thee.  Ah, information, how you overwhelm me.

As a person that loves to learn (and apply what I’ve learned), the world wide web has been both an asset and a liability.  On the one hand, I love that I have the ability to access information so readily.  Click here.  Go there.  Google it.  But on the other hand, how do I know that that the information at my fingertips is valid or verifiable?

As I’ve worked in my small spot on the map of the health care world over the past 7 months, the question of the quality of health information available online has been posed more than once in light of the growing movement toward higher quality, lower cost, patient-centered care.  And, as the patient-centered medical home (PCMH) transformation picks up speed, the conversation will no doubt resurface again and again.

So how do we cull the good from the bad while trying to move toward better patient engagement?  On the one hand, patients have greater access to health information.  That’s good.  We don’t want to take that away.  On the other, patients have greater access to health information. That’s bad. We do want to lower the risks to the people we care for and arm patients and caregivers with tools that can improve access to better information.

So, how do health care providers, and those like myself that support them, find quality patient-centered health information to share with our patients or guide our patients to viable and trustworthy online resources? 

We start sharing.  And we change the conversation.  We shift from a monologue to a dialogue with the patient at the center.

Wielding the sword

Imagine if you will the impact on health outcomes if we move from an ineffective provider/patient exchange to productive engagement…

Scenario 1: Ineffective provider/patient exchange

Patient:                “Hey doc, I found this on the internet.  It says I can lower my blood pressure if I…”

Provider:             “Don’t believe everything you read online.  You just need to lose weight.  Now take this medication and let me know if it doesn’t work.”

Scenario 2: Productive engagement

Patient:                “Hey doc, I found this on the internet.  It says I can lower my blood pressure if I…”

Provider:             “There are some great online resources to help you get your blood pressure under control.  Where did you find the information?”

Patient:                “I found it on…”

Provider:             “Is finding information online something that you believe would be helpful to help you get your blood pressure under control?”

Patient:                “I think so.  I like to find good ideas and try them.”

Provider:             “Good.  While I’m not familiar with the resource you found, here’s an information prescription for some good online resources that you can check out.  Take this, go online, find the resources that you believe can help.  If you’re not really sure about what you find, email my staff and they can look at the information with you.  Together we can find the best plan that will work for you.”

Productive engagement solutions

I’ll provide you with two quick tools that can help you move toward more productive provider/patient engagement.  There are definitely more out there, but for those of you that haven’t started curating content, I wanted to get you off to a slower, more manageable start.

Tool Number One.  MedlinePlus.

MedlinePlus is an extremely easy tool that you as a provider or your patients can use to support self-management.  You and/or your patients and their caregivers can sign up to proactively receive patient education content via email. 

Here’s an example.  I’ve signed up for MedlinePlus Weekly Digest Bulletins by health issue (i.e. “high blood pressure”). Here’s what I received:

New on the MedlinePlus High Blood Pressure page:

High blood pressure and diet
Wed, 03 Aug 2011 13:26:03 -0500

Blood pressure monitors for home
Wed, 03 Aug 2011 13:26:03 -0500

Blood pressure measurement
Wed, 03 Aug 2011 13:26:03 -0500

High blood pressure medications
Wed, 03 Aug 2011 13:26:03 -0500

Tool Number Two.  Kansas PCMHI Summit 2011: Context for Engagement.

Yes, it’s a self-serving plug (Is there really any other kind?), but a good one.  The upcoming Kansas PCMHI Summit 2011: Context for Engagement Sep 30 & Oct 1, 2011 at the KU Edwards Campus in Overland Park can help you begin to master self-management support and learn how to effectively use online resources to deliver higher quality, more readily accessible, patient-centered care.

Our keynote speaker, Dr. Kathy Reims will deliver two outstanding presentations to really challenge how we engage our patients in effective self-management.  She’ll lay the groundwork by providing context for the conversation and help us:

Explore examples of how practices have utilized SMS in the field

Understand the importance of SMS from a patient perspective

Understand SMS as a change process

Discover tools for SMS that can be adapted by the practice

Learn how to use a 5-step approach for implementing SMS in an ambulatory practice

And when you leave the session, you’ll have the tools you can use to plan the next steps to enhance SMS in your practices.

So, you can keep clicking here.  Or going there.  Or Google on your own.  And you can continue to cringe when you hear: “Hey doc, I found this on the internet…”  Or you and your teams can learn to effectively wield the powerful sword of information and deliver higher quality, full access, patient-centered care. 

The sword is yours.  The choice is yours.  You decide.

TO REGISTER FOR THE KANSAS PCMHI SUMMIT – CLICK HERE.

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The double-edged sword of information

Can you say "business" and "health care" in the same sentence?

Shifting business models in healthcare requires thinking of health care as a business.

Some would argue that to reframe our thinking of health care delivery as a business smacks in the face of the mission of health, but I would propose that the shift in thought is more purposefully aligned to the mission of health.

As I've learned about the healthcare system and its many facets over the past few months as a "newbie" in the healthcare world, I have heard many of the non-profit leaders share the following mantra..."No margin. No mission."

Never could it be more true.

As part of our current Kansas patient centered medical home initiative (PCMHI) we are building the revenue model, the business case, for better health.

While we are not focused only on Medicare patients in our initiative, we are instead looking at all patients of all ages.  We are looking at people like you and I.  People with and without insurance.  People that are healthy.  People with special health needs.  People that universally share one common life desire - personal health.

I would urge my readership to consider their personal health and the system that delivers it.  I would encourage them (this means you) to elaborate on the non-profit mantra and rally around the following cry..."To deliver health, we must build healthy businesses." ◦

Can you say "business" and "health care" in the same sentence?

What’s a Kansas PCMH? The Sequel. Or the Cool Things about Elevator Speeches.

While sequels often get poor billing, (After all, who can top the original?) I have decided to do my best to provide you with a more tantalizing experience than the one you may or may not have had with Part One-The Original. For those of you that missed Part One-The Original you can find it on this blog.  For the rest of you, I’ll just pick up where we left off.

As I struggle to explain the Patient Centered Medical Home (PCMH) Concept, I have tried to reframe it into one of my favorite forms of business communication – the elevator speech.  To explain a business concept or idea, many successful individuals often turn what is referred to as an elevator speech, or perhaps you’ve heard of it referred to as an elevator pitch.  Basically, you break down a complex concept into something the person you are conversing with can remember.  Whether or not they actually remember, or even repeat it to someone else, is often determined by how well you crafted your speech. There are no hard and fast rules for the speech, only that it is first and foremost meaningful to your audience and short, sweet and to the point so they can remember and (hopefully if it’s valuable enough) repeat.

Cool Things

For the PCMH speech, I know that I’ll have to craft multiple versions for the individuals I am engaged with at the time.  Sometimes I’ll be talking with health care consumers like myself.  At times I’ll be conversing with health care purchasers (employers) or providers (physicians and the like) or vendors or policy makers.  And over time, I will have to change what my speech looks and sounds like based on what I’ve learned.  And, I’m okay with that.

You see the first cool thing about an elevator speech is that it doesn’t have to be a speech in the traditional sense of the word.  It can consist of key words that can be morphed (primarily due to our synonym-extensive English language) on an as needed basis to create a truly meaningful exchange.  The second really cool thing about elevator speeches is that they are co-created.  That’s right.  You heard me. You don’t have to make these things up on your own.  So, how do you do that?  How do you find a co-creator or creators?  Ask.

Take the time to learn about who your audiences are, what’s important to them, what their pains are, what they care about.  It was Habit Five of Stephen R Covey’s 7 Habits of Highly Effective People that he shared this pearl of wisdom and sound advice: “Seek first to understand, then to be understood.”  This is true of all communication.  I have been very blessed in that my business communication professor at the University of Oklahoma, Dr. Betty J. Robbins, pounded into my head through her sage classroom instruction: “Know your audience.”  This has guided me well through many communication experiences and activities.  And while she still might give this blog a “C”, I thank her every day that this very important three-word mantra has stuck.   

So, in the spirit of this blog…. Tell me a little about yourself.  It is my goal to understand.

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What’s a Kansas PCMH? The Sequel. Or the Cool Things about Elevator Speeches.

What's a Kansas PCMH?

Just a quick note to thank you for visiting the Kansas Patient Centered Medical Home blog.  While we haven't completely nailed down what this blog can do for you, we will do our best to make it informative, interesting, and interactive. 

What is a Kansas PCMH?  Or what is a PCMH for that matter? Here's the 25 words (more or less) version...

The PCMH is a health care delivery model focusing on the relationship between you, as a health care consumer, and your personal physician. Your physician leads a comprehensive health care delivery team dedicated to providing you with synergistic (and hopefully seamless) quality care.  The model is designed for health care consumers to receive the right care at the right time, lowering your health care costs and improving your overall health across the health care system.

Okay, so the definition may be more than 25 words, and still filled with some medical speak in its current form, but we're working on that.

In the meantime we invite you to check out our Kansas Patient Centered Medical Home website to learn more about the Kansas PCMH and PCMHs in general (Warning:  There are acronyms a plenty) and stay in touch with our team.

Subscribe and Stay tuned! ◦

What's a Kansas PCMH?