THREE WAYS OF “CENTERED-NESS”

Robert L. Addleton, EdD, CHCP, FACEHP

Executive Vice President

Physicians’ Institute for Excellence in Medicine

DISCLOSURE

I have no conflicting relationships to disclose

Practice-Centered

Self-Centered

Patient-Centered

Practice-Centered Patient-Centered

Self-Centered

THINGS TO WORK ON: PATIENT-CENTEREDNESS

Patient ExperienceConvenienceComfortCaring

Population HealthValue-Based Payment

PATIENTS’ BIGGEST PET

PEEVES

Here's your opportunity to learn what you might want to avoid saying — or doing — next time a patient comes to

your medical practice.

PATIENTS’ BIGGEST PET PEEVES

Lack of discussion about alternate treatment options and associated costs

"[Physicians] don't always disclose all the facts or options

so that you can make an informed decision."

PATIENTS’ BIGGEST PET PEEVES

Failure to disclose if you are "out of network"

"Calling ahead to confirm that you are covered by insurance and that the doctor

that you are seeing is in your network, only to find out after you have seen the doctor that you are not in their network and your$35 copay has shot up to a $200 fee. [I'm]

still fighting this bill ... for the past nine months!"

PATIENTS’ BIGGEST PET PEEVES

Being asked the same questions numerous times

"I hate that [staff members] ask you to describe what's wrong when you check in and they take notes, then the nurse comes in and asks you what's wrong and takes notes, then the doctor comes in and asks you what's wrong and takes notes. Are they all just

doodling when they're taking the notes?"

PATIENTS’ BIGGEST PET PEEVES

Inefficient and repetitive paperwork

"Filling out the same eight-page forms over and over again just because, 'It's a new year,' or filling out the same information on multiple

forms [is my big pet peeve]." I have no patience for such illogical inefficiency."

PATIENTS’ BIGGEST PET PEEVES

Poor scheduling

"Overbooking patients and then making everyone wait

over an hour to see the doctor [is my big pet peeve]."

PATIENTS’ BIGGEST PET PEEVES

Letting technology get in the way

"I hate it when the doctor faces the computer to take notes instead of facing me. My nephew just got a job as a doctor's scribe

to do the computer note-taking while the doctor actually has a two-way conversation

with the patient."

PATIENTS’ BIGGEST PET PEEVES

Setting inaccurate or unrealistic expectations

"I hate it when the doctor leaves the room after a brief exam and says, 'I'll be right back,' but doesn't return. I can be quite

assertive and have actually been able to get the doctor to come back by complaining to the nurse that I had more questions to ask

the doctor."

PATIENTS’ BIGGEST PET PEEVES

Lack of resolution

"They might have more knowledge and application experience than the Internet, but

they are often still guessing or using 'tried and true' methods. I fall far outside the

norms in many cases and those methods fail. That being said I empathize with them as people and having to deal with issues like

mine from a professional standpoint."

PATIENTS’ BIGGEST PET PEEVES

Jumping to prescribe too soon

"They insist on prescribing drugs for everything as opposed to treating the

whole person."

PATIENTS’ BIGGEST PET PEEVES

Failing to consider the patient's perspective

"My GI thinks she knows more about my body than I do. That's annoying. She thinks diet doesn't affect my GI issues. She insists

on prescribing pills and totally dismisses theidea that almost all of my GI symptoms could

be controlled by diet."

WHAT DOES IT MEAN TO BE “PATIENT-CENTERED”?

Think of a way your practice could be more patient-centered

Think of a specific patient for whom you could be more patient-centeredThink of specific things that could be done “Say” the patient’s name in your mind; visualize the patient

How could you be more patient-centered if the patient was your Mother (brother, wife, closest friend, etc.)

We've got to go from cultural competency to cultural proficiency

Warren Jones, MDAAFP Past PresidentApril 30, 2015

WHAT DID HE MEAN?

“It's a skill set that requires a physician to be able to listen with empathy, explain his or her perceptions of a problem, acknowledge and discuss differences, recommend treatment that considers the patient's cultural parameters, and negotiate a treatment that fits the patient's cultural framework.”

THINGS TO WORK ON: PRACTICE-CENTEREDNESS

Financial HealthWork EnvironmentRecruitmentWorkflow/Efficency (Lean Principles)

THINGS TO WORK ON: PRACTICE-CENTERED CONSTITUENCIES

StaffPartnersOther ProvidersFamily of Patients

Recognize Me

Nothing: Self-Motivated

Inspire Me

Give Me Autonomy

Pay Me More

Train Me

Promote Me

Don't Know

0 5 10 15 20 25 30 35 40

What is the most important thing that your man-ager or company currently does (or could do) that

causes you (or would cause you) to produce Great Work?

Source: O. C. Tanner, “Recognition Trends for 2015” Orange Paper #6

"The important thing to remember is that if you don't have that inspired enthusiasm that is contagious, whatever you do have is also contagious.“

- Danny Cox

THINGS TO WORK ON: SELF-CENTEREDNESS

If something does not bring joy, satisfaction, or flow, can it be Eliminated Modified Delegated

“Sharpen the saw” (Stephen Covey) Take a break Pursue an interest

Reconnect on why you do this work Explore past decisions People you have helped Talk with others

RAND STUDY 2014 PHYSICIAN SATISFACTION DRIVERS

“I provide quality care to my patients.”

“My practice facilitates the delivery of quality care.”

Ability to control factors affecting everyday clinical work.

Values well-aligned with those of leaders.

Frequent meetings within the practice fostered greater collegiality.

Practice supports acceptable balance between work, quality, and income.

Satisfaction when work matched their training.

Working with well-trained, trusted, capable staff.

What motivates physicians is: autonomy, being able to do interesting work, being able to treat their patients. The most valuable resources for physicians are their minds and their time. Doing their work takes a lot of energy and thought, and if we could find ways of saving them time or enabling them to do their job more easily, that’s what’s going to motivate them.

Douglas Hough, Ph.D., The Johns Hopkins Bloomberg School of Public Health

THE LAST TIME I WAS HAPPY

Where I wasWho I was withWhat I was doing

Developing Competence

Source: Based on the work of M. Csikszentmihalyi

Panic Zone

Drone Zone

Practice-Centered Patient-Centered

Self-Centered

WHAT’S RIGHT FOR YOU?

ADDITIONAL SOURCES

Bodenheimer, T and Sinsky, C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider Ann Fam Med November/December 2014 12:573-576;doi:10.1370/afm.1713 http://www.annfammed.org/content/12/6/573.full

Friedberg, M, Et Al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy 2014 RAND Corp./New York http://www.rand.org/pubs/research_reports/RR439.html

Simon Sinek, Fulfillment https://www.youtube.com/watch?v=5Z4vdoo16F0