Category Archives: Population Health

In Healthcare: Respect= Safety

Written by Deborah Caputo Rosen, RN, PhD

Finally!  Respect= Patient Safety. From that wise purveyor of direct- to- consumer information and education, Consumer Reports, comes a report written in easily understandable language that underscores the message of the Wilson-Stronks advocacy program: Improving Healthcare by Putting Patients in Patient Safety (How Not to Get Sick(er) in the Hospital).

Consumer Reports conducted a survey, of 1,200 recently hospitalized patients, funded by the Gordon and Betty Moore Foundation.  It demonstrated a clear link between participants’ perceptions of respectful treatment and their safety during the hospitalization. The survey defined measures of respect, including:  “the ways staff members and physicians communicated and, whether they acted with compassion, honored patients’ wishes and acknowledged mistakes”.

Whether it is called patient satisfaction, patient engagement, or patient and family-centered care, people who are actively involved in their own healthcare, experience better outcomes and have lower health costs than those who are not (Dentzer 2013). In the Consumer Reports survey, one-third of respondents felt doctors and nurses did not always listen to them without interrupting, 25% said staff did not always treat them as adults able to be involved in their own care decisions, and 34% felt their expressed wishes were not honored. Twenty-one per cent felt they experienced actual discrimination in their care.  Those who rated their experience of respect poorly were two and a half times more likely to experience a medical adverse event than those who described usually being treated respectfully.  And dismissive or poor treatment made survey respondents feel uncomfortable asking questions about their care and the steps being taken to keep them safe. Those who did not “Speak Up” were 50% more likely to have experienced at least one medical error during their hospital stay.

The Consumer Reports article also includes a table called Top and Bottom Scoring Hospitals for Safety and Respect. The data are drawn from the organization’s hospital ratings tools and are based on January 2014 data from CMS . Reported safety scores are based on mortality rates, infection rates and hospital readmissions.  Patient experience (respect) scores include doctor and nurse communication, communication about discharge and overall impression of the hospital.

Many consumers will benefit from the wide availability of this Consumer Reports coverage.  Their recommendations parallel what Wilson-Stronks teaches patients/families and providers in our advocacy curriculum: “Know-Ask-Speak”!

  • Choose the right hospital
  • Help providers see you as a person
  • Invite your doctor to have a seat
  • Have “Your People” with you
  • Know when errors tend to occur
  • Find a “Troubleshooter”
  • Be assertive and prepared but courteous
  • Keep the concept of partnership in mind
  • Write things down
  • If you don’t understand, ask again

Once healthcare consumers recall that they are the CEOs of their own healthcare teams; are purchasing services from healthcare professionals, and have choices, rights and clear expectations about the outcome of care, more than half of the work is done! Then, some expert coaching of necessary communication skills, negotiation skills and facts about their diagnosis and treatment options can restore a balance of power and assure a safer, more respectful healthcare experience.

Contact us to learn more about how we are “Putting Patients in Patient Safety”.

Work Cited:

Dentzer, S. Health Affairs. February 2013, 32:202. Accessed January 10, 2015
“How Not to Get Sick(er) in the Hospital”. Consumer Reports. February 2015, p. 32-37.)

Population Health and Culturally and Linguistically Responsive Healthcare

Posted by Deborah Caputo Rosen

We have been thinking about population health at Wilson-Stronks LLC. Soto notes, “(M)any see attention to population health as a potent opportunity for health care delivery systems, public health agencies, community-based organizations and many other entities to work together to improve health outcomes in the communities they serve.” (1)

Although there are a variety of definitions of population health they share some common themes. Population health has a wider scope than traditional public health because it explicitly includes the health care delivery system itself, and its accountabilities. Not only are health outcomes measured but also the factors that influence them—social determinants of health and disease prevention efforts. A population health management focus includes the active reduction of health disparities and the pursuit of health equity.

Health care administrators have taken a renewed interest in health promotion and disease prevention. One of the drivers for this has been the Patient Protection and Affordable Care Act (ACA). Regardless of your political opinion of “Obamacare”, the law creates structure that motivates healthcare organizations and realigns their interests. Increasing insurance coverage increases access; especially for populations traditionally disadvantaged from preventative services, screening and the resultant early case-finding and improved outcomes (with associated lower healthcare and societal costs).

CMS and the Patient-Centered Outcomes Research Institute, among others, plan to track and study patient results as a research-based means to improve quality. The ACA includes a variety of approaches to increase both the quantity and quality of primary and preventive care, including the development and funding structures of Accountable Care Organizations (ACOs).

A new IRS requirement under the ACA mandates health care organizations and public health systems to engage in community health needs assessment every three years. Communities, including their health needs and health resources, must be described along with a prioritized implementation strategy to meet those needs. Both health outcomes and accountability measures are required.

One size does not fit all” is the lens through which Wilson-Stronks always has advocated and offered services. The new reality of the world of health care provision requires that the population eligible to be served must be identified, its needs and current resources characterized, and the interventions individualized to meet those needs. This offers renewed opportunity to consider culturally-responsive and linguistically effective communication in the design and delivery of care.

Finally, target outcomes must be identified, risk-adjusted metrics developed and mutually accepted and information must be sharable to promote evidence-based promising practices. In the highly competitive and diminishing margins of health care provision, patients and providers alike will benefit when, to quote Thomas Friedman’s book, The World is Flat.

1. Soto MA, “Population Health in the Affordable Care Era”. Academy Health, 2013, pp.2-6