It’s not just altruism that has moved area hospitals toward more precise attention to patients. In fact, according to one official, the practice results in roughly equal improvements in both medical outcomes and cost controls – a true win-win for patient and provider.
Note: The story below is an excerpt from our Jan./Feb. 2015 issue. For the full story download our FREE iOS app or view our digital edition for FREE today!
At LewisGale, the perspective is building a culture of patient-first, to the extent that it becomes the unspoken expectation.
New technology and evolving standardization is transforming the healthcare industry, but the Roanoke Valley’s regional providers continue to work on improving the patient experience too.
State-of-the-art medical care can give doctors and nurses better tools to evaluate and treat a patient, for instance, but that time in the hospital or office makes up only a small fraction of that patient’s time. A personal connection may well inspire the patient to embrace his or her role in taking the next step and making changes to prevent a future visit.
Consider the story of a truck driver with diabetes, as told by Anthony Stavola, vice chair of Carilion Clinic’s Department of Family and Community Medicine.
This long-haul truck driver had to go on insulin. His troubles managing his diabetes pulled him off the road, and he eventually lost his job. The driver was forced to move in with family members and became depressed.
When he came into one of Carilion’s offices, “our medical team there – nurses, care coordinators and the physician – all got involved in working with this patient,” Stavola says. “We helped him get the medication he needed, spent time working with him on his diet and setting goals. He ended up losing weight and being able to get off the insulin. Then, because he was off insulin, he was able to get license back and go back to driving again for his company, and was then able to reconstruct his life financially.”
Some time later, the truck driver ran into one of the Carilion team in a grocery store and expressed his gratitude: “You gave me my life back.” The Carilion staffer’s response: “We didn’t give you your life back. We just helped you find it.”
The tale isn’t just a feel-good story for Carilion – it illustrates the modern-day emphasis on engaging patients in their own care. The driver didn’t just go to the doctors for help but goals to improve his diet and lifestyle.
That patient engagement is key to the modern approach to medical service, and it overlaps across the Roanoke Valley’s major healthcare providers – Carilion Clinic, LewisGale/Hospital Corporation of America and Salem VA (Veteran’s Affairs) Medical Center.
Richard Embrey, chief medical officer at LewisGale, says it’s working to measure its care quality – not just processes and outcomes, but the patient experience.
“Sometimes patients receive good medical care by the book, but they come away not feeling good,” Embrey says. “They have the feeling they were not treated as an individual or were involved as part of the care process, but that they were part of a production line and just being moved through.
To that end, LewisGale provides training to its staff not just on diagnosis and treatment but in working with patients, particularly during times of stress.
“A lot of it is leading by example,” Embrey says. “That’s a real culture thing, putting the patient first, and if you can develop the culture, then everyone who works here knows that’s the unspoken expectation.”
Carilion Clinic is likewise focusing its efforts to deliver a better experience for patients. It’s working to develop better electronic patient records that cut down on duplication – if a patient has had a test with one doctor, they don’t necessarily need to repeat it with another – and also alert medical staff when a patient has missed appointments, allowing outreach to ensure that person is getting the care they need.
Stavola says Carilion is working to adapt to its patients’ schedules. That may mean doctor’s offices that are open later into the evening or on weekends, or – as in the example of the trucker – it could be working to help ensure they implement necessary lifestyle changes.
One year ago, Carilion adopted a best practice from the Cleveland Clinic for patients at Carilion Roanoke Memorial Hospital. The bedside prescription delivery brings medicine to patients without them ever having to leave the room. That may seem like a small thing, but in the discharge rush, when patients are ready to leave the hospital, making an extra stop by a pharmacy, even one in-house, can be a burdensome process.
The bedside prescription delivery ensures that patients get their prescriptions well before leaving the hospital’s confines while giving them a chance to ask questions of a pharmacist by dialing an in-house number.
Additionally, Carilion has implemented a processed called “Ask3 Teach3” when giving out medication – another Cleveland Clinic best practice. The “3” refers to bits of information presented to patients: the name of the medicine, the reason it’s being given and any potential side effects. Nurses and doctors are also instructed to ask patients open-ended questions to ensure they understand it.
Why so much emphasis on prescriptions? It’s because medicine is part of an ongoing process that occurs well after patients leave the hospital – and because an estimated 30 to 40 percent of prescriptions go unfilled, according to Patrice Weiss, Carilion’s chief medical officer. The clinic hopes that by improving communication to patients about that medicine, that number will shrink.
“Personalizing that communication can really affect patient outcomes and patient compliance,” Weiss says.
Similarly, a focus on patients helped the Salem VA Medical Center weather a national storm of controversy involving veterans who found themselves mired in long waiting lists to get health care.
Inspectors conducting an audit of VA centers found that the Salem center had shorter wait times than other facilities in Virginia, North Carolina and West Virginia. New patients typically wait roughly 35 days to get seen, while established patients can get in within a couple of days, inspectors found. That compares to months-long waits at some other centers.
The center is incorporating new measures to make it more patient-friendly, too. It now holds quarterly veterans’ town hall meetings to answer questions and hear concerns. It’s directing more patients to an online system that lets them resolve issues without having to go through a phone maze.
Each fall, the Salem VA Medical Center also stages a “drive-through” flu clinic. “They just drive up and we have a trailer near the entrance,” says VA Public Affairs Office Marian McConnell. “They show their documentation, stick their arm out and get a shot. They don’t even have to get out of the car.”
Carilion and LewisGale facilities have fared relatively well when stacked up agains their peers, too. Last spring, the Leapfrog Group gave B’s to the two organization’s Roanoke Valley hospitals. By fall, LewisGale improved to an A, while Carilion Roanoke Memorial Hospital fell to a C. Carilion officials say the score declined because it elected not to participate in Leapfrog Group’s survey.
Ultimately, says Embrey, the patient experience plays an equal role with medical outcomes and cost controls.
“The human aspect of medical care is just as important as the scientific basis of medical care. That’s a major focus for us,” Embrey says. “Sometimes because of the complexity of medical care, it’s hard for patients to know if they got the right care, but it’s pretty easy for them to know if they got compassionate care.”
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