Patient-centered EMS leadership

Patient-centered care partnerships with patients and family need to start at the top


By Roxanne Shanks

If you have been involved in healthcare at all the past 15-20 years, you have undoubtedly heard the term “patient-centered care.” In 2001, the Institute for Medicine identified patient-centered care as one of the six aims of quality improvement for the U.S. healthcare system. If you Google this term today, you will see numerous articles, research and initiatives of healthcare organizations and sectors continually working toward achieving this goal in one form or another.

What is patient-centered care? There are literally hundreds of definitions for patient-centered care, but I think the following sums up the ultimate goal; “The pursuit of genuine partnerships with patients and family members.”

Patient-centered care represents a shift from this traditional role of patients and their families from one of passive order taker to one of active team member. (Photo/USAF)
Patient-centered care represents a shift from this traditional role of patients and their families from one of passive order taker to one of active team member. (Photo/USAF)

Recently, 17 years after identifying patient-centered care as a priority in improving the healthcare system, the Institute for Healthcare Improvement posted its new focus, person- and family-centered care, which it defines as; “Putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care.”

You will notice both the of the above definitions refer to “genuine partners or partnerships.” In EMS, partnerships and collaboration have been the key components of successful programs, no matter what type of service model you provide. EMS has understood for years the importance of these partnerships; whether they be with other EMS agencies, fire services, county officials, hospitals, community members, etc.

These partnerships are essential to any organization that is providing a service to a community and are built on strong foundations that contain several key elements. When developing genuine partnerships that require collaborating with patients and family members, those same key elements can apply:

  • Customized care/service according to needs and values.
  • Shared knowledge.
  • Freely flowing information.
  • Evidence-based decision making.
  • Safety is a system property.
  • Transparency is necessary.
  • Anticipated needs.
  • Decreased waste; improved efficiency.
  • Cooperation among providers is priority.

So how do these key elements translate into the actual care of the patient? Healthcare, for so many years, was designed by hierarchy, orders and directives being carried out with very little communication to the patient and family. Patient-centered care represents a shift from this traditional role of patients and their families from one of passive order taker to one of active team member. Shifting to patient-centered care has truly taken a massive shift in the way the healthcare system functions. This table visually demonstrates where we have been and where we are going.

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We have seen this transition over the years through processes, such as team rounds in the hospitals, discharge care planning with families, to things like mobile integrated healthcare and community paramedicine programs. This continuum of care, and involving the patient and family in those decisions has been the transformation healthcare has been undertaking for many years and it continues to evolve.

In EMS, this transition has continued to advance through patient-centered models for prehospital care, such as alternative destinations, whereby patients are not automatically taken to an emergency department. What is more patient centered than a system where EMS evaluates the patient to determine what they truly need, instead of the system automatically dictating the patient destination? This may mean the patient is taken to an urgent care clinic instead or treated at home, with the goal being to provide the right resource, at the right time, to the patient.

Leadership plays a vital role in providing patient-centered care. This is not for the faint of heart or something that just naturally happens overnight. This is a cultural transformation that requires everyone in an organization, starting at the top, to be engaged in the process.

The Picker Institute, a private nonprofit organization, has been dedicated to advancing patient-centered care and improving the patient‘s experience and interaction with healthcare providers. They have a patient-centered care improvement guide that serves as an invaluable resource for any organization wanting to embark on this cultural transformation. The comprehensive guide shares some key points for leaders and their roles in patient centered care:

“In their own behaviors and values, leaders set the tone for implementation of patient-centered care. Walking the talk means communicating openly, soliciting and responding to input from staff, patients, families and others, and ensuring staff members have the resources and flexibility they need to provide patient-centered care. Building credibility as a champion of patient-centered care requires a leader to understand the experience from both the patient perspective and the staff perspective. Many leaders at patient-centered organizations accomplish this by spending considerable time in the field.”

This focus continues with leadership development and styles that support patient-centered care, behavioral interviewing processes to ensure you have the right candidates in leadership and front-line staff, and employee engagement focus efforts. Leaders must model the way, inspire the shared vision, challenge the current processes, enable front line staff to act, and encourage the development of those genuine partnerships. This requires a completely different way of thinking, planning, communicating, and ultimately caring for patients and their families.

In this day of surveys and results tied to reimbursement, one of the greatest challenges for leadership is to not get caught up in chasing patient satisfaction scores and lose sight of the goal of patient-centered care, or improving the patient experience.

With the introduction of the Hospital Consumer Assessment of Healthcare Providers and Systems patient experience of care survey, a standardized tool to evaluate the way care is provided from the patient perspective now exists in the hospital setting. This is different than the traditional patient-satisfaction surveys most organizations have utilized for years. Whether in a hospital or pre-hospital setting, leaders need to keep in the forefront of their minds that nothing will derail a patient-centered care cultural transformation quicker than inadvertently sending mixed messages.

If leaders are merely focused on measuring compliance to surveys, they may not be successful in achieving patient-centered care. However, it has been shown time and time again, that an organization will be successful in achieving key results once it focuses on shaping a culture to match its strategic objectives. Leaders must be very intentional in communicating the priorities of the organization and then supporting those same priorities through their actions.

About the author

Roxanne Shanks, MBA, is a senior associate at Fitch & Associates. She serves as the CEO for LifeFlight Eagle Air Medical Program in Kansas City, Mo., and also as the executive director for the Association of Critical Care Transport in Platte City, Mo. She has an extensive background in healthcare leadership with more than 20 years of experience in progressively responsible clinical and leadership roles within an integrated delivery system. She can be reached at rshanks@lifeflighteagle.org.

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