Charting the Course: Launching Patient-Centric Healthcare

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While the first book dealt more with the "why" of a cultural revolution, this sequel deals more with the "how" of changing an ingrained hospital culture. Get A Copy. Paperback , pages. More Details Other Editions 1. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about Charting the Course , please sign up. Lists with This Book. This book is not yet featured on Listopia. Community Reviews. Showing Rating details.

More filters. Sort order. Nov 09, Laura rated it really liked it. Jul 26, Rhonda Sue rated it really liked it. This is the sequel to "Why Hospitals Should Fly" and a great read. I actually liked this book better as it was meatier and more practical. Like other medical books on cultural change, this provides a good roadmap to improving safety and quality for hospitals.

There's helpful info for hospital administrators, but also for board members, which is certainly needed. The stories and anecdotes are poignant. I would recommend this in conjunction with the Toyota Productions Systems and Virginia Mason and other books on HROs and changing cultures of complex organizations. The appendix has helpful tools which I recommend reading and using where applicable. I was surprised by the numerous typos, which I hope were picked up by now.

May 29, Jim Duncan rated it really liked it. Fictional account of transforming the culture at a hospital. Touches on change strategies. One section describes how budgets need to serve the mission rather than adapting the mission to fit the budget. Emphasis on concurrent top down and bottom up improvement efforts where top down is driven by servant leaders. Paul Halverson rated it it was amazing Jul 23, Marie Whitehead rated it it was amazing Dec 26, Samantha Dowd rated it really liked it Sep 30, Dgirl rated it liked it Jan 02, Carolyn Fowler rated it really liked it Dec 02, Jason rated it it was amazing Sep 30, BV rated it it was amazing Jun 06, Below are the available bulk discount rates for each individual item when you purchase a certain amount.

The sequel to John J. Limited Time Offer: You may also purchase the two book combo set at a discounted price Nance, JD, and Kathleen M. Quantity Discounts are available for this book. Please refer to the chart below for pricing information. Nance, JD, the James A.


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Hamilton ACHE Book of the Year, he advanced a paradigm—a model of what a good, successful, safe and efficient hospital looks like. Will Jenkins. His battle, and emerging wisdom born of tragedy, illuminates the norms of the current culture and illustrates why each member of every medical facility, regardless of rank, must be a leader and owner of the cultural revolution needed to keep our system viable and our patients safe. John J. Nance , JD , brings a rich and varied professional background to American Healthcare.

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A lawyer, Air Force and airline pilot, prolific internationally-published author, national broadcaster, and professional speaker, he was one of the founding board members of the National Patient Safety Foundation in , and has become one of the major thought leaders in reforming the culture of medicine. Kathleen Bartholomew, RN, MN , is an internationally known speaker and consultant who uses the power of story and her strong background in sociology to study the healthcare culture. The author of Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication and Ending Nurse-to-Nurse Hostility, she utilized her clinical experience as nurse manager of a 57 bed surgical unit to raise awareness of, and provide ground breaking research on, horizontal violence and physician-nurse communication.

Thus, patients have been able to learn how their behavior and decisions impact their health outcomes and improve their health conditions. Healthcare delivery continues to change to adapt to an aging population, increased prevalence of chronic conditions, genomic medicine, and information technology advances. Dorianne C. Miller, formerly of the University of Chicago Medical School discussed three examples of innovative approaches to improve healthcare delivery by extending care outside of the clinical practice setting. The first example is a patient electronic health records portal that facilitates communication between chronically ill patients and their providers and allows patients to store all of their health-related information together in a shared care plan.

Although results are not yet available, the program has drawn interest and highlighted the importance of addressing privacy and security for the participants. A final example is electronic provider visits, which extend the availability of primary care providers to care for nonurgent conditions and enhance patient—provider communications.

Barriers to broader adoption of these electronic applications include the social acceptability of visiting doctors via the Internet, limited access to the Internet among certain groups, a lack of electronic health records in many physician practices, and unknown reimbursement for delivering care electronically. Presenters of the papers included in Chapter 7 explored the added value of shared decision-making tools in helping patients decide among clinical options, ways to develop evidence that better meshes with individual patient needs, and methods for communicating evidence when the evidence base is uncertain.

The current method for patient feedback—the informed consent process—falls short of the goal of helping patients understand risks and benefits to make informed decisions, according to Dale Collins Vidal of the Dartmouth Institute for Health Policy and Clinical Practice. An alternative to the current decision model is shared decision making, a process that requires both patients and providers to contribute information and participate.

Dartmouth has implemented shared decision making by deploying decision aids, conducting surveys of patient preferences and reported health information, providing feedback to patients about their health behaviors and conditions, and feeding forward information helpful to clinicians at the point of care. Results from experiments with shared decision making have shown its impact on treatment choices: 30 percent of patients changed their initial treatment preference, and the overall rate of surgery was 22 percent lower Deyo et al. Further adoption of this patient decision model will require comprehensive training of healthcare providers, increased consumer health literacy, and the successful identification of implementation models.

Evidence standards and their application to treatment decision making must account for specific clinical circumstances, individual variation, and the range of intervention types. As described by Clifford Goodman of The Lewin Group, evidence hierarchies and their application to patient. Although randomized controlled trials provide strong internal validity, overreliance on this experimental design is a critical limitation to getting the right care to the right patient at the right time.

Goodman suggested the need to develop a diversity of evidence methodologies that are better tailored to specific research questions and account for real-world variations in individual circumstances, patients, and settings. An alternative evidence rating approach has been introduced by the Evaluation of Genomic Applications in Practice and Prevention initiative, which advocates a systematic process for evaluating genomic tests based on analytical validity, clinical validity, and clinical utility. Other promising approaches use multiple and complementary methods to triangulate findings.

Advances in evidence standards will require engaging the public on the nature of evidence, as well as fostering greater interaction among innovators, regulators, payers, and health technology assessment organizations with respect to evidence expectations. Ensuring that patients are informed and active partners in health care requires effective approaches to translating and communicating evidence. Unfortunately, many health messages are delivered to the public in an overly brief and simplistic manner. Fran Visco of the National Breast Cancer Coalition reviewed the effects of this communication strategy in cases where evidence is uncertain.

One illuminating case study is the controversy over the U. One reason these recommendations generated such controversy is that they conflicted with previous communication campaigns that ignored the limitations of mammographic screening, and failed to address the uncertainty surrounding the evidence behind screening.

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Lessons learned from this case study include the need to be honest with patients about uncertainty; the role professional societies play in influencing clinical recommendations; and the need to better educate policy makers, the media, and the public about the importance of evidence. A system in which health professionals work as individuals limits the coordination of care, prevents the flow of information, and discourages quality improvement. Therefore, a team-based culture is key to a learning health system and improved patient care.

Presenters of the papers included in Chapter 8 addressed fundamental elements of team culture, ways to create and sustain an environment that fosters the pursuit of clinical excel-. According to Allan Frankel and Michael Leonard of Pascal Metrics, successful continuous learning environments link teamwork with improvement. Currently, few in health care methodically combine these elements, probably because of differences in the origins and backgrounds in teamwork training and improvement science.

Teamwork training is based on a combination of psychology, sociology, and engineering while being heavily influenced by the science of human factors. In contrast, improvement science focuses on using statistics to manage variation in stable industrial processes and derives from the teachings of skilled statisticians and managers. Weaving these disciplines together is the responsibility, and a core function, of hospital leaders and healthcare managers. Frankel described several key barriers to the implementation of a collaborative improvement model.

First, the culture of medicine often has a hierarchical structure, whether based on academic stature, hospital—physician relationships, or other factors. Second, managers currently have limited appreciation of the components of a continuous learning environment or how such an environment can be achieved.

Finally, senior leaders must devise strategies and allocate resources to ensure that continuous learning systems thrive. Developing new models of collaborative care requires engaging all team members, including patients, in the development of evidence and its use to ensure that healthcare decisions are grounded in effectiveness, safety, and value. As noted by Joyce Lammert of the Virginia Mason Medical Center, this paradigm shift in the practice of medicine will require a fundamental change in the approach to learning and its application in providing health care—one that involves leveraging teams to support systems of clinical excellence and continuous improvement.

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Rapid advances in science and technology, as well as the complexity of twenty-first century care, have made old paradigms of learning and caring for patients obsolete. The necessary culture change must start in medical school, with a focus on examining patient care processes.

As much of the content of medical education will be out of date by graduation, more emphasis is needed on skills for lifelong learning,. Similar changes may be needed on the organizational level and throughout residency training as well to encourage interdisciplinary and team-based practices. Finally, moving toward a learning health system will require other changes in such areas as recruiting, the practice environment, continuing education, and the payment structure.

Adverse events often occur during care transitions and too often result in hospitalizations, lower quality of care, and reduced patient satisfaction. The plan is now being implemented, with workgroups refining and deploying a statewide form and process for interfacility transfer, and education efforts on effective care transitions being initiated.

Transformative change of the health system will require incentives that are aligned with a learning health system. Incentives should focus on promoting value over volume, revamped payment schemes supporting science and value, and changes in insurance design. Presenters of the papers included in Chapter 9 provided examples of strategies that show promise for helping to realign the health system.

Taken together, these papers offer key strategies that can contribute to a reengineering of the system. If the current trajectory of healthcare spending continues, by the U. Michael Chernew of Harvard University argued that addressing this fiscal situation will require a focus on value and reduced growth in spend-.

Chernew discussed several incentive structures designed to promote value, from pay for performance, to episode-based bundled payments, to global payment. Although all of these approaches are promising, each has technical challenges that must be addressed before its widespread application can reduce the cost trajectory.

In particular, each new payment model will require performance measurement that can account for new clinical evidence and healthcare innovation.


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Crucial determinants of success for these and future payment systems will be their capacity to contain costs, the way they incorporate quality and performance measures, their ability to incentivize patients appropriately, the availability of cost and quality information, and the way they encourage organizational reform. Innovation in the American health system is driven by financial incentives that reward volume and provider revenue.

According to Richard Gilfillan, formerly of Geisinger Health Plan, there are ample opportunities for improving the value for patients in the healthcare system. Gilfillan illustrated the impact of the current healthcare business model on innovation. Businesses proactively select innovation and learning initiatives that promise to provide a positive return on investment. Businesses further avoid innovations that might threaten their future success; an example is hospitals traditionally avoiding programs designed to decrease readmissions.

Therefore, changing healthcare practice will require changing the healthcare business model toward one that rewards value. Gilfillan noted further that improvement will require multiple incentives, not just financial ones, as well as dissemination of best practices and leadership by clinicians and payers. Although financial incentives are clearly instrumental in transforming the health system, powerful nonfinancial incentives can be used to influence behavior and create a learning culture.

Anne Weiss of The Robert Wood Johnson Foundation highlighted several of these nonfinancial incentives, from performance measurement, to technical assistance, to patient engagement. These incentives are central to the Aligning Forces for Quality strategy, which is currently being implemented in 17 regions across the country. Although still under development, the strategy has produced several insights into how to move toward a learning health system. First, health care is delivered locally, and different localities will have different needs. Second, strategic communication is critical to engage the general public, physicians,.

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Third, progress will require participation by multiple stakeholders, from health system leaders to patients, each of whom has a role to play in measuring and improving quality. While the Aligning Forces for Quality project focused on nonfinancial means of creating a learning culture, such efforts are impeded by traditional payment systems that often punish learning and improvement, a fact that underscores the importance of reforming the payment system to reward quality and value. The workshop participants expressed optimism about building a learning health system that focuses on patients and consumers.

Although many barriers may hinder this transition, transformational change is within reach. Comments offered throughout the workshop highlighted the following key questions, many of which may be addressed through the convening capacity of the Roundtable, whose exploration offers opportunities for advancement in different healthcare sectors. Berwick, D. Health Affairs 28 4 :ww Beckman, H. The effect of physician behavior on the collection of data. Annals of Inernal Medicine 5 Blumenthal, D. New England Journal of Medicine 5 New England Journal of Medicine 6 Elmendorf to Daniel K.

Deyo, R. Cherkin, J. Weinstein, J. Howe, M. Ciol, and A. Involving patients in clinical decisions: Impact of an interactive video program on use of back surgery. Medical Care 38 9 Fagerlin, A. Sepucha, M. Couper, C. Levin, E. Singer, and B. Medical Decision Making 30 5 suppl SS. Report to the President and Congress.

Greenfield, S. Kravita, N. Duan, and S. Heterogeneity of treatment effects: Implications for guidelines, payment, and quality assessment. The American Journal of Medicine 4A Hartzband, P. Untangling the web—patients, doctors, and the internet.

Charting the Course Launching Patient Centric Healthcare

New England Journal of Medicine 12 IOM Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Initial national priorities for comparative effectiveness research. Clinical data as the basic staple of health learning: Creating and protecting a public good: Workshop summary. Learning what works: Infrastructure required for comparative effectiveness research: Workshop summary. Computational technology for effective health care: Immediate steps and strategic directions.

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OECD health data. Sepucha, K. Making patient-centered cancer care a reality. Cancer 24 Tang, H.

Charting the Course: Launching Patient-Centric Healthcare

Googling for a diagnosis—use of Google as a diagnostic aid: Internet based study. BMJ VanLare, J. Conway, and H. Five next steps for a new national program for comparative-effectiveness research. New England Journal of Medicine 11 Wennberg, J. Collins, and J. Extending the p4p agenda, part 1: How Medicare can improve patient decision making and reduce unnecessary care. Health Affairs 26 6 Woolley, M. Public attitudes and perceptions about health-related research.

Journal of the American Medical Association 11 Zikmund-Fisher, B. Couper, E. Singer, C. Levin, F. Fowler, S. Ziniel, P. Ubel, and A. As past, current, or future patients, the public should be the health care system's unwavering focus and serve as change agents in its care. Taking this into account, the quality of health care should be judged not only by whether clinical decisions are informed by the best available scientific evidence, but also by whether care is tailored to a patient's individual needs and perspectives. However, too often it is provider preference and convenience, rather than those of the patient, that drive what care is delivered.

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