Strategies to Develop Patient Centred Care

• Sneha Praveen

MIS Practicum Final Report

Analysis of online patient reviews and its effect on healthcare providers

1. Introduction

With the advent of social media, online forums have become a major platform where users share their views and these platforms affect all the involved stakeholders sometimes positively and sometimes adversely. Word of mouth has become an important tool for publicity and sometimes a bad review posted without ulterior motives can do much damage. Most of such reviews and posts that we read on platforms like twitter, Facebook and online forums affect our decision making as we tend to trust judgment of others.

But healthcare as an industry is still not very patient centric and not enough importance is given to patient’s opinion. This case is even more valid in the context of USA as there is no official channel for patients to leave their reviews and experience about a healthcare provider. This is very surprising as all other industries – food, retail, and consumer industries revolve around what customers have to say and millions of dollars are spend on “customer satisfaction”, whereas, healthcare industry still relies on their processes without bothering to collect feedback from patients they serve. The main reason accredited to this could be that as payers, insurance companies and as service providers, physicians play the most important role. Patients in this context are mere subjects of treatment who are assumed to be not very vigilant of their own health condition. But is this situation same all around the world? And if not, then US healthcare needs to adapt and learn from such countries to improve its care and service quality. One such online forum implemented in the United Kingdom is “Patient Opinion”. This forum acts as a bridge between patients and healthcare providers to help improve the healthcare quality provided by National Health Service (NHS) to its citizens. In this paper, I will analyze data collected from patient opinion forum and present by findings answering how USA can benefit from a review outlet like Patient Opinion and how this forum has helped NHS to improve their quality and service.

2. Why Patient-Centric Care:

It is well proven that any industry benefits from customer reviews and helps in reducing cost and improve service. Slowly, healthcare needs to move towards Patient-centered care which supports active involvement of patients and care givers. It means being responsive to patient’s preferences, needs and feedback to ensure that service quality improves and slowly there is more involvement of patient in healthcare delivery and design. [1]

A patient centered care has below attributes [2]:

• “Whole-person” care.
• Coordination and communication
• Patient support and empowerment
• Ready access
• Autonomy

A patient centered care focus on guiding patients by giving them information about options and risks. It means considering patient’s preferences and background and valuing their feedback. According to 2001 Institute of Medicine a focus on patient centered care is one of the factors constituting high quality health care.

Source: http://hcca-act.blogspot.com/2011_11_01_archive.html

The current system is physician centered which means that effective care is defined by physician’s standards and skills instead of centering on patient’s satisfaction from the service rendered. For example- orthopedic surgeons use the Harris Hip score to judge the success of a hip replacement. This was designed solely by physicians and does not include any feedback from patients to include their satisfaction from the procedure [3]. Thus, it is impossible to correctly define the output of any model in healthcare until the patient experience has been taken into account for.

3. What Patients Want

Most tools that we use to judge patient satisfaction or outcome of a medical service cannot be accurately quantified. Also, the success metric for a medical care varies from physician and patient’s point of view. An example of such tools was administered by Steward.et al in 2000 where many physician-patient interactions were audio taped and patients rated these conversations. After analysis, it was deduced that patients recovered faster, had better emotional health and perceived the care as satisfactory if the care was patient-centered. The faith of patients on their healthcare providers increased when there emotional needs were taken care of by the physicians leading to less number of diagnostic tests and fewer referrals.

A similar methodology can also be used to study physician empathy. Researchers at Jefferson University developed the Jefferson scale to test physician’s empathy where physicians rated their own empathy but this scale could not be used to judge patient satisfaction. Thus, a new scale called Jefferson Scale of Patient’s perception of Physician Empathy was used which judges patient’s rating of physician’s empathy which correlated to patient’s satisfaction. Mostly what patients want is a relationship of empathy with physicians, who can help them communicate with the problem and develop a personal relationship with them. The perception of care is different from physicians and patient’s point of view and we need to move our focus from “what’s the matter” with our patients to “what matters” to our patients. [1]

4. Hindrance in achieving true patient centric care

One of the most crucial factors stopping US in achieving true patient centric care is the current reimbursement system and focus on physician practice model. There is no measure in US to gauge the quality of care, empathy and relationship of a physician with patients. Reimbursement is not correlated to these factors, instead it is based on per patient encounter. Due to this, primary care physicians focus on increasing the volume of patients and reduce the time spent with each patient. Most physicians are in a hurry and under stress which leads to misdiagnosis, useless tests and referrals, decrease in quality of care and a very formal relationship between physician and patients. [6]

Next important factor is that physicians employed by hospitals are incentivized or prized depending on number of patients that they bring but there is no measure to the quality of care they impart. The volume of patients precede quality because the financial benefits are huge e.g.-

Each lab tests physicians’ order, each referrals they make, benefits hospitals in terms of huge monetary benefits which in turn becomes a basis of primary care physician’s salaries. Thus, understandably what drives physicians is to employ methods to increase volume of patients, decrease time spent with each patient and other ways to monetize each patient-physician interaction. [3]

The third hindrance is hospitals hiring generalists called hospitalists to provide care to patients with the goal of reducing patient days per admission. This might lead to improve in care for a certain amount of time but the reason behind hiring such individuals is not to improve patient care but instead to benefit hospitals financially.

5. The Patient Centric Approach model

• Patient Centered Medical Home

Patient Centric medical home helps address the patient centric approach by emphasizing on high quality patient care and lower the healthcare cost. They reorganize primary care practice by recognizing the importance of patient’s experience and works on system based approach to transform health services being offered. PCMH centers their service on elderly with acute care needs, patients with physical disabilities and with specific preferences in terms of culture and values.

The care offered is comprehensive and designed to meet patients’ needs including physical and mental attention, chronic care and long term assistance like help in performing daily ablutions for patients with functional limitations. [8]

• Accountable Care Organizations

ACOs have been set up with the goal of ensuring high quality of care is given to patients at the right time to prevent medical errors and reduce medical costs. Mostly ACOs are formed by group of doctors and hospitals who voluntarily come together to serve Medicare patients. [9]

The basic promise that ACOs hold is to have patient centered care and treat patients with empathy, care and work towards avoiding unnecessary costs and develop a personal relationship with patients. Thus, government should incentivize formation of more ACOs to ensure more patient- centric approach.

• Strategic IT investment

IT is the obvious answer to increase efficiency, reduce medical errors and improve quality of care in US. Though there are many facets of IT that can be used, use of Electronic Health Records (EHR) and Electronic Medical records (EMR) are the most important tools to use.

EMRs are digitized version of patient record keeping for a physicians. EMR has been instrumental in reducing medical costs overtime by enabling better interactions between departments and monitoring patient’s visiting time and medical information. Patients can also log on and know about their health records and be better prepared.

EHRs stores patient’s records so that if needed emergency departments can access it before giving them any medicines. This saves the cost of duplicate tests because all the data needed to prescribe medicines are present in EHRs.

• Feedback and review model: Patient Opinion

Patient opinion was founded in 2005 and is the leading feedback platform for healthcare in UK. They allow patients to write their reviews/ stories about their experience and tag the particular provider. Other users can then favorite the post if they have experience the same thing. Patient Opinion also has an analytical engine which does sentiment analysis for each hospital and show what areas need improvement and which departments received positive reviews.

The hospitals can read these reviews posted about them and respond to the complaints and praises. This helps them to improve their quality of care and address the issues raised by patients.

Patient Opinion is a social enterprise and a NGO which is independent of NHS but share the same values. It is funded through user subscriptions, healthcare providers and healthcare Commission. Providers subscribing to Patient Opinion get the access to all patient feeds and can respond to the reviews. Though, use of patient opinion by patients is free. Patient Opinion is available across England but not (yet) the rest of the UK. It covers all acute trusts. As of today, 600 hospitals are registered with patient opinion and working together to improve the healthcare quality in UK. [5]

6. How Patient Opinion fits the review model:

It allows patients to give feedback on their health services and to see what others are talking about. It also acts as a platform to hear and respond to reviews and complaints posted by patients. They can compare their ratings with other hospitals and find out which of their departments are doing good and bad. All the opinions are reviewed before publication and editorial policies are public. The critical reviews are marked and directed to the healthcare providers while maintaining patient identity.

Below are some feedback posted by patients for “King’s Mill Hospital” over a period of 2 weeks:

Post num	Reporting Date	Story	Response Date	Response from King’s Mill Hospital
Title	Post
1	5/1/2014	Occupational Therapist on Ward 53 Excellent	Whilst my father spent four weeks on Ward 53 recently the OT, one therapist was a shining light during this experience. She provided both practical and professional advice whilst finding out relevant information for the family. She showed genuine concern which was much appreciated.	Not available yet	Not available yet
2	4/30/2014	Poorly managed care services.	Went in for an injection to the eye for MD. And had to wait 4 hours for them to fetch the needle form the pharmacy. They dont talk to each other. Complete waste of time	Not available yet	Not available yet
3	4/25/2014	Feedback	My Uncle was first admitted to The Royal, Chesterfield 9 March 2014 with broken hip. Doctor stated was happy to release him to rehab, from this day he has been either sat in a chair or in bed getting weaker in mind and body he is 96 year old. The only light in his dreary life was being moved to Kings Mill Hospital 15 April, ward 41, not so nice when he was put straight into an isolation room. Today as I write this I have just tried to talk to social services and PALS but no one is there to answer the phone, my Uncle has at last been told he will be going home with a care package. He is so weak in mind and body what ever time remains for him has been spoilt by red tape and stupidity that has kept him in this situation. He remains in an isolation room, yesterday 24 April the scheduled 3pm observation visit just didn’t happen, we left at 4.15 and realised he was being ignored, it seems he is being treated like a leper instead of the 96 year old who has worked all his life and has this nightmare to live through as payment. We are disgusted at the way he has been treated during the last 7 weeks.	4/28/2014	Thank you for your comments. We have spoken to PALS who have advised they may have spoken to you late last week. If you still require the teams assistance please contact them again on 01623 672222 and they will be happy to assist further.
4	4/21/2014	Emergency care – suspected DVT	I was seen within 15 minutes of arrival and appropriate tests were made. Happily no irregularities were discovered. I was so grateful for the attention: staff were professional and caring and the whole process was carried out efficiently and successfully. Particular thanks and congratulations to the team in the DVT clinic who were so positive and caring. Particularly PAM who I saw several times. What a good team! Well done the NHS!	4/24/2014	Thank you for your comments which have been circulated to the Accident and Emergency department leader to share with his team and with our DVT nurse.
5	4/22/2014	Urology Dept. Prostate Cancer treatment	I was seen very promptly after being referred to the dept. in King’s Mill and waiting times were very acceptable. The support staff – clerical and scanning – were helpful and courteous. Particular thanks go to the Specalist nurses who were so sympathetic and helpful both to me and my wife: they were available at the end of the ‘phone at all times during the day for those occasions when I needed support and advice. The overall experience was outstandingly good. Congratulations to all concerned.	4/24/2014	Thank you for taking the time to post your comments. We will ensure that the Urology team are made aware of your feedback.

Taking “King’s Mill Hospital” as our example for this study, let us look at some figures which help us better understand the Patient Opinion model:

*Data collected is for the month of April:

Total number of posts in April	30
Total number of positive posts	20
Total number of negative posts	10

Analysis:

Analysis:

Total number of posts in April	30
No. of posts which has reply from the Kin’s Mill staff	26

As of now, for the entire Patient Opinion database, feedback opinion so far is around 50% positive, 30% mixed and around 20% critical.

Below is data of number of posts till date:

Number of stories told	81,307
Staff responded and implemented change	2584

In the last month, of all the posts, 53% had a response from hospital staff and 6% of responses actually lead to change. The numbers do look small but in the larger picture, it is an incremental change which slowly is changing the face of UK healthcare.

7. Conclusion:

Patient centric healthcare is the answer to the problems of rising cost and low quality of healthcare in USA. A patient centered communication gives more satisfaction to patients and increase their faith on the physician and treatment. Emotional health is better when patients feel that they have a personal equation with their physicians and their preferences, culture and values are being considered while treatment.

It is very important to increase emphasis on physician’s empathy towards patients and introduce feedback model to increase efficiency of hospitals. Patient Opinion is bringing change into the healthcare scenario of UK by making patient reviews an important tool of decision making. Hospitals are responding to these reviews, trying to make amends and improve the quality of care. Currently, healthcare of USA is financially driven and patients are not treated as a valued customer. In future, if we want the healthcare cost to go down and expect better service, it is very important to bring the focus on patients and build the system around them.

References:

[1] Jo Anne L. Earp, Elizabeth A. French, & Melissa B. Gilkey: Patient Advocacy for Health Care Quality

[2] Bechtel, Christine.“If You Build it, Will They Come? Designing Truly Patient-Centered Health Care”.Health Affairs

[3] http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/

[4] Moira Stewart, Judith Belle Brown, Allan Donner, Ian R. McWhinney, Julian Oates, Wayne W. Weston, John Jordan, The Impact of Patient-Centered Care on Outcomes

[5] https://www.patientopinion.org.uk/info/about

[6] Improving Patient Opinion Mining through Multi-step Classification, Lei Xia, Anna Lisa Gentile, James Munro, José Iria

[7] http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx

[8] Ensuring That Patient-Centered Medical Homes Effectively Serve Patients With Complex Health Needs, AHRQ

[9] http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/

[10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC64755/