News and Commentary The Next Level of Patient Partnerships

There has been increasing focus on understanding how patients view their own roles within health care delivery and how to better engage them as full partners in their care. Last year, the Josiah Macy Jr. Foundation issued a set of Conference Recommendations to foster partnerships among patients, families, communities, and health professions education and clinical practice organizations. In December 2014, members of the Institute of Medicine’s Roundtable on Value & Science-Driven Health Care released a white paper on the closely-related topic of forging effective partnerships between patients and their health care teams. Macy Special Advisor to the President Stephen Schoenbaum, MD, MPH, one of the co-authors of that paper, shares his views on what it will take to make patients truly feel a part of the health care team.

Q: What did the IOM learn about patients as partners with their health care teams?
SS: We have good evidence that patients, particularly those with chronic conditions, benefit when care is delivered by an interdisciplinary team of health professionals. Health care professionals, however, still have a long way to go to create effective partnerships with patients.

Q: There is so much focus now on patient centered care. Is that misused or exaggerated?
SS: At the moment there is a lot of lip service being paid to patient-centered care. But in fact, a lot of what is said to be patient centered isn’t that at all. It’s true that a growing number of primary care practices are being designated as patient-centered care medical homes. But what the IOM committee found – even in our limited research – is that practices that thought they were providing a team-based model of care weren’t always perceived as having one by their patients. And, patients didn’t always feel like they were being treated as a member of the team when there was one. There is literature on patient activation or engagement so that patients become interested in and knowledgeable about taking on a major role in their own care. But our research showed that while a number of practice settings are interested in engaging patients, there is very little in the literature giving guidance about how teams of health professionals can best establish a partnership with patients.

Q: What is it going to take to develop models that others can look to?
SS: This very much relates to the subject of the Macy conference held last April (2014) on “Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education.” There tends to be a fear that if we do new or different things that benefit the patient those efforts will somehow impose a substantial cost on providers. I have not found any evidence to support that opinion. The only way it is going to change is when there are leaders within the health system who truly understand the value of involving and serving patients in a more deliberate and intentional way and that doing so will be a “win-win.” Patients must be an integral part of the process of health care delivery redesign and the process of designing interprofessional education (IPE) programs so we can create models for others to draw from.

Q: What is your message to the health professions’ education field?
SS: Health professionals need to learn how to establish partnerships as well as how to function in teams with their colleagues. IPE is now a core part of learning to foster better teamwork to yield good patient outcomes. But the next level needs to address how we can also better partner with our patients and link them to the health care team in the most effective way.

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