Hospitals WANT Guitar Hero Healthcare

"Hospitals want involved patients" - from the Chicago Tribune.

Good piece, but a bit outdated.

The Joint Commission's Speak Up! Program has been around for a few years (at least since I used it as a Patient Advocate 'rounding' in 2003-2004), but you rarely see a specific staff person within the acute care setting responsible for implementing the program.

Our hospital, however, had a team of 5 Patient Advocates rounding on inpatient floors discussing the Speak Up! Program with patients and families.

What, we found, however, upon administering the program is indicative of the healthcare system's larger 'chronic' issues....

The process looked a bit like this:

1. PA enters the room, cheerily confirms identity with double checks (name, armband) - after asking if we can chat about the program and if the patient would like privacy while we do so.

2. Hands patient or family member/friend/caregiver/partner Speak Up! brochure while we give the pitch, usually multitasking and wiping staff board, refilling water pitcher at bedside, etc. Some people don't want the paper or the pitch, so PA asks if any other questions or any assistance we can provide.

3. Asks if patient has any questions or if we can be of assistance. 9 times out of 10 answer is resounding "yes" and issue is NOT related to Speak Up! program but medical care continuity (ie are my labs in yet? When will I be discharged? Who is my new nurse? What's for lunch?)

4. Chase down medical staff (nurse, tech, or in VERY rare cases doc) if it's a medical issue. Otherwise repeat we are 'only' PAs and not qualified to give medical information, but we have feet, and lungs, and can thus chase down and corner medical staff who can give correct info. (This would be why I wore sneakers, Nike Prestos, to work).

5. Bug caregiving staff incessantly if big issue, deliver message and confirm 'report' handoff verbally (and usually in my notebook with time and staff name cited in case I later had to do a variance).

6. Return to patient room and report progress on issue/contact resolution. Deliver sunshine and a smile (or 50).

Final findings from a year spent as a Patient Advocate:

1. Patients want to be involved. (10-80-10 rule: 10 percent unwilling/inable to self-advocate and be participatory, 10 percent hyperengaged, Guitar hero healthcare types, and middle 80 percent may be involved at varying levels).

2. Family members want to be involved.

3. Many doctors don't know how to treat patients who are verbally self-advocating...but if someone whips out a notebook and starts taking notes during the conversation they're on best behavior.

4. Communication between docs and nurses is often FUBAR. The blame baton is passed back and forth like care delivery communication is a contact sport. The rest of us, including patients, are relegated to acting as befuddled spectators.

5. Top issues of concern to patients are related to the 3 Cs: cure, care, communication.

Every initiative that purports to encourage increasing 'guitar hero healthcare' or 'patient involvement' must take systemic deficiencies in addressing the 3Cs into account. To ignore any of them is to court systemic failure.

Right now Ted Eytan is continuing to push on the most complete, viable definition of Health 2.0 for consumer-centric, patient-directed care advocates. Take a look. It's important work.

Until we can define 'involved' patients at a basic level, hospitals will have a hard time connecting idealistic goals to real strategic planning.

Patient involvement, CONSUMER involvement, is a vital component to figuring out 'what's next' for Health 2.0, and beyond.

Yesterday I sat in a nearly empty room at HIMSS DC Summit 2008 watching Jay Parkinson present the first truly consumer-centric GP practice model (here's some WSJ coverage).

Jay's new practice, Hello Health, is opening it's first storefront July 1st in NYC. Pay attention policymakers, hospital execs - the future of healthcare is closer than you think.