We believe that it is possible to achieve the goal of patient-centeredness in the US health care system through efforts at the systemic, organizational, and individual levels.

Surgery_bestsurgicalthinking

Scientific American™ Surgery: Best Surgical Thinking

 

One of the most common tools that hospitals and other institutions have been using to measure patients’ experience of their health care is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey produced by the Agency for Healthcare Research and Quality (AHRQ). In 2011, the American College of Surgeons and other specialty societies partnered with the AHRQ to expand on this to create the CAHPS Surgical Care Survey by including items relevant to surgical care, including informed consent, anesthesia care, and follow-up after surgery. It contains questions such as Did the surgeon discuss nonsurgical options with you, and was your procedure explained to you with the help of pictures and diagrams? and Did you meet with the anesthesiologist before surgery, and were you physically comfortable/was your pain well controlled during your stay? On a more patient level, Aboumatar and Pronovost proposed a three-question framework for patients to evaluate the patient-centeredness of care provided.1 The questions are as follows: (1) Are my needs being met in the hospital? (2) Am I involved in my hospital care? and (3) Am I prepared to care for my condition at home?

We believe that it is possible to achieve the goal of patient-centeredness in the US health care system through efforts at the systemic, organizational, and individual levels. At the systemic level, hospitals and providers should be incentivized for providing patient-centered care through accreditation and reimbursement. At the organizational level, providers should train employees in cultural sensitivity and ensure that their policies and structures foster and reward a culture of patient-centered care. Finally, we should remember that without the patient, there is no patient-centered care. Patients, their families, and patient advocacy groups should be involved in institutional decision-making processes. There are many such examples where hospitals and programs have significantly improved by creating and listening to patient and family advisory councils. And at the individual level, we do not need to wait for official mandates; we can begin by taking the extra time to involve the patient’s family or draw a diagram to ensure that our patients know what their surgery entails and what to expect after the operating room. In fact, our patient’s idea of conducting rounds in the patient’s room is probably the perfect and easiest way for us to begin providing patient-centered care, and we can start doing this today.


 

Dr. Haider is the principal investigator of the Equality Study, which aims to develop a patient-centered method to ascertain a patient’s sexual orientation or gender in the emergency department and is funded by the Patient-Centered Outcomes Research Institute (PCORI). He is also cofounder of Patient Doctor Technologies, which operates the patient engagement Web site and mobile app Doctella. Use of Doctella is free for patients.

 


 

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Written by Adil H Haider, MD, MPH, FACS & Muhammad Ali Chaudhary, MBBS

Center for Surgery and Public Health, A Joint Initiative of Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA