Hot Talks – The History of the 'Patient Experience'

June 24, 2011 The patient experience is becoming a health sector priority, even if it may not feel like it when youre waiting in an emergency room for hours or a doctor limits your visit to 10 minutes.

The patient experience took centre stage earlier this week, when a group of health practitioners and advocates spoke at the Hot Talks on Health conference in Toronto, hosted by the Change Foundation, an independent think tank focusing on health issues.

Barbara Balik, a senior faculty member at the Institute of Healthcare Improvement in the US, delivered the keynote address. Panelists included Susan Eng , VP of CARP Advocacy, Danielle Martin click here for bio , Chair, Canadian Doctors for Medicare, and Adalsteinn Brown click here for bio , Chair, Public Health Policy, Dalla Lana School of Public Health University of Toronto.

The History of the Patient Experience

Balik discussed the evolution of the patient experience from the early days of healthcare to the present. In broad terms, she said, the history of the patient experience can be described in three stages: doing to patients, doing for patients, and doing with patients.

Doctors fixing patients and patients obediently following doctors orders characterized the doing to stage, which was common practice through the 1980s. Families were treated as visitors rather than participants, and there was little accountability and transparency in the administration of healthcare

The doing for stage saw an improvement in the treatment of patients, with doctors becoming more aware of client satisfaction and needs. Nevertheless, this stage was and in many places still is – characterized by a top-down approach to care, with doctors explaining processes and treatments, and managing expectations rather than working with patients to understand problems and deliver the best care.

The doing with stage is the next phase of the evolution of patient experience, and while its still hasnt taken firm root across the health system, it promises a more collaborative approach to caring for patients. In this stage, Balik argues, patients and their caregivers are fully involved in the planning and administration of care. Doctors are encouraged to engage patients in their treatment and better understand their needs and problems in order to design better, more personalized, and collaborative care.

Balik argues that working collaboratively with patients and caregivers not only improves the patient experience, but leads to a better system of care for all. It reduces wait times, unnecessary tests and procedures, and leads to more equity in the system.

Balik admits that most health systems and practitioners arent fully in the doing with stage. For instance, she mentioned a study that showed the average patient needs only two minutes to fully communicate their personal information. Unfortunately, the average doctor listens for no longer than 17 seconds.

Prioritizing the Patient Experience

According to Balik, the health system is making improvements, but more needs to be done to prioritize patients, their families and caregivers.

Speaking from a doctors perspective, Danielle Martin
click here for bio said we have to be careful to not simply expect doctors to do more with less. Like Balik, she believes doctors need to get better at talking with patients, understanding problems, and effectively communicating options.

She cautioned, however, against simply appeasing patients. For example, 98% of CT scans are medically unnecessary, but are often prescribed by doctors because everyone feels better doing something rather than nothing.

Doctors are one part of the patient equation, but Susan Eng discussed the crucial role of politics in any attempt to improve the health system. Only resolute political will – and the impetus provided by patients, healthcare providers, and voting Canadians – is likely to produce real changes to the healthcare system and how it is experienced by the patient.

There are certainly challenges ahead, but improving the patient experience is part and parcel with improving the health system as a whole.

Keywords: patient, wait times, treatment, doctors, healthcare