Engaging Patients: Appeal To The Elephant

I am in the middle of reading a book called Switch.  It’s a very compelling book about some clear things you can do to make change happen when it seems hard.  The authors elegantly outline some strategies that seem very doable, and can apply to both personal changes to organizational changes. 

Imagine a person riding an elephant along a path.  The concepts in Switch revolve around three aspects of change:  “The Rider,” “The Elephant” and “The Path.”  The rider is a person’s rational self, the elephant is a person’s emotional self, and the path is the environment.  The rider is smart and tries direct the elephant where to go, but the elephant is big, unwieldy and takes a lot of energy to get going.  But don’t underestimate the landscape:  If the rider and elephant are going full-blast, in a landscape of quick sand, you’ve got serious problems.  For many Big Changes, you likely need to address all three. 

One question I keep hearing about the medical home is – Yes, we can do all these wonderful things in our practice but how can we make the patient value them?  What I’m hearing in this question is really two questions:  1) How can we inspire the patient to value their health more and 2) How can we inspire them to value our array of services more? 

I believe that engaging patients in the medical home needs to hit the rider, the elephant and the path.  For the rider, that means explaining what medical home is, why it is important, and what an individual practice is doing to become a medical home:  the brainy stuff.  For the path, that involves some new ways of interacting – like care teams, or a patient portal.  But I believe elephant will pack the real punch with engaging patients in their health and healthcare.

I recently had a very ‘elephant’ experience with my primary care provider.  They never used the words ‘medical home’ and they could certainly beef up their 'medical home-ness' but because of what happened, I plan to always see that team for my care.  I had bronchitis that just would not go away.  At one point, on my 2^nd round of antibiotics, my doctor actually called me at home to see if I was feeling better!  Later, I had to have a test and she asked that I call and speak with her directly to get the results.  I am not sure I’ve ever had a doctor express to me they actually cared about me as a person the way this doctor did.  It hit me right in my elephant.

The rider and path are crucial, but that big ol’ elephant needs to move.  Making patients feel like they have a provider/team who knows and truly cares about them will be the core of any desirable changes at the patient level.

PCMH: Devilishly Angelic

I heard a story on a webinar the other day. A very experienced healthcare practice coach (practice coach = somebody who helps guide practices through changes such as quality improvement processes and PCMH work) said how, during the span of her work, providers had likened her to an angel and a devil. The provider who likened her to a devil said something to the effect of, ‘When we know she’s coming to visit, we know that change is ahead and it’s going to be hard’. The provider who likened her to an angel said something like, ‘When we know she’s coming to visit, we can expect she will bring us new knowledge and resources that will help us get where we want to be and deliver better patient care’.

Though nobody has put such a fine point on it, I can really relate to this story. I feel that sometimes in my role of guide/coach that I am like an angel and a devil – often at the same time – and that the whole PCMH transformation process is both devilish and angelic, at the same time. Thus is the nature of change, especially when you believe that the result will be for the good.

Here is a good example of how PCMH transformation process itself can be devilishly angelic.

A practice in our PCMH Learning Collaborative recently fully implemented team-based care, a big change for them. The change included rearranging furniture and phone lines, explaining changes to patients, and – most importantly – putting people into color-coded teams with a new modus operandi. Understandably, this presented some real challenges and people were feeling stressed.

But they were dedicated and committed to the change, for good.

I was honored to facilitate a team-building activity for them to help. In the process, I got to hear some wonderful stories about the positive impact the new arrangement was having. In one story, a referral coordinator talked about now being able to spend more time connecting patients to community resources and was proud of recently securing care for a high-risk pregnant mom.

The devil may have been in the details of this momentous practice change, but it meant that a care team member got the chance to be that mom’s angel that day. For me, folks, this is what it’s all about.

My history with CHC's

I started my career as a Community Health Center (CHC) nurse about 23 years ago. I had worked at the local health department and loved community health nursing. My job with the health department ended due to funding cuts within the state of Virginia. I was heartbroken when I found out my job with the health department was over. Little did I know my career as a community health nurse was far from over…it was just beginning!

When I started my new job…I really did not have an understanding of what a CHC was and it took several years to fully understand the CHC “world”. Some days, I feel as if I still do not fully understand this “world”. The CHC “world” is unique and CHC employees are some of the best you will find anywhere. They are some of the most dedicated, loyal, and hard working people you will find. Once you work in the CHC “world”, it is very hard to leave.

I have lived in the community where I work my entire life. CHC communities are as special as the CHC’s who serve them. I love going to work each day knowing I am taking care of my family and friends. I just helped celebrate my grandmother's 93rd birthday this past weekend! I like giving back to the community who has given me so much. My husband is also from the same community and we are raising our two sons here, as well. I like raising my sons in a small town and the fact that I know most of their friends as well as their parents. It is a lot harder to get into mischief when everyone knows everyone…

Saltville, Virginia

Southwest Virginia is the place to be!

Hi, my name is Jill Talbert and I am a registered nurse in a Community Health Center (CHC) in southwest Virginia. This month, I have been asked to blog about my experiences as a CHC nurse. I grew up in a very small town in southwest Virginia called Saltville. Our town has a current population of about 2,500 people. I was the first of two daughters for my parents and I had always known since I was about ten that I wanted to be a nurse. This is probably because my mom always wanted to be a nurse, but didn’t have the opportunity. I entered nursing school the summer right after I graduated high school.

A lot of people asked why I chose to stay in my small hometown instead of moving away to a larger town or city. My reply is: I want to raise my sons the way I was raised and I want to give back to the community I was raised in. My Community Health Center, Southwest Virginia Community Health Systems, Inc. is very near and dear to my heart. I began my career as a CHC nurse 23 years ago.

When I was hired, I have to admit, I did not know what a CHC was. I was hired as an office nurse working in two physician office. I learned a lot of new things not taught in nursing school such as how to take x-rays (which nurses aren’t allowed to do now without a license). I loved the people I worked with and the schedule was very convenient for my family, but I especially loved the patients I cared for and I like to think they loved me back.