It's been over a century since hacking off a limb was considered the best cure for a deep cut, and even less than that since frontal lobotomies were forcefully prescribed for the melancholy.
The dark ages of medicine are seemingly behind us. Sterilization revolutionized medicine during the Civil War, as did refrigeration decades later. Leaps forward in prosthetics, anesthesia, and new ways of looking into bodies without actually opening them up have further advanced modern healthcare into what many know it as today.
Innovation in this field has long been tied to the latest technologies, the most impressive devices, the fastest-acting medicines, and the advantages they bring to helping patients recover. But this definition covers only a fraction of the "patient experience."
Quality patient care should be centered around the patient, not just healthcare technologies.
Human-centeredness is an adjective as of late used in describing product and systems design techniques, heavily reliant on understanding an individual’s needs before devising a solution. The process involves interviews with users, small incremental changes, and a constant stream of feedback guiding future development. It's not far removed from the intake procedure at a physician's office: interviews are conducted, doctors and nurses document each patient's "story" and take action based on inferences from that data. With a practice so closely tied to "user feedback," healthcare would seemingly be the most appropriate application of the human-centered approach.
Obviously, that's not always the case, as evidenced in questions of whether or not healing people is a sustainable business model, and opioid-addicted communities are being cultivated at great human expense. In contrast to these ultra-capitalistic outliers, human-centered care does make a difference.
In 2001, a team of Canadian physicians published in The Journal of Family Practice, "Patient-centered communication influences patients’ health through perceptions that their visit was patient-centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals."
The findings of that team have been echoing across the Great Lakes for just as long, if not longer.
Cherry Health has been serving the healthcare needs of West Michigan since 1988.
Open to those who might otherwise have little or no access to healthcare, the patient base of Cherry Health is reflective of the entire West Michigan Community.
"That's one thing we're proud of," says Jodi Pyper, Registered Nurse and Director of Health Center Programs. "Absolutely everyone is welcome here."
While there is often a stigma attached to the quality of care of federally backed healthcare providers, the care patients receive at Cherry Health is top rate, Pyper says. And, the facility has the recognition to back it up. In January 2018, nine of the care provider's facilities were accredited as Patient-Centered Medical Homes by the National Committee for Quality Assurance (NCQA).
Just as Cherry Health locations across the region welcome patients from all walks of life, the various needs physicians must accommodate may differ greatly as well. These are not just physical or mental ailments, but issues of ability, access, and empathy. If hours need to be extended, if home visits need to be made, if special attention needs to be paid, it will be done.
Doctors and nurses at Cherry Health work to understand more about their patients through the initial intake interviews, but it's in fostering that relationship with specialized Care Teams, patient surveys, and other communicative channels, that the human-centered care approach begins to take shape.
Different disciplines are commonly involved in the patient care experience at Cherry Health. Care teams, built around the needs of their patients, may draw on behavioral health and social determinant screening, interventions within visits, care management services for high risk patients, CDE for diabetics, or anything else required in providing quality care.
Similar to the kanban method popularized by Toyota that revolutionized automobile manufacturing, the care team approach puts the appropriate talent where it's most needed, instead of placing all the responsibility on a single practitioner.
Cherry Health is using specialized Care Teams to improve patient health and experience.
"Members of the care team provide needed services to allow our practices to serve a greater number of patients, and to have services delivered by care team members who are experts with certain diagnoses and resources," says Tiffany Aldrich, communications director for Cherry Health.
Cherry Health's care teams evolve with patient needs, and with at least 900 staff members and growing, there is no shortage of forms they can take, all in the name of quality, which is actually a department of its own.
"We have a director of quality," Aldrich says. "We weave quality into everything we do. Quality is not just a department, it’s a culture."
The care team approach championed by Cherry Health isn't brand new. In fact, it's not even unique to Cherry Health. A growing trend in healthcare is the use of team huddles: interprofessional care teams that connect over the treatment of a single patient.
"Often times they include the patient right in the huddle," says Jean Nagelkerk, Grand Valley State University's Vice Provost for Health and formerly a practicing nurse. "They'll bring in ambulatory care staff, maybe a medical assistant, the physician and nurse practitioner, sometimes they bring the registration clerk in or the individuals to deal with electronic health records.
"They take about five minutes or more, making sure everyone understands what their role is for the day."
Once the routine is ironed out, the care process goes much smoother. Practitioners are able to share urgent concerns about particular patients, and follow up to make sure those concerns have been remedied.
Clear communication is the goal. In its absence, care outcomes are actually much less likely to succeed.
Nagelkerk recalls the findings of "To Err is Human: Building a Safer Health System," an article published in 2000 by the National Academy of Sciences that maintains "as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS—three causes that receive far more public attention."
A study conducted by the Joint Commission for Accreditation of Hospitals later found that these sentinel events, those in which a patient was badly injured or died as a result of the healthcare setting and not their illness, were prompted more than 70 percent of the time by miscommunication between care facilities.
Through a voluntary participation survey, the JCAH measured an increase in the number of reported sentinel events between 1995 and 2017, but warns that its findings are related to only a small proportion of actual events.
Communication errors occur much more often during a transition of care or a handoff; being discharged home, or sent to another place, Nagelkerk says.
"What we know now is that communication among healthcare providers is very important. More and more, care providers and staff at hospitals are communicating more by getting into huddles,” she says.
Outside of professional care facilities, academia is also embracing the merits of collaboration. Heath-focused departments at GVSU emphasize interprofessional education, Nagelkerk says. Her university has a responsibility to further such work, as a chair of the Midwest Interprofessional Practice, Education, and Research Center, which is comprised of 24 organizations across the midwest.
"They're all coming together to infuse interprofessional education and practice into our communities so that we can hopefully improve the quality and safety of care that we deliver," Nagelkerk says.
For Kelly S Hassberger, a Naturopathic Doctor and owner and director of Grand Rapids Natural Health, human-centered care begins slowly.
"So many of our interactions with doctors are really quick," she says. "The doctor might be sitting behind a computer and typing while the patient is there, interacting with them and trying to tell them their story. We try to reverse that a little bit and connect with the patient."
Patient care at GRNH is defined by patient interaction. Initial consultation meetings could last anywhere from an hour to two hours long, and follow up visits just as long. Practitioners use this time with the patient to learn their stories and everything that led up to the diagnosis that they may have received.
"I think that really helps our outcome," Hassberger says. "We are able to dig into the reason behind why someone is sick, versus the typical 15-minute appointment with a doctor. I think it's hard for a doctor to assess that."
GRNH is an integrative, complementary health care facility, relying on what's been labeled "alternative medicine," but used in conjunction with mainstream patient care. Rather than prescriptions from a pharmacy, a naturopathic doctor may recommend supplements, dietary changes, or other alternatives to mass-produced pills.
"A lot of allopathic medicine is really symptom-driven," Hassberger says. "A patient comes in with a symptom and a medication is prescribed in order to alleviate the symptoms. We're really looking at prevention and changing the person's entire lifestyle; mental, emotional health as well, and really getting to the core of what's going on with them. So they will get better, and not just turning the symptoms off."
Hassberger's work in naturopathic medicine began at an early age. Her mother emphasized healthy nutrition and even owned a building in which a naturopathic doctor worked. Continuing her education in college, and eventually becoming an ND herself, Hassberger opened GRNH six years ago in a chiropractor's office. Her practice has since moved, and her own responsibilities have grown. Hassberger's current role is building a community of other NDs who can offer the same services.
Whether that means making lifestyle changes, addressing nutritional issues, or incorporating exercise or mindfulness into a daily routine, human-centered care at GRNH is focused on helping patients learn how to make themselves feel better.
It may not seem like a sustainable business plan when compared to Goldman Sachs' definition, but that's because Hassberger defines her business differently
"The best patient is the one that no longer needs to see us, because they've been given the tools to take care of themselves," she says. "There really is kind of a medication epidemic. People rely on so many medications and in the end they don't really feel any better. Sometimes they're experiencing side effects of the medication, versus anything else.
"We're really about looking at the whole person versus the symptoms."
Though the most obvious relationship in the healthcare experience is between the patient and practitioner, systems that put those practitioners in place are just as important to quality care systems.
Hello West Michigan started as a small organization, focused on solving a big problem. A group of CIOs from around the region, brought together by The Right Place, shared concerns in 2007 that specialized talent was hard to find, and when it could be found, it didn't stick around for long.
Program Manager Rachel Bartels notes that Spectrum Health was the first healthcare partner for Hello West Michigan, which currently helps doctors and nurses coming to the region to work at several area hospitals, behavioral and mental health facilities, children's health centers, cancer centers, and other care operations, learn more about the culture and opportunities of the community.
Hello West Michigan is funded through the annual dues of employers, which includes local hospitals and healthcare providers. It's unique in the sense that other such initiatives rarely grow out of the format of a semi-yearly advertising campaign.
According to Bartels, Hello West Michigan does its own share of advertising, and has landed a few long-term staff members as the result of such. However, its lifespan is much longer. Now just over a decade old, the organization boasts over 80 member companies in total, a number that continues to grow each year.
With each new nurse, naturopath, or doctorate level practitioner that comes to West Michigan, the opportunities for personalized treatment and collaboration increase. The skills and diversity of our region's medical community is as much an asset to our community as they are to the facilities that employ those physicians.
The healthcare industry experiences innovation at an astounding rate. Examine cases from even a decade ago and that fact is clear, but flashing lights, beeping machines, and X-ray vision do not world-class care make. The next wave of innovation in healthcare is a personal one, and West Michigan is home to several examples of such advancement.
Urban Innovation Exchange highlights the people and projects transforming West Michigan through sustainable efforts. Matthew Russell is the editor for UIX Grand Rapids. Contact him at [email protected].
Photography by Autumn Johnson of Bird + Bird Studio.