What Matters to You? Flipping Health Care

Ninety-eight year old Millie lives with her son and family in a suburban neighborhood. Millie has been in the hospital 6 times this past year for problems related to heart failure. She has been back home for the past week. Millie doesn't have much of an appetite and so when she says she would like a whole, old-fashioned deli pickle with her lunch, her son doesn't question her.

If Millie wants to stay home (she says that's her goal) there are some dietary guidelines that she needs to follow. The salt in one pickle is more than half Millie's daily allotment. Millie's heart failure requires a balancing act. The amount of salt she takes in with her food affects that careful balance.

We have entered a new age of health care. Unfortunately, we haven't see huge dramatic changes, yet. Change requires many shifts in mind set and many shifts in how health care is delivered. Health care reform will challenge each of us to change how we think. The patient plays the central role in managing their conditions and the entire health care team is there to help improve health.

Flipping Healthcare

Healthcare should be flipped, delivered in a way that’s convenient for patients, not their providers, says Institute for Healthcare Improvement president and CEO Maureen Bisognano, who used the phrase in her National Forum keynote last month.

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The idea, borrowed from education ( “flipping the classroom,”) is that healthcare should be provided in a way that meets what the patient wants, and providers should be allowed to teach caregivers what they need and that caregivers should listen. “We need to flip from focusing on the medical condition to focusing on the patient,” Bisognano says. In this framework, the balance of care is “flipped” from the hospital to the community.

In many respects, the healthcare community has been health professional-centered. If a person is not feeling well, a call is made for an appointment and the patient goes to the doctor’s office or hospital. People are asked “what’s the matter, what’s wrong?” as opposed to “what matters to you?”

In the “flipped” care philosophy, the focus moves away from health care to health.

Home health care providers are at an advantage with this focus. We negotiate, as invited guests, the focus of the care being delivered. Home health care professionals are focused on care delivery as a care team, at work with other community professionals to treat patient- where they live. The balance of power shifts away from the healthcare team to the individual and their family in a health partnership to support the patient and family build skills and confidence they need to lead active and fulfilling lives.

What are the risks to the person’s safety in their home?
What are the risks to the person’s health in how they live?
What matters to the person?
What are the person’s goals?
What does he hope to gain from our visits?

Visits to a person’s home provides clues to what is important, what may affect her health, what lifestyle choices may need to be negotiated for change in order for health to be realized. Flipping care requires active listening to the patient: finding out what is important, what can be negotiated, and then aid and inspire patients to become informed about their conditions and take an active role in their treatment.

For Millie, flipping healthcare could mean understanding that the deli pickle is not a point of negotiation. She may decide that she is not willing to stop eating the pickle. Flipping care means that the home care team gives her the knowledge to make the decision to eat the whole deli pickle, and budget the balance of her daily salt allowed by understanding food labels and using a food chart to find the salt values in foods without labels.

Knowledge is power. This power, coupled with understanding the early signs and symptoms of heart failure trouble, will give her a plan with actions steps to communicate with her doctor on the telephone. Together they make medication adjustments. This power is much more preferable than treating the consequences of poor health management with another hospital stay.

Flipping healthcare matters to Millie.

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