Healthcare is all about the patient. Our patients are the reason we come to work each day. They compel us to do more, to do better, to make a difference. Only we’re beginning to realize that we’ve been getting it wrong.
The call to move away from a paternalistic approach to healthcare and toward a partnership model came in 2001 when the IOM called upon clinicians to engage patients and families by “ensuring patient preferences, needs, and values guide all clinical decisions”. No one would disagree that this is a much-needed change and the right thing to do.
Despite the national focus on replacing the paternalistic approach to patient care with a partnership approach and widening the lens to look beyond clinical outcomes to the broader experience of receiving care, we still find that we’re getting it wrong much of the time. Patients feel like cogs in a wheel, disempowered, dissatisfied, dehumanized. It turns out that many healthcare practitioners who entered the field and expected to derive a sense of fulfillment from their work feel much the same way. In a 2016 survey conducted by the Physicians Foundation, 54% of physicians indicated negative morale and are choosing to get out of patient care all together, while a 2017 Career Builder survey found that 70% of nurses are feeling symptoms of burnout. One has to ask: where are we missing the mark?
Healthcare is a unique environment because it exposes the vulnerability of patients and families and at the same time asks the professionals working in that environment to cover up their vulnerability. And yet, in the “environment of care” our experiences as human beings are interconnected. The experience of healthcare professionals directly impacts the patient experience. Frontline staff manage heavy patient care loads, have their decision-making power reduced by restrictive organizational policies, and feel powerless to address the source of patient and family complaints.
The ultimate goal of providing safe, high-quality care and the experience our patients and families deserve is dependent upon our willingness to address the needs and challenges of those who deliver the care. Thankfully, in recognition of the fact that healthcare is an interplay of human relationships and interactions, the broader definition of “patient experience” is evolving to include staff & provider engagement.
Despite this evolved approach to examine the human experience of healthcare, we still view professionals and patients as standing on opposite sides of the fence. We assume that because they’re viewing the experience through different lenses, providers and patients won’t agree on where we have opportunities to improve. Patients don’t understand the payer and regulatory challenges associated with delivering care and providers don’t understand what it’s like to be regarded as a patient, rather than a person. So how can organizations effectively address experience challenges for the people delivering the care and the people receiving it?
Experience-Based Co-Design (EBCD) is a partnership-based improvement model that connects patients and staff with the emotions associated with their experience through storytelling. Working with emotions is key because it clearly illustrates the need for change and motivates staff to make and sustain meaningful improvements. EBCD creates space for the shared vulnerability of patients, families and staff, illustrating the benefit of true partnership in a very tangible way.
Unlike other models of patient-family partnership, EBCD engages patients and families throughout entire continuum, from identifying opportunities for improvement, to developing, testing and implementing solutions. In this way, it goes much farther toward breaking down the barriers and adversarial relationships that hinder partnership.
The process initially separates staff and patients/families into two groups to enable them to speak freely and honestly about their experiences working in and receiving care in a specific clinical area. Each group identifies priority areas for improvement based on emotional “pain points”. Then the staff and patient/family groups come together to agree on shared priorities and to form co-design groups that will design improvement projects for these priority areas.
In the EBCD projects I’ve facilitated, the process has clearly illustrated that the experience of healthcare staff is intertwined in the patient experience, and that in fact, many of the same conditions that patients identify as detrimental to receiving care are also identified by staff as challenges to delivering care. By working together in this way, staff and community members break down the barriers inherent in the “provider” and “patient” roles and can more clearly see how their perspectives overlap in many ways.
EBCD transforms shared vulnerability into collective strength to make positive change. Now that’s empowering.