For decades, hospitals have tried to stop designing their work to suit the needs of their staffs more than the needs of their patients. Yet patient-centered care remains a challenge. One example: some hospitals require loved ones to leave when visiting hours are over, even if a patient requests that visitors stay and would benefit from their support, comfort, and advocacy.
At Decatur Memorial Hospital in central Illinois, Larry Holder, MD, medical director of hospitalist services and chief medical information officer, set out to find new ways to shift his hospital’s operations away from focusing on staff needs and onto patients.
Ending a staff-centered history
“Classically, medicine is very paternalistic—we know best—and that’s how it’s been practiced, especially on the hospital side. We don’t see patients being involved in their own care and decision-making,” says Holder, an internist. “I wanted to have a patient-centered hospital.”
After attending a 2011 nurse and physician leadership conference, Holder became convinced that 300-bed Decatur Memorial needed to implement wide-ranging changes. The facility already was well-versed in Six Sigma management, so Holder proposed using that framework to implement key changes.
He pulled together a multidisciplinary team—including physicians, nurses, administrators, case managers, patient representatives, and clergy—to develop “quick win” projects. The team’s vision was anchored on a quote from Donald Berwick, recent administrator of the federal Center for Medicare and Medicaid Services (CMS): “Patient-centeredness is the property of care that welcomes me to assert my humanity and my individuality.”
Open visiting and patient-family rounding
With that sentiment in mind, Decatur Memorial did away with visiting hours, allowing family members and friends to stay with patients whenever they desired. Rounding on the medical floor became another target. Traditionally, staff gathers to discuss the case before entering the patient’s room. In the patient-centered model, the team started in the hospital room to immediately bring the patient and loved ones into the discussion. This way, patients have the same information as the care team; they can ask more questions, make their desires known, and get involved in making decisions about treatment.
“It’s been quite successful,” says Holder. “The families enjoy it, and it’s been a benefit to the staff and the hospitalists. Rounding might take a little bit longer, but people get their questions answered.”
Not only are patients and staff more satisfied with their care and work environment, Holder believes this system will ultimately cut costs by significantly reducing patients’ hospital stays and readmissions. Patients who are more involved in decision-making about their care will likely follow doctor’s recommendations more readily, thus healing faster. In addition, they will feel empowered and motivated to consistently keep up with after-care that helps them avoid relapse or re-injury.
White boards and blood draws
Decatur Memorial has made numerous other patient-centered changes. New white boards in all rooms improve communication, offering space to write down caregivers’ names, treatment plans for the day, and questions. The hospital also switched blood draws from 4 a.m. to 8 p.m. Results are ready for morning rounds, and patients get a better night’s sleep.
Implementing the patient-centered model is a work in progress—and positive results are still anecdotal —but it’s one that Decatur will continue to pursue. Holder aims to add more patient representatives to various committees, extend pilot projects to other floors, and give patients access to their electronic medical records.
Though it’s hard work changing ingrained professional and institutional traditions, Holder champions the shift to patient-centered operations because it will improve care in the long run. “It’s a big culture change, getting people to think away from staff-centered to patient-centered care. Some people don’t like change and they are scared of change,” he adds. “But for me, it’s the right thing to do to put the patient at the center of their care.”