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Accountable Care: What's Your Part?

By Dr. David C. Pate, News and Community
March 27, 2012

All St. Luke’s employees, physicians, and patients, and family members and others who participate in the care of St. Luke’s patients, have a role to play as we continue our transformation and work to deliver accountable care.

 Here are the top five things you can do:

 Promote Patient and Caregiver Satisfaction

  • Employees can demonstrate their caring.
This is what we are known for and this is our culture, one of caring for patients and their families. Do something to delight a patient or their family every day. It is the little things that make such a difference. 

When I was at the hospital with my daughter two days after my outpatient knee surgery, the nurses brought in a reclining chair so that I could elevate my leg. They also offered me a bag of ice for my knee. 

But I was particularly moved by the genuine caring and compassion that I noticed when all the staff – nurses, nursing assistants, resident physicians, chaplains, lab techs, etc. – interacted with my daughter. It was the smiles on their faces, the hand-holding, the things that let patients and their families know that we truly care. 

Not all employees are bedside caregivers. Those who are not still make a difference. I remember the friendly faces of the people in registration, in the cafeteria, the volunteers in the gift shop, the security guard, and many others every bit as much as I remember my care team.

We are depending on all of you to learn AIDET and how to manage up, and to put these habits into daily practice. They work!

  • Physicians can be truly present.
We know how busy you are, but when you enter a room and sit down with a patient and family, it sends the message that you are truly there in the moment, and that patient is the only thing on your mind. 

Take time to explain things and remember that many patients and families are too shy or respectful of your time to ask you all their questions. Encourage them to ask you questions. Make sure that you answer their questions without using a lot of medical jargon. 

And AIDET and managing up are for you, too. I have seen this in action as a family member and as a patient, and it instills great confidence when another physician is consulted or is covering for you.

  • Patients and caregivers can share their concerns. 
Help us help you and make you more comfortable. Ask if you don’t understand something. It is often helpful to write down questions so that you will remember them when the physician is with you. 

If there is something that is on your mind but you are uncomfortable asking the physician, ask your nurse, or ask your nurse to be present when you talk to the physician. And give us your ideas for how we can improve. You have a unique and very valuable perspective that we need to hear! 

 Improve Patient Safety

  • Employees play a critical role in keeping our patients safe. 
Always speak up any time you see a potential safety threat. You may prevent an error or avoidable harm. 

Make sure patients are educated regarding fall risks, medication risks, and infection risks.  Make sure that you are following our hand-washing protocols. And make sure that you prevent exposure to patients by keeping up on your own health and preventative measures. Make sure that you get your flu shot every year!

  • Physicians are welcome to speak up if they have a concern or see the potential for an error, and can encourage others on the team to do the same. 
Give staff permission to question anything that doesn’t seem quite right. Set the example for hand-washing. You might be surprised to know how many staff members don’t think hand-washing is important when they see that a physician isn’t following the proper protocols. 

And take time to explain medications to patients and caregivers, so that they will know what to expect or what signs should be a concern.

  • Patients and caregivers can ask questions, lots of questions. 
 If you don’t see someone wash their hands, ask them to do so before they touch you. 

Ask questions about treatments and medications, and anything else that concerns you. You are a partner in your own care, and having you be well-informed will increase the likelihood of the best possible outcome. 

Take an Active Role in Your Own Health

  • Employees and physicians can be role models for healthy behaviors. 
Patients are less likely to be persuaded to take an active role in promoting their own health when members of their care team appear not to. If you need help, contact one of our health coaches in the Healthy U program. Share your tips and successes for how you incorporate a healthy lifestyle into your own hectic schedule with patients, who may then be willing to do the same.
  • Patients can ask for help. 
Think of something as a goal, something that would motivate you to improve your health and live longer, or an activity that you would like to be able to do. Set realistic goals that start small but daily, and start to build healthy habits. 

Maybe you are just going to commit to walking or riding your bike for 10 minutes a day. Maybe you are going to make healthier food choices and are going to start by drinking more water and eliminating carbonated soft drinks and alcohol, or high-calorie desserts.  

Regardless, set small, attainable goals (you can adjust them as you progress) and have an accountability partner. Tell your physician what your goals are, and ask for help and suggestions.

  • Caregivers can support patients in their new behaviors.
Be his or her accountability partner.  Help reduce opportunities that will sabotage efforts, and look for opportunities to help.  Ensure that you are taking care of yourself, as well as providing support to the patient.

Promote Prevention and Health Screenings

  • Employees, physicians, and caregivers can set the example.
Undergo regular health evaluations to ensure that you receive all the recommended preventative care and health screenings. Help remind patients regarding recommended preventative care and health screenings. 

And don’t forget your own families. Remember, you can’t be there for patients unless you are taking care of yourself.

  • Patients can speak up.
Make sure that you talk to your physician to make sure you understand all the preventative measures and health screenings that are indicated for you. One of the best things you can do is the thing you do to prevent a costly disease or injury in the first place, or alternatively, detect it early and treat it. 

Help Us Reduce Costs

  • Employees and physicians can help us reduce waste. 
Take our TEAMwork Foundations training to learn about the St. Luke’s Lean methodology, and read the guest blog entry from St. Luke’s Health System Vice President of Performance Excellence Mike Reno for more information on this. 

Help us identify waste throughout the organization and ways that we can eliminate it, or if not possible, at least reduce it. 

Physicians, you can be a tremendous help in our efforts to lower supply costs. When we standardize supplies, we lower costs, promote efficiency, and make errors less likely.

  • Patients and caregivers can help us control out-of-control health care costs by asking for generic medications when your physician agrees they are appropriate, and by seeing your physician in his or her office whenever possible to avoid unnecessary visits to the emergency room. 
Following a discharge from the hospital, be sure to set up your follow-up visit with your physician right away. Seeing your physician can help reduce unnecessary readmissions to the hospital. 

Make sure you take all your medications as you and your physician have discussed, and that you contact your physician with any questions, or if any symptoms are worsening or you are developing new symptoms. 

Attend Spring Forums

Here's a sixth thing physicians and employees can do:

I’ll be hosting spring forums for physicians, employees, and volunteers starting April 10 in McCall and finishing April 18 in our Shoreline building. I look forward to spending time with you and continuing our discussion. Details are available in The Weekly and on our Intranet home page.

There is much more to do, but this will be a great start. We are on a journey, and we will get there faster if we all do our part!

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.