When a patient compares physician scores online, those scores don’t report on trust — they report on quality. So how can patients choose their health care team if they don’t know who to trust? What happens to that trust if their team is chosen for them?
All patients should be able to choose their doctor, says Nirav Shah, but within health networks, that choice is becoming increasingly rare. To address this issue, Kaiser Permanente Southern California is measuring connectedness between individual patients and psychiatrists. “We want to make sure there is that connectedness — trust, in a different way — because that’s going to be key to the therapeutic relationship. And we reassign patients as a result.”
Connectedness drives outcomes, adds Wendolyn Gozansky. “If you don’t have that, we’re not going to accomplish what the goal is of having that connection to begin with.”
But sometimes, the team wants a different outcome than the patient. Gozansky asks — is there an alignment model for getting goals of the patient and the goals of the team on the same page?
That is one of the critical takeaways, says Toyin Ajayi. How do we first elicit the patient’s conception of their health care needs, including social needs? There are ways to structure the questions we ask patients to better understand their current state and perception of their needs, she says. Many of the patient’s perceived needs will overlap with the care team’s perception — but not always.
Begin at the place of confluence, says Ajayi. “That may not be an objective hierarchy of what the patient’s true medical needs are, but it allows us to start at a place where there is common ground, where we agree you are homeless and housing is a priority. Let’s start there, and maybe we’ll wait a little bit before we start to talk about your insulin therapy,” she says. “We need to work with patients within the space where they also see need and see value, and that’s the only way to start to build that trust.”
“Doctors are so overwhelmed today, they’re scared of taking on new work, no matter how important it is,” adds Shah. There are ways to make these add-ons easier for the care team that also build patient trust. Shah describes a warm handoff from primary care physician to psychiatrist down the hall, and a standardized health 12-question questionnaire addressing social nonmedical needs. If a patient checks Yes on any part of that list, “there’s something to be done and you don’t have to do it,” he says. “That makes all the difference. There are real opportunities as the evidence evolves, as we create the evidence, to make it easier for all parts of the team to take ownership of it in one sense, but not be held accountable but be held responsible.”
From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.