View from the Bridge

Who Belongs at the Center of Everything We Do?

Ask a healthcare system leader where they focus and the answer will generally be the same, “We put the patient at the center of everything we do.” Laudable, but examine how budgets are spent, where efforts are focused, and you’ll find that providers are more often at the center. This needs to change. Has someone tested this model against others to ensure that outcomes are maximized by taking that approach?

I started my career as a biostatistician at the Wadley Institutes of Molecular Medicine, a cancer and leukemia research complex in Dallas, TX. In our quest for understanding, we searched for patterns to correlate actions and outcomes. Though there may be an exception somewhere, one of the highest correlations between actions and outcomes for humans is associated with birth – every person begins life as part of a family event – where at a minimum the baby and mother are part of a patient and family experience.

For years after that initial experience, the child as a patient is incapable of self-care. You certainly can’t target education at the child as a patient. Family is the target. Effective health and care depend upon that patient-family relationship. At the end of life, patients often become incapacitated. Between these two stages of life, let’s not ignore how often we’re incapacitated by illness. Again, health and care should be focused not just on the patient, but the patient and family where the family is now defined by the patient. If we’re fortunate during our lives, health and care will always be a patient and family experience.

So, should we put the patient and family at the center?  Yes, but not only the patient and family. There are 3 other important parties that should be there. The first are the providers who are critical to help design and execute health and care plans for us. Yet, it is seldom, if ever the case that a single provider sustains health or provides care alone. Every interaction with the healthcare system involves an expert team to provide what patients and families need and deserve. Though we often equate provider with physician, it’s the team that supports the physician, often millions of others when you think about all the people whose efforts provide the education, support, supplies and services necessary to keep us healthy or enable us to recover from illness, or die with grace and dignity. Let’s call them the community. There’s a community supporting every provider, patient and family.

That’s only four parties. The fifth is also important – the payer. Health and care are expensive. Payers are necessary because the cost of care is too expensive and the risk too high for most patient and families to bear themselves. The risk has to be spread over the population, the larger community, to ensure and insure that care is available to all who need it.

Our heath and care calculus then is comprised of five elements: Patient + Family + Provider + Community + Payer. That calculus will, however, fail because it is additive. To be effective we need to make the relationship between the elements multiplicative.

Proposed Health and Care Calculus:  Success = Patient x Family x Provider x Community x Payer

Health and care require collaboration, radical collaboration, for real success. Collaboration alone is not enough – providing help when asked is kind, but radical collaboration means looking at each participating party’s role in a patient outcome and making sure that all parties are communicating, coordinating, and contributing in order to achieve success. When all parties participate to the best of their ability, every party succeeds.

This calculus is simple arithmetic. When you’re measuring success, if any of the elements in the equation above are not at their optimal level, success will be suboptimal. If any element is ignored, the product will be zero which means failure or incomplete success for the whole.

We need to think about health and care using this new calculus. We need to extend our focus, change our vision. We need to put the patient, family, provider, community, and payer at the center of everything we do.

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