Strategies to Develop Patient Centred Care

Strategies to Develop Patient Centred Care Sneha Praveen MIS Practicum Final Report Analysis of online patient reviews and its effect on healthcare providers 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 â€Å"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 â€Å"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. 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. 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 â€Å"what’s the matter† with our patients to â€Å"what matters† to our patients. [1] 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. 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] 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 â€Å"King’s Mill Hospital† over a period of 2 weeks: Taking â€Å"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: Analysis: Analysis: 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: 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. 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, Josà © 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/

B.tech Essay

Unemployment means lack of work for those persons who are willing to work. There are two categories of unemployed persons-uneducated persons and educated persons. Unemployment among the educated people is increasing. Besides, unemployment, there is under employment also. Under employment means insufficient employment. For example, a farmer is under employed because he does not have work for the whole year. Unemployment is one of the major problems of the Indian economy. We know India is an underdeveloped economy and therefore the nature of unemployment here differs from the one that prevails in a developed economy. In India there is chronic under-employment or disguised unemployment in the rural sector and unemployment among the educated classes in the urban areas. The main cause of unemployment among the educated lot is the slow rate growth of the economy in relation to increase in the number of educated persons. Several factors are responsible for the problem of unemployment. Our defective system of education which lays too much emphasis on literary training is perhaps the main cause of unemployment. Our government’s faculty planning is also responsible of this problem to a great extent. It fails to create suitable job opportunities for all. Population explosion is a big reason to bring this problem into existence. Population of our country is increasing at fast rate but job opportunities are not increasing accordingly. Engineering and Medical profession have a great attraction for many. But even those professions do not present a very bright picture. First of all it is very difficult to get admission in a Medical or an Engineering College. The education in professional colleges is so expensive that only the rich can afford it. Thus young men and women are facing very tough time. Sometimes it has been seen that they choose a career for which they possess neither the capability nor the attitude. This is the root cause of many young men’s failure in life. It is therefore necessary to provide young men and women with educational as well as vocational guidance. This will help them choose a profession in accordance with their capability and aptitude. Our government has taken several important measures to solve this growing problem. With a view to increase employment government has made sincere efforts to adopt and encourage labour intensive investment and production programmes. In this connection attention was paid on agriculture, agro-based industries, and cottage industries. Since 1976 a weekly Journal-â€Å"Employment  News† is being published both in English and Hindi. Education is also being planned in such a way that educated youths should be free from employment problem. Vocational education with the needs and requirements of the country is being arranged. A new education policy, 1986 has been launched. With the primary objective of generating additional employment, especially in backward regions and weaker sections, a nu mber of employment programmes have been started by the Govt, of India. These are IROP, The Desert Development Programme, tne National Rural Employment Programme, The Rural Landless Employment Guarantee Programme, the National Scheme of Training of Rural Youth for Self Employment increase in employment has been one of the major objectives in all Five-year Plans of India. Technical and Vocational education is being given in schools. Family planning is encouraged among the young men and women to control population. Different technical and professional colleges are being established in every state. This is a good sign that government is trying its best to uproot this problem.

Sociological Imagination s Critical Review - 1319 Words

The Sociological Imagination Critical Review Essay â€Å"The sociological imagination enables us to grasp history and biography and the relations between the two within society. This is its task and its promise.† C. Wright Mills writes about the sociological imagination in an attempt to have society become aware of the relationship between one’s personal experience in comparison to the wider society. By employing the sociological imagination into the real world, individuals are forced to perceive, from a neutral position, social structures that, in turn, influence behavior, attitudes, and culture. Mills just wants the world to be able to see the connection between the individual and society. Everything is influenced by an outside force.†¦show more content†¦He claimed that sociological research has come to be guided more by the requirements of administrative concerns rather than by intellectual concerns. According to Mills’ mentality, one has to tr uly fulfill the promise that social science requires people to focus upon practical problems, and to relate these kinds of problems to historical features of the sociocultural system. Mills continues on in his book, expressing ideas that he finds troubling in professional sociology. In his opinion, the sociological world should retreat back to the classical roots from which it has derived. According to Mills, society as a whole has failed to carry out the work in which he believes in. First and foremost, Mills addresses what he calls â€Å"grand theory.† Grand theory is what he uses to try and explain all social structures in all societies. This, in turn, provides general descriptions of all social interactions and he refers to this as a concept. Mills associates this theory with Talcott Parson. Parson was a very important American sociologist, if not one of the most important. He thought there was one big social system and all of society operates the same way. Mills continued on to say that Parson’s work is too general and dense, as he makes big theories about human nature, as well as, the shape of all societies. When writing about grand theory, Mills states â€Å"when people share the same values, they tend to behave in accordance with the way they expect one another toShow MoreRelatedSociological Imagination And Its Impact On Society Essay1204 Words   |  5 PagesIntroduction The sociological imagination is the point at which an individual perspectives his general public as the potential reason for his day-by-day triumphs and disappointments. People regularly tend to see their own issues as social issues and attempt to interface their individual encounters with the workings of society. The sociological creative ability tries to think of foundations for certain social patterns and gives a structure to fathoming the social world. 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The Adventures Of Huckleberry Finn s Life And The Book

Tom Sawyer plays a huge role in both Huckleberry Finn’s life and the book. His character allows the reader to see Huck’s increase of maturity throughout the story. Tom is the constant, his immaturity not changing from the beginning to the end of Adventures of Huckleberry Finn, while Huck is the changing variable. Tom’s head is in the clouds when we first meet his character. He imagines daring adventures of robbing Spanish merchants and rich Arabs, and we see Huck fantasizing over the same things as if they are reality. Tom’s justifies their actions constantly by saying â€Å"I’ve seen it in books; and so of course that’s what we’ve got to do,† (12). With Tom, everything has to be an adventure. Everything has to be a challenge to†¦show more content†¦Without him, we may not have seen Huck’s great character development throughout the story. Adventures of Huckleberry Finn takes place in Antebellum South. War has not come yet, but people have already begun to choose sides. Huckleberry Finn, still an innocent young boy, navigates his way throughout this turbulent time period. Because he, himself, is treated like a slave by his own father, Huck is able to sympathize with the slaves. He thinks of Jim as a friend, not his property. Huck is the protagonist of the story for this reason, representing the North in the civil war that would begin not long after the story ends. Huck’s encounters with various Southern men, women, and families all represent the South in the war, but it is Tom’s uncle, Silas Phelps, that represents the South the most. Physically locking Jim up with chains, Phelps shows the brutality towards the slaves and how they are treated as property in the South. Huck and Tom fight against his uncle by helping Jim escape, just as the North does for slaves in the South at the time. Mark Twain’s writing style contributes greatly to the book. If we weren’t hearing from Huckleberry Finn himself, the story would be completely different. Twain uses accents, slang words, and spelling mistakes to truly portray Huck as a real person. Because of this, people can relate to Twain’s characters in a way