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Speak Up! Addressing the Paradox Plaguing Patient-Centered CareSpeak Up! Addressing the Paradox Plaguing Patient-Centered Care

Kathleen M. Mazor, EdD; Kelly M. Smith, PhD; Kimberly A. Fisher, MD; and Thomas H. Gallagher, MD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 9 February 2016.

From Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington.

Grant Support: By the Agency for Healthcare Research and Quality (grant 4R18HS022757-03).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2416.

Requests for Single Reprints: Kathleen M. Mazor, EdD, Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605; e-mail, Kathy.Mazor@meyersprimary.org.

Current Author Addresses: Dr. Mazor: Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.

Dr. Smith: MedStar Health Quality & Safety, 5565 Sterrett Place, Suite 210, Columbia, MD 21044.

Dr. Fisher: University of Massachusetts Medical Center, University Campus, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Gallagher: University of Washington, 1959 Northeast Pacific Street, Suite BB-1240, Box 356526, Seattle, WA 98195-6526.

Author Contributions: Conception and design: K.M. Mazor, K.M. Smith, T.H. Gallagher.

Analysis and interpretation of the data: K.M. Smith, T.H. Gallagher.

Drafting of the article: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.

Critical revision of the article for important intellectual content: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.

Final approval of the article: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.

Obtaining of funding: K.M. Mazor, K.M. Smith.

Administrative, technical, or logistic support: K.M. Mazor, K.M. Smith, T.H. Gallagher.

Ann Intern Med. 2016;164(9):618-619. doi:10.7326/M15-2416
© 2016 American College of Physicians
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Although most health care systems encourage patients to provide feedback about the care they receiv, few choose to do so. This article proposes several strategies for encouraging patients to speak up and why it may be beneficial for health care systems to respond to these issues in a timely manner.

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Submit a Comment/Letter
Follow the Dollars
Posted on May 7, 2016
Albert Fuchs, MD
Private Practice, Beverly Hills, CA
Conflict of Interest: None Declared
It's difficult to foresee how care will become patient-centered as long as it is not patient funded. Health care organizations work for third party payers and then jump through administrative hoops to try to appear that they work for patients. If all but catastrophic and indigent care was paid by patients, care would immediately become patient-centered, and patients would finally be treated as customers. Prices would also plummet, which is why the vast majority of doctors and hospitals would oppose this.

Until then, we'll just continue to read more articles about why the latest attempt at patient-centered care seems to be failing.
Speak Out! Caring for our patients is what we do
Posted on June 18, 2016
Lauren Meade, Jennifer Grover, and Mark Rudolph
Sound Physicians, Tacoma WA, Tufts University Medical School
Conflict of Interest: None Declared
We read this with some surprise as our healthcare delivery system has been profoundly altered by the impact of the patient and family experience focus. Mazor and colleagues (1) describe two paradoxes in addressing patient-centered care: 1. Health care has put the burden on patients to voice their concerns and 2. Most health care institutions cannot respond in real-time if patients express concerns.

We report two interventions in our large physician practice that defy the paradoxes described by Mazor and colleagues: 1. Observation and coaching and 2. Bedside patient feedback (BPF). We train all providers, over 2500 physicians and advanced practice providers, using a customized communication skills curriculum based on the AIDET fundamentals of communication. Providers are then observed annually by other care team members who act as coaches after receiving training on observing and giving effective feedback.. The observer asks permission from the patient to witness the encounter and explains that the providers are eager to improve their communication skills. The patient receives this intervention without a burden to report. In a second intervention, one of our Hospitalist RNs (“HRN”; a process improvement focused role) collects and shares with the provider BPF from admitted patients. HRNs ask questions through a conversation and open sharing with patients as they work to establish a relationship of safety. Like observation and coaching, BPF offers providers individual feedback that recognizes and reinforces positive behaviors and highlights opportunities for improvement. HRNs also facilitate just-in-time interventions based on the feedback. A sampling of intervention categories includes: Care Coordination (i.e. Plan of Care), Pain Management, Patient Assistance (Physical, Emotional, Environmental), Patient/Family Concerns and Service Recovery, and Patient/Family Education.

In 2015, our practice completed 41,292 BPF assessments nationwide and facilitated 13,957 just-in-time interventions. We have the opportunity and obligation to implement innovative strategies that provide ‘true patient-center care’ that does not require the patient to ‘speak up’, but rather empowers our healthcare system to create an environment in which patients do not ‘suffer in silence’ as put forth by Mazor and colleagues. The expert provider of our time solicits feedback on a regular basis for self-discovery so that we can truly ‘care’ for our patients and families in the communities we serve.

1. Mazor KM, Smith KM, Fisher KA, Gallagher TH. Speak Up! Addressing the Paradox Plaguing Patient-Centered Care. Ann Intern Med. 2016;164:618-619. doi:10.7326/M15-2416
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