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Patient Involvement in Their Care

October 26, 2010

Anna Roth, Chief Executive Officer for the Contra Costa Regional Medical Center and a Lean Healthcare advocate, wrote a provocative piece titled “The Perfect Storm” for the National Association of Public Hospitals and Health Systems blog, “The Safety Net.” [i] Under her leadership, CCRMC has been actively including patients in their discussions about the systems of care they are defining. I was particularly intrigued about their Behavioral Health Kaizen and the inclusion of community members and clients in the event. [ii]

Chugachmiut is currently reviewing the prospect of bringing a Community Health Center (CHC) to one of our communities. Our purpose would be to help provide care for our underserved population. In Alaska, our primary care providers are increasingly turning away patients on Medicare. The Anchorage Daily News published an article describing the efforts of one elderly patient to find a physician willing to take Medicare. [iii] This patient called 63 clinics before finding one who it sounds like, took pity on her, and accepted her as a patient. A CHC can help reverse this trend.

In my healthcare career, I have listened to many patients talk about the care they receive. Sometimes it is downright hostile. Comments made to 2 female patients I spoke to so turned them off to continuing care that they suffered for it. In another case, the patient described how her surgeon was talking on his cell phone in the surgical suite, then proceeded to operate on the wrong part of her arm. I listened to a story about another patient who refused to go to the bathroom because she wasn’t provided with an escort of the same sex. They spoke to me or those they knew who had access to the provider’s representatives because they had no other way to communicate their dissatisfaction. In contrast, read this post by a mother whose son was harmed by a poor system after her involvement in a Kaizen assembled to address the problems that contributed to her son’s harm. [iv] Here is part of her comment:

“Anna is right; the system has harmed my son and my family. Prior to my first Kaizen experience, last July, I would have justified blaming anybody that works in the system for that harm. Not anymore. I know better now. I now know that nobody comes to work to harm my son or my family. I have also learned that you can’t change what you can’t see and how blind one can be to the obvious. These lessons are teaching me to be less angry at the system that has harmed my family. That first Kaizen created our “Vision of Hope.”

Patients deserve care, and they deserve the right to participate in how that care system is designed to respond to their needs. As we look at the underserved population, they don’t even have the privilege of being treated poorly, much less participate in the design of their care. They suffer because of their lack of access to providers, even when they have the ability to pay (albeit at Medicare rates). Toyota’s twin pillars of Continuous Improvement and Respect for People is the foundation for building an organization that cares enough to involve the Patient in constructing the system that delivers their health care.


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