Diane Bohner, M.D., FACP, has always been good with patients. In private practice, her patient satisfaction scores consistently hovered at the top. But while attending a recent intensive training seminar sponsored by the Institute for Patient and Family Centered Care, she learned about new and exciting possibilities for patient and family centered health care—and about and what she and Christiana Care had not been doing.
“I wasn’t surprised that I didn’t know everything,” she said. “But now that I understand the possibilities for patient and family centered health care, I can’t imagine continuing the other way.”
The “other way” was patient-focused. Christiana Care has long been patient-focused, Bohner says. We do the best things “for” our patients. We provide the best treatment “to” our patients. And we deliver excellent results, but we have an opportunity to do even better.
A patient and family centered approach means that we stop doing things “to” and “for” our patients and instead make choices “with” our patients.
In November 2011, Dr. Bohner was appointed medical director of Patient and Family Centered Care and Resource Management. Since then, she has been on a mission to educate herself and her colleagues about what it means to be patient and family centered.
“We work very hard to help patients, but often we don’t actually ask the patients in what way we can help them best,” she said. “It reminds me of the first Christmas with my husband when I didn’t ask him what he wanted; I just bought stuff. Yes, I got some things right and some things not so right. As medical professionals, when we realize that we can ask and involve the other person in decisions, we can be so much more successful.
“In medicine, we create frontline processes, but we don’t always ask the frontline person what would work best for him or her. We create processes for the patient without asking them about what they want or need and then wonder why we’re not as successful as we should or could be.”
Dr. Bohner believes that the time is right for a major transformation in how we provide care.
“We have pressures that are forcing this change,” she said. “We have changing payment sources for the hospital that now focus on outcomes, on patient satisfaction and on readmission. These changes can be stressful, but with all of the regulation changes, we can no longer simply do what we’ve always done.
“Everything we’ve done for the past two years has worked to make us very good but has not necessarily made us great. I think that patient and family centered care is a platform for us to be great.”
Patient and family centered care was first introduced at Wilmington Hospital in 2008, under the leadership of Janice Nevin, M.D., now chief medical officer. The concepts and core practices have already taken hold in many parts of Christiana Care. Hospital units on both campuses have implemented bedside shift reporting, patient-communication whiteboards, AIDET, multidisciplinary rounds and nurse manager rounding. Patient and family advisory councils currently exist for the Wilmington campus, the Helen F. Graham Cancer Center, Women’s and Children’s Services, and the NICU. Patients and visitors have noticed a change in culture at Wilmington, in particular as staff routinely smile and greet patients and each other in the hallways, elevators and public spaces on campus.
Over the next year, Dr. Bohner hopes to see these core practices become uniform across Christiana Care. Working with a new council structure that includes a Think of Yourself as a Patient focus, she plans to foster an environment in which staff on both campuses and in every unit share a common vision for what the patient and family centered experience should be at Christiana Care.
Bohner also has been tapped to develop a new program based on a concept called “medical home without walls,” along with Patty Resnik, corporate director, Quality & Utilization Management. The program will include a team of an RN or LPN and a social worker who will work with high-risk patients while in the hospital, and then continue to see those patients after discharge at a place convenient for each patient—at home, on the street, at a shelter, etc.
“The great thing about patient and family centered care is that it ultimately helps us to be better at taking care of our patients,” she said. “It puts us in the frame of mind to take care of patients as whole people—to think about the quality of their care from inpatient to outpatient, and their quality of life while they are in the hospital and also after they go back out into the community.”