• Change the Conversation

    May 15, 2014

    If it’s true that patient and family engagement is the single most powerful force you can harness to transform your organization, why do so many organizations make a token effort?

    Jim ReinertsenFor years, I have told board and executive leaders that the most powerful of the Institute for Healthcare Improvement’s (IHI’s) seven leadership leverage points is “put patients and families on your team.” The leaders have dutifully nodded in agreement, and made plans to engage patients.

    But when I would follow up with them a year or two later, many leaders would confess that they really hadn’t done much with their patient and family engagement plans, despite serious work on other IHI leverage points, such as “engaging with physicians as partners in improvement.” And those leaders who did take action—for example, by starting a Patient and Family Council—noted that this was often largely a token effort with little impact.

    Very few leaders had implemented meaningful leading-edge practices in patient and family engagement, such as the following:

    • Adopt a policy to have patient members on all clinical service design teams
    • Add two patient members to the Board Quality Committee
    • Put patients on the search committees for senior executive positions 
    • Make a patient a voting member of the Medical Staff Executive Committee (MEC)

    Question Your Excuses

    Wait a sec. Make a patient a voting member of the MEC? Have patients help decide who gets appointed and reappointed to staff? Yes, St. Joseph’s PeaceHealth, in Bellingham Wa., made a retired Army nurse and cancer patient a full voting member of the MEC. And it changed the conversation—just as it does whenever patients and families are in the room with us as we make plans for coordinating care, reducing overused services, or implementing any other effort to improve quality and value.

    How do patients change the conversation? For one thing, our usual excuses sound lame when patients and families hear them. “We couldn’t possibly coordinate care more efficiently because it would require our medical group to work closely with a competitor.” “We can’t expect doctors to follow the safety rules every time.” Really?

    For another, patients and families bring in fresh ideas, especially for chronic conditions where patients and families deliver the vast majority of their care themselves. And perhaps most important in terms of transforming our systems from volume-driven to value-driven: Informed patients who participate in decisions about expensive interventions and technologies almost always select more conservative, rather than more profligate, choices.

    I hear a lot of answers as to why organizations are not engaging patient and families in meaningful ways, but I think that this is about power—about executives, physicians, and nurses sharing power with patients and families, from the boardroom to the bedside—and that’s why it’s so hard to do.

    Start Small

    The hardest part of power sharing, as for many things, is getting started. So here’s a specific suggestion. Put two patients on the Board Quality Committee. Don’t obsess about picking perfect candidates. Choose two articulate, strong people who are regular patients in your system. Ask them to sign whatever confidentiality agreements the other committee members sign. Tell everyone, “We’re trying this out.” Try it for three meetings, and reflect on how it’s going for both the patients and the committee. Make any needed adjustments, and try it for three more meetings. It’s called a “small test of change.”

    If you actually do this, I am confident of two things. It will change the conversation. And your organization will never go back to the way it was.