Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September

The Pivotal Role of Communication in Healthcare Reform and Risk Reduction

by Arnold Mackles, MD, MBA, LHRM
11-4-2 It’s all about communication! Despite having superbly trained healthcare providers, state-of-the-art medical technology, and well-established therapies at provider’s fingertips, the American healthcare industry remains beleaguered by unacceptable numbers of preventable medical and surgical mistakes.  A significant percentage of adverse events are simply caused by the inability to communicate effectively. Given the major focus today on healthcare reform and improved patient safety protocols, successful healthcare organizations will realize that effective communication is the key to reaching the Triple Aim of Better Health, Improved Care Experience, and Reduced Costs. Although errors resulting in patient harm have plagued the medical profession for generations, it has only been in recent years that healthcare professionals began to identify the root causes of these events.  Since IOM’s “To Err is Human: Creating a Safer Health System” came out 15 years ago, this landmark report has served as a thunderous wake-up call to the industry, leading to private initiatives and governmental reforms to improve patient safety and quality care. The healthcare industry now faces wide scale reforms that impact traditional methods of practice and provider reimbursement. Payments to providers will be linked to performance and patient outcomes. Third party payors no longer reimburse providers for hospital acquired conditions considered to be “never events.”  Hospitals with excessive 30-day readmission rates are currently facing reimbursement penalties for specific conditions. The Institute for Healthcare Improvement (IHI) considers healthcare reform to be a key component of an overall strategy to achieve the “Triple Aim.”   The First Component of the “Triple Aim:” Better Population Health The core principle of Better Population Health is that of identifying individuals in the community who are “at risk” for specific health issues and providing appropriate services needed to proactively improve health. This can be accomplished by reaching out with patient interviews, surveys, obtaining clinical information and data from payors.  This requires functional collaboration and communication among diverse healthcare providers to identify “at risk” patients requiring services and support. Although Better Population Health is a forthcoming goal for entire geographic areas, research has already shown how specific populations of high risk patients can receive safer and healthier care. For example, Lu and co-workers evaluated a population of hospital patients being discharge to skilled nursing facilities.  Hospital readmission rates, at both 30 and 60 days post-discharge, were significantly reduced by utilizing pharmacist medication reconciliation techniques, nursing oversight, and communication with providers to resolve discrepancies in discharge orders. The American retail industry has courted consumers for decades with phrases such as “the customer is always right.” For whatever reason, healthcare organizations are late arrivals to the notion that customer satisfaction is directly associated with higher quality products, services, and financial success. As a result, government healthcare reform has instituted measures to improve both patient satisfaction and patient outcomes.   The Second Component of the “Triple Aim:” An Improved Patient Care Experience A report by Health Grades revealed the important role that communication plays in both patient education and providing high quality care. The Health Grades study compared results of  a patient satisfaction survey, the HCAHPS Survey (Hospital Consumer Assessment of Healthcare Providers Systems) with the number of hospital adverse events as determined by specific patient safety indicators (PSI), established by the Agency for Healthcare Research and Quality (AHRQ).  The report found that “Hospitals with the highest ratings on nursing and physician communication had better track records with lower rates of the 13 patient safety indicators.”   The Third Component of the Triple Aim:” Reduce Per Capita Healthcare Costs Reducing costs while providing optimum patient care is the third facet of the triad of initiatives to improve overall healthcare.  To accomplish this goal, healthcare providers will need to practice evidence-based medicine and eliminate unnecessary tests and procedures. In addition, the Centers for Medicare and Medicaid Services (CMS) have introduced the Hospital Value Based Purchasing (VBP) Program, which provides financial incentives for quality of care, rather than for the numbers of medical and surgical procedures performed. By practicing safe, quality patient care hospitals can maximize bottom line performance by avoiding non-reimbursement situations and penalties imposed by governmental and third party payors. Preventable medical errors considered to be “never events” and excessive hospital readmissions can often be avoided by instituting effective communication initiatives coupled with process improvements. A good example is the ability to decrease hospital 30-day readmission rates by instituting a “Transition of Care Model.”  Essentially, these care models utilize an interdisciplinary team that helps a patient transition from hospital admission through discharge and the post-discharge period. The teams coordinate care throughout the process and educate patients as to their specific condition and care plan, both as an inpatient and after discharge. Follow-up calls or visits are made within 24-48 hours after discharge to check for any problems and to, once again, confirm that the patient is following the post-discharge plan.  A study by Coleman evaluated a transition of care model for hospitalized elderly patients. One group of patients had an intervention consisting of a transition coach, encouragement to participate in the care process, and post-discharge home visits and follow-up calls. The second or control group received routine care.  Results revealed that the intervention group had an 8.3% 30-day readmission rate while the control group was as high as 11.9%, providing further evidence that simple and effective communication does make a difference!   Indeed, significant progress has been made in the area of patient safety in recent years. Yet, there remains a great deal still to accomplish. Future success, and even the very survival of healthcare organizations, will depend on the ability of providers to utilize effective communication to promote quality care, patient satisfaction, and cost savings.   Bibliography Coleman EA, Parry C, Chalmers S, Min SJ. “The care transitions intervention: results of a randomized controlled trial.” Arch Intern Med. 2006; 166:1822-1828.  http://archinte.jamanetwork.com/article.aspx?articleid=410933 Accessed May 21, 2013 Health Grades. “Patient Safety and Satisfaction: the State of American Hospitals” Health Grades. 2012   Kohn, Corrigan and Donaldson.  Institute of Medicine; To Err is Human: Building a Better Health System; National Academy Press: 2000   Lu, Y., Clifford, P., Bjorneby, A. et al. “Quality improvement through implementation of discharge order reconciliation.”  American Journal of Health-System Pharmacy. May 1, 2013 vol. 70 no. 9 815-820; Abstract. http://www.ajhp.org/content/70/9/815 Full article: http://www.ajhp.org/content/70/9/815.full.pdf+html?hw-tma-check=true   Institute for Healthcare Improvement (IHI). “IHI Triple Aim Initiative.”  http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx   Accessed August 24, 2014   Mathews, C. “Healthcare’s Triple Aim.” Health Management Technology        http://www.healthmgttech.com/articles/201301/healthcares-triple-aim.php  Accessed August 24, 2014   McCarthy, D. Klein, S. “The Triple Aim Journey: Improving Population Health and Patients’ Experience of Care, While Reducing Costs.” The Commonwealth Fund, July 2010   http://www.commonwealthfund.org/publications/case-studies/2010/jul/triple-aim-improving-population-health Accessed August 24, 2014