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23 June 2014

Patient-Centered Care: Beyond the Diagrams

Steve Lesky

Ginger Rogers and Fred Astaire. Chocolate and Peanut Butter. Portland, Oregon and Rain Gear. What are things that stand on their own and are even better together? Add to that list, patient-centered care and patent engagement. Each of these health reform concepts stand on their own but are even better together. I would go a step further and say we should never talk about one without the other.

Those of us “in the business” have all seen and/or created one version or another of a patient-centered diagram. Creating diagrams and visual representations is an important (and the easiest) step. Creating systems and environments where patient-centered care is the standard model of care is a much heavier lift. It is more than rearranging functions and people on a diagram. It is becoming more aware of and shifting our mindsets. For most of us, it is stepping outside our familiar comfort zones and cultural norms.  I am no exception.

Recently, I had the honor of participating as a member of a panel speaking on funding opportunities at the Oregon Health Authority Transformation Center’s  Community Advisory Council Summit. It brought together health providers, advocates, and most importantly consumers to share strategies and best practices that can improve community health across Oregon. I came prepared to speak. And afterword, I did the old BBBS. For those who attend conferences, you know what that is because you have seen it or done it: Bounce Between Breakout Sessions. Although I came prepared to speak, I failed to come fully prepared to learn from patients at the center of our new care model. I talked about how the Cambia Health Foundation  is committed to partnering and working with community-based organizations which I am proud to say is very much the case. What I did not fully embrace is a mindset to learn from and with patients and consumers attending the conference. As I bounced between sessions, I heard people talking about not only the barriers to achieving good health but about solutions. I heard people with transportation barriers ask how they could help problem-solve. I listened as people asked questions to better understand data and terminology so they could contribute. It is too easy to forget how much everyone has to offer in achieving optimal health, especially in the face of tremendous needs.

Patients at the center of care models that are not empowered and actively engaged in developing solutions is a model that will not work. Providers and services not adequately informed about the person in the center is a model that will not work. Everyone working together to be better informed will bring the diagram full circle (pun intended!) and is absolutely necessary. Successful health reform must seek out opportunities to support new mindsets that will make those diagrams come to life with better understanding and new strategies.  I would like to share two such opportunities.

OpenNotes is a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other providers. It is designed to have the entire care team working on the same page, respecting the role of all team members while empowering the patient. The Community Health Worker Research and Education Consortium at Portland State University is working to highlight the value of community health workers both within and outside a clinical setting.  In doing so, they are making the case that community health workers are a critical part of a patient-centered model of care.

A theme throughout both of these projects is mediation. In the case of OpenNotes, it is mediation between medical information and those that need it to make informed decisions, the patients. In the case of the Community Health Worker Research and Education Consortium, a member described it best as cultural mediation. Whenever you have one demographic providing a service to a very different demographic, cultural mediation needs to take place. Let’s all make sure that mediation is a part of every patient-centered model of care starting with our own mindsets. What is our comfort zone and do we need to step outside of it?