The past two days I've focused on the recent Institute for Healthcare Improvement seminar I attended titled "Achieving the Triple Aim: The Simultaneous Pursuit of Excellent Health, Ideal Care, and Controlled Costs." Today we're discussing the second aim: the individual patient experience.

Some background: in 2001, the Institute of Medicine released their report Crossing the Quality Chasm: A New Health System for the 21st Century. The centerpiece of the report is the six aims, one of which is patient-centeredness. IHI's Web site has a great synopsis: "Health care should be patient-centered. The individual patient's culture, social context, and specific needs deserve respect and the patient should play an active role in making decisions about her own care. That concept is especially vital today, as more people require chronic rather than acute care."

Cathy Heiman from Genesys Health System in Michigan described how they "meet people where they are" with Health Navigators. These individuals can be registered nurses or other professionals with enough clinical training to understand how a patient should successfully navigate primary care. They help the patient adopt a healthy lifestyle and self-manage their chronic disease. They also coordinate care across delivery sites. Health Navigators also support physicians by reinforcing key messages with patients, helping patients comply with doctor orders and giving feedback to the physician about any revisions necessary in the plan of care. Lastly, Health Navigators support the physician practice by providing data and facilitating quality improvement, helping establish delivery of preventive care, and facilitating a team approach to the medical home. (In a forthcoming case study, we'll profile the Health Educators of the Hill Physicians Medical Group.)

Additionally, Dr. Douglas Eby from the Southcentral Foundation at the Alaska Native Medical Center shared his thoughts on redesigning primary care that are quite worthy of mention and relevant to the ideal patient experience. He explained the medical care process as examining signs and symptoms, which leads to differential diagnosis, leading to tests, then definitive diagnosis, and finally treatment. So let's look at one of those vignettes I alluded to on Monday like Dr. Eby did.

Frank is a 79-year-old widower with lung disease, heart failure, and diabetes. He lives alone and feels unable to manage his conditions. He frequently dials 911 to be taken the ER and even keeps a packed suitcase by his chair. A traditional diagnosis would list his three chronic illnesses; his providers are an array of specialists. But Dr. Eby recommends a different look at Frank: His primary diagnosis for his health care problems should list anxiety, loneliness, insecurity, confusion, dependency, and lack of confidence. His secondary diagnosis lists his three chronic diseases; his primary interventions include personal care coordination and behavioral-based motivational interventions. Behavior change and customer service come first.

To use the Niagara Falls analogy from yesterday, simply looking at Frank's clinical conditions and dealing with his frequent ER visits is akin to buying more lifejackets for the loads of people going over the Falls instead of preventing them from crashing down into the water. Truly caring for Frank involves confronting his anxiety and loneliness. Remember, the purpose of health care is to help people. If we want to help Frank, don't you agree that this approach would be best?

Health care has a lot to learn from customer-focused organizations. Dr. Eby pointed out that Disney starts with being friendly, clean, on-time, and safe. These are assumed. On top of that they add value: excitement, learning, family bonding, and the like. Meanwhile, in health care, we are striving for clean and safe, and patting ourselves on the back if we accomplish those items. On-time and friendly? If you're lucky.

Two books I'd love to read on this subject are If Disney Ran Your Hospital and The New Gold Standard (about Ritz-Carlton customer service). There's much to learn in this area.

I'll finish out the series (probably on Friday) with the third aim: cost containment.