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Adapting and Cooperating to Scale a Shared-Decision Making Program to Improve Patient Experience and Outcomes

Posted By Gloria Stone Plottel, MS, MBA, Wednesday, April 1, 2015
Updated: Thursday, April 2, 2015

Global payment structures and evolving reimbursement calibrations are driving innovation in healthcare to improve patient experience, become more patient-centric and manage for population health. The magnitude of these changes requires individuals and organizations to willingly adapt and cooperate to develop the processes and programs to thrive in this altered landscape. It is worth pausing and reflecting on these efforts, especially when done well.

We’ll take an in depth look at a successful change initiative from Partners HealthCare, an integrated health system seeking to more fully engage patients in their own care so as to improve patients’ health and care outcomes. Partners HealthCare was founded by Brigham and Women’s Hospital and Massachusetts General Hospital and, in addition to its two academic medical centers, the Partners system includes community and specialty hospitals, a managed care organization, community health centers, a physician network, home health and long-term care services.

As part of its patient engagement strategy, Partners wanted to scale a successful Shared-Decision Making (SDM) program at Massachusetts General Hospital across its 10 hospitals, so patients throughout the health system would benefit from SDM. SDM helps patients who need to make significant medical decisions with their primary care provider and specialist by providing patients with evidence-based, balanced decision aids and coaching services. Decision aids give patients information (written and video) about diagnoses, different treatment paths and variables to consider as they think about treatment options that best reflect their values, life style and health goals. After reading and viewing the decision aids, patients meet with their coach – physicians, nurses, or other licensed healthcare professionals trained to guide this type of conversation – and together evaluate treatment options, the patient’s goals and values and decide on a treatment path that will work best for the patient.

Scaling this program involved a number of departments throughout the health system:

  • Legal and Finance to obtain rights to use patient decision aids in the other hospitals
  • Training of clinicians and staff – doctors, nurses and medical assistants needed to be trained to use patient decision aids and have shared decision making conversations with patients and family members
  • Worksheets and other tools needed to be developed to support shared decision making conversations when there are no patient decision aids available
  • IT needed to develop applications within the electronic medical record to notify physicians when patient decision aids were available for a diagnosis, and to enable ordering of decision aids and access through the patient portal, and to document delivery of patient decision aids
  • Mail Services was needed to deliver hard copies of patient decision aids to patients who did not have portal access
  • Physician office staff in some specialty practices needed to implement new protocols to incorporate delivery of decision aids to eligible patients when scheduling a visit
  • Leadership was needed to prioritize and champion this initiative
  • An advisory group with representatives from the major hospitals and patient representatives was created to provide input on the expansion strategy

Seven departments at a minimum and their staff were involved in scaling the SDM program across the health system. SDM aims to engage patients in making informed decisions about their treatment path, and in so doing increase patient satisfaction, increase patient adherence to treatment plans and improve patient outcomes. The initial expansion targeted primary care practices and orthopedic departments, specifically spine and hip and knee arthoplasty. At the time of writing, the expansion has been underway for five months and several practices at four of the hospitals are now using the decision aids, and the roll out to the rest is underway.

Many individuals – physicians, nurses, clinical and administrative staff, and patients and family members – are involved in scaling the SDM program to make it available to thousands of patients. Scaling the program requires significant willingness on the part of individuals to adapt and work together to increase patient engagement, improve patient experience and improve outcomes. The degree of change in healthcare delivery is large and stakeholders need to work together to build the processes and infrastructure that will enable organizations to thrive. Are you and your colleagues willing to adapt?

Gloria Stone Plottel, MS, MBA is the Founder and CEO of GSP², a boutique consultancy focused on helping healthcare organizations develop and implement strategies and infrastructure for patient engagement, advisory councils, communications and marketing. Ms. Plottel consulted to Partners HealthCare to develop the patient engagement strategy for the health system and Pioneer ACO.

Tags:  healthcare  leadership  patient experience  shared-decision making 

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