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Interview
by Leigh Morgan Ever since she entered nursing school at the University of Calgary, Susan MacRae, RN, has taken an interest in holistic models of care. After practicing as an oncology nurse specializing in surgery and rehabilitation, she enrolled in the MacLean Center for Clinical Medical Ethics at the University of Chicago and later served as ethics program coordinator for a Cook County public hospital, where she focused on a patient-centered approach. “We started looking at what was happening at the bedside as the very core of the organization’s strategic plan,” she said. In 1997, MacRae became a research and development associate at the Picker Institute in Boston, a nonprofit organization focused on the patient-centered care movement. There she is studying quality improvement and the best practices in healthcare delivery. MacRae has spent much of the last year traveling around the country to meet with CEOs, nurses, physicians, and other staff from healthcare organizations that emphasize patient-centered care. Q: What’s the single most important step healthcare leaders can take in improving patient care? A: Design and develop your program around what patients say they need. Quality really has two dimensions. One is technical excellence—the skill of professionals and the effectiveness of equipment, procedures, and systems. But the other has to do with subjective experience, the perception of wellness and health through the patient’s eyes. In many cases, patients are the only ones who can judge aspects of quality, and it’s wrong to assume that patients and healthcare professionals want the same thing. For example, ask healthcare professionals what a top concern is of women with breast cancer, and they will give you a lot of descriptors about treatment and infection and so forth. But one primary concern of a breast cancer patient might be “Can I drive and wear a seat belt?” It’s really about trying to listen, with an understanding that the person who is affected by the illness is the one who matters. Q: Can you give an example of a common problem that has a simple and often overlooked solution? A: A big problem is a lack of information in the healing process. All sorts of data suggest that better health information yields better outcomes, yet patients consistently report that they’re not getting enough information about what’s going on with them. There are many easy, simple ways to provide it. Open the doors of your library to patients and family members. Provide credible Web sites. Give patients informational material to take home, so they can hear it when they’re ready. Give them workbooks or diaries so they can do their own self-assessments and have a place to record questions. There’s also something called “coached care programs” that are like confidence training for patients before they see a doctor. The program teaches patients how to ask the right questions, how to interrupt, and how to get out of the encounter what they want. Q: What role can health professionals play in improving patient care? A: I think staff need to become educated in how the healthcare game has changed in terms of shorter length of stay, fewer resources, more informed patients, and rising expectations. With less time now in health care, let’s begin each interaction by asking patients what they need. Some hospitals have had a lot of success by having the nurse start off by asking, “How can I help you?” We should make it a regular part of our work to ask patients about their experiences without a task associated with it. I think that patients really are our greatest teachers, and if we can just listen to what they have to say, they’re not asking for a lot. |
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