The Tao of patient-centered care

"Tao (pronounced "dao") means literally "the path" or "the way." It is a universal principle that underlies everything from the creation of galaxies to the interaction of human beings. The workings of Tao are vast and often beyond human logic. In order to understand Tao, reasoning alone will not suffice. One must also apply intuition." — Derek Lin Patient-centered care (aka client-centered care, patient-directed care, patient-driven care, etc.) has infused the published descriptions of today’s healthcare industry and professions.  National and world health organizations include patient-centered care as a hallmark of best practice. A casual medical database search of this term immediately yields articles in journals of nursing, dentistry, medical devices, surgery, social work, hand therapy, health management, primary medicine, behavioral medicine, rehabilitation, emergency medicine, mental health, occupational therapy, and many more. Yet, according to the same body of literature and my own observations, truly patient-centered care remains largely unpracticed. It consists of attitudes and actions that can be a challenge to live up to, an ideal to be ever sought and only attained through practice and diligence. True story:  A 17-year-old girl was admitted to a hospital psychiatric unit with terrifying hallucinations and delusions. She wept copiously and had not slept for days. She continuously prayed aloud or ruminated about having brought the Zika virus into the world. Her parents, immigrants from South America, were distraught, and asked to have their priest perform a rite of exorcism as soon as possible. The patient and parents were counseled about the neurobiological nature of schizophrenia and importance of medication, but remained firm in their request. The psychiatrist and team made this possible by providing a private area for the ceremony to take place, and interacting with [...]

Our productivity is based on patients, not the bottom line

“Productivity — the amount of output delivered per hour of work in the economy — is often viewed as the engine of progress in modern capitalist economies. Output is everything. Time is money. The quest for increased productivity occupies reams of academic literature and haunts the waking hours of C.E.O.s and finance ministers.”  - Tim Jackson, ecological economist and professor of sustainable development at the University of Surrey I am an occupational therapist and six years ago I also became a small business owner. My parents were hard-working entrepreneurs, so I had lots of early exposure to the ways of business. Our dinner table conversations often included discussions about bills of lading, sales reports, delivery dates and inventory. I learned the essential nature of a sustainable business: more money coming in than going out. I understand that healthcare is an industry. Whether the hospital, outpatient clinic, rehabilitation center, skilled nursing facility or home health agency is set up as a not-for-profit or as a traditional business, if it runs at a deficit it is unwell and ultimately unsustainable. In my parents’ business the main measure of success was selling goods at a profitable rate, while maintaining low-as-possible overhead costs. Each quarter they would hope to do a little better than the one before. Some years were better than others, but over time they became skilled at figuring out how many lawn mowers or hedge clippers to order, and ways to keep their employees productive even in the Midwestern winter (answer: sell snow shovels and Christmas trees instead of lawn equipment). Healthcare professionals typically view our main measure of success as the degree to which we help those we serve. The organizations we work for usually highlight [...]

 Interprofessional healthcare is a big deal

The World Health Organization has been pushing interprofessional healthcare delivery for more than 50 years, and is not alone. Almost every major professional association has endorsed IP team approaches, including the American Nurses Association, American Speech and Hearing Association, American Occupational Therapy Association, American Physical Therapy Association, American Academy of Physician’s Assistants and American Academy of Family Physicians. In the past 10-15 years many universities have developed courses or curricula to infuse interprofessional practice into entry-level medical, nursing and allied health education. The young practitioners coming out of these programs are better prepared than ever before to engage in interprofessional teams, given the opportunity. If you were educated prior to 2010, you may be confused by the relatively new emphasis on interprofessional teamwork in healthcare. Patients pretty much everywhere receive care from an array of different professionals within each setting, so you may think that a bunch of care providers all working alongside one another equals an interprofessional team. Not so. What is this unicorn of healthcare delivery? Authentic IP teamwork looks like this: There is an IP Plan of Care for each patient that is negotiated and decided by the team. Roles of care providers are fluid and determined by the patient’s current key needs. Team members are both experts in their disciplines and knowledgeable about others’ skills and roles. Everyday work is coordinated and often shared. Communication is regular and frequent. " may think that a bunch of care providers all working alongside one another equals an interprofessional team. Not so." If your everyday work experience resembles this model, you are lucky! Despite universal agreement regarding the desirability and effectiveness of IP practice, the majority of clinical practitioners have yet to achieve this ideal. [...]