Can We Finally Put the Patient at the Center?

“I don’t care if it hurts I wanna have control“

-Radiohead

As a US citizen by birth but culturally still a product of an upbringing abroad and hence an aspiring American, I pay close attention to those rituals that signal belonging.  Unsurprisingly, a trip to Disneyworld emerged as de rigueur activity when my kids were of the appropriate age.  It is still a favorite family memory, but for me, it was also professionally transformative.

On arrival at our Disney hotel, we stood briefly in line.  A young woman with a tablet stood in our midst.  In response to my query, she proudly stated, “I am tracking how many minutes each customer is waiting so we can adjust our personnel on this day next year to decrease the wait.”  I won’t bore you with more examples but putting customers first is the guiding light of the company.   The customer experience is designed and then monitored closely, with continuous improvements based on documented consumer feedback and direct observation.

Like most systems, ours has evolved over decades.  It hasn’t been comprehensively designed with the patient experience at the center.  It reflects the challenges, constraints, and idiosyncrasies of LCHC’s past 50 years.  Each problem has tended to be solved as a discreet issue, and not necessarily as a piece of a process embedded in multiple workflows, all used by staff, patients, or both.  Now, we have been granted the opportunity to design the system as a whole, the way our patients experience it.

The challenge I have for my readers is the following: what should we consider changing if the patient is truly at the center of what we do?

As we strive for a redesign of our services, because of the centrality of the patient convenience, some of the needed improvements are straightforward.  Calls should be answered promptly.  Outside clinicians should be able to reach their colleagues rapidly.  Referrals should be scheduled while the patient is still present.  Forms should be filled in and returned within 24 hours.  Patients should be able to schedule on-line, choosing which member of their team they wish to see and by which modality.  A patient should be able to count, for routine visits, on getting in and out in under 45 minutes.  Our schedules should match community demand.

On a more complex note, what should a team look like?  We have traditionally focused on clinicians and nurses.  Do we need more health coaches?  Community health workers?  Technology navigators?  Do patients need a different orientation/introduction to the variety of our services?  Is our chosen vehicle, the 1:1 encounter, still the dominant block in a system designed to improve quality and lived patient experience? Where is our technology most maladapted to our needs?

Are these services offered to all, or will it be based on a severity index?  If prevention of all kinds and chronic disease management is taken care of routinely, what will a clinician/patient encounter consist of?  How much time will be spent 1:1 with patients versus coordinating care plans with all the involved services?  How do we decide how many resources to dedicate to a particular patient?

I am curious to know which areas speak to you the most loudly as needing redesign.  To be clear, I am not looking for solutions, i.e., we should decentralize our call center, but I am curious about which areas you believe are most in need of attention.  We are launching our formal design process in September, anchored by a multi-functional and disciplinary team.  The team will treasure such insights.  Although everything changes, we need starting points for this deep transformation, presumably areas of highest priority.