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Making Human Understanding tangible in healthcare

In collaboration with Greg Makoul, NRC Health, posted at beckershospitalreview.com.

When you hear someone say they love their physician, what do they give as the reason for it? I asked this question to a hybrid audience at the 27th Annual NRC Health Symposium in August. Here are the responses we heard:

“They communicate.”

“I trust them.”

“They spend time with me.”

“They care about me.”

“They listen.”

“They’re available when I need them.”

“They know me.”

“They know why I’m there.”

What these responses make clear — and what emerges each time I’ve asked this question over the years — is that people see relationships as the key to great care experiences. The responses also break down the false dichotomy in the question, “Would you rather have a physician who is a great clinician or a great communicator?” People want the whole package. This is the essence of human understanding in healthcare: Turning transactions into relationships improves the experience and delivery of care for both patients and members of the care team.

So how do you build healing relationships in your everyday clinical practice? It starts with acknowledging that the vast majority of a patient’s life happens outside of the care setting. Even a patient who has a 15-minute physician visit every week of the year spends 99.8 percent of her waking hours doing something else. So it’s vital to understand how that patient’s life affects, and is effected by, her health. “Meetings between experts” is a good way to think about productive relationships in healthcare, where clinicians are experts on clinical care and patients are experts on their lives. Care works best when each participant respects the other’s expertise.

Incorporating contextual information to inform care requires focusing our attention on patients as unique people, learning what matters to them and hearing their stories. Through no fault of their own, most clinicians don’t have the time — whether in the office, at the hospital, via telehealth, or during home visits — to get a clear view of what matters to each patient at that moment. The challenge is to reconcile what patients want and need with the time providers can realistically devote to each patient. How can health organizations make human understanding tangible?

Matching Care to the Context of Patients’ Lives

We know that patients want to feel seen, heard and respected as the unique people they are. In order for clinicians to deliver on these expectations, they have to first understand what matters most to their patients. In this connection, innovative digital tools like NRC Health’s Stories can be hugely beneficial to help patients share, help care teams listen and help organizations learn. Driven by communication science, Stories makes it safe and easy for patients to provide essential perspectives ahead of their clinical encounters. An inSIGHT summary is then shared with clinicians via the EHR, which helps improve each patient interaction. In just 15 seconds, clinicians are able to gain a deeper understanding of what matters to their patients as people, enabling them to personalize care at the n=1 level and do an even better job without taking longer. At the population level, leaders can see reports that are curated to drive learning and improvement.

I think of this as radical common sense: We can do a better job of meeting a patient’s needs if we know what those needs are. Broadly, this approach increases patient engagement, optimizes care and improves the overall care experience, leading to better relationships and increased patient and provider loyalty. More specifically, focusing on what matters most to patients—things like their agenda, their goals, their barriers, their pressures, their worries and how their health affects their lives — helps care teams:

  • Combat implicit bias by tailoring care to the person, rather than guessing what “people like them” think or need
  • Build trust by making personal connections, acknowledging preferences and addressing issues
  • Meet expectations ahead of time, instead of playing catchup after the encounter
  • Provide support to help the patient meet the challenges they face
  • Rediscover purpose and joy in practice by connecting with their patients

Improving Outcomes

In our first implementation five years ago, 95 percent of patients using Stories reported that their visit went “extremely well,” up from 81 percent of visits pre-implementation. And that’s just the tip of the iceberg. A recently published randomized controlled trial showed double-digit gains in patient perceptions that their provider “treated me with respect” (+13 percentage points; p = 0.04), “showed interest in my ideas” (+14 percentage points; p = 0.03), “showed care and concern” (+16 percentage points; p = 0.02), and “spent about the right amount of time with me” (+11 percentage points; p = 0.05).

Even providers who have many years of experience with their patients report that Stories is transforming care: 82 percent confirmed that the inSIGHT summary helps them know what’s most important to their patients, and 72 percent noted that the tool adds no time at all to the patient visit. As one physician leader at a major health system put it: “This is the most revolutionary thing we’ve done since implementing the EHR.”

The successful implementation of Stories reinforces the power of capturing patient-generated contextual data ahead of clinical encounters and making it easy for care teams to use it, in the moment and at the point of care. Armed with this data, patients and providers are building stronger connections and better care on the foundation of human understanding, and transforming healthcare in the real world.