Patients are Untapped Experts

Click Here to See Maureen Bisognano's Day 1 Presentation with Slides

Maureen Bisognano understands exactly what needs to be done to transform  the current health care delivery  system. Not just because she is president and CEO of the Institute for Healthcare Improvement, which created the Triple Aim approach to reforming health care. Not just because she has worked as both a nurse and a hospital CEO, responsible for  developing a comprehensive quality improvement program at her hospital.  Not just because she has worked closely with some of the most respected quality experts in the world. Her understanding and effectiveness comes largely from her passion for what she does and for those who rely on the health care system.

 “We’ve been building a system around us,” she told more than 300 health care providers present at the 4th Annual South Carolina Patient Safety Symposium held in Columbia, SC. “We need to build it around the patient. We can do a whole lot better.”

She urged health care workers to remember the journeys we travel with our patients.  “The greatest untapped resource we have is the wisdom of patients and families. How do we bring them in?”

One recommendation is not to simply ask “How was your care?”  Instead, invite the patient to “tell me about your life.”  Then, as Bisognano often does, she revealed what she had learned from a patient named Gilbert, a paraplegic who shared with her what it was like when a tire on his wheelchair went flat and needed replacement.  The entire process took three weeks and involved getting a prescription from his doctor, waiting for the number of bids required by Medicare before a tire could be purchased and shipping it to the doctor’s office. Then Gilbert made an appointment with the doctor’s office only to make an agonizing trip on his flat tire to have the new one installed.

How does he get around during that three week period?  He rolls the wheelchair with the flat tire, which creates a lot of pain in his shoulder. 

Admitting that in her many years in health care she had never considered the problems caused by a flat tire, Bisognano  compared Gilbert’s experience to that of a motorist who can get road assistance to change  a flat automobile tire in an hour.

Encouraged by having someone really listen to him, Gilbert went on to explain that Medicare covers only 15 catheters per month, yet he catheterizes himself four to six times each day. So he has to clean his catheters very well before he  reuses  them.  He talked of the reaction of those who catch him in the men’s room at work scrubbing the catheter. He explained that  he had tried using the microwave in the employee lounge to speed up the process, but that didn’t go over very well.  The situation is both embarrassing and dangerous to Gilbert, who ends up in the hospital six to seven times each year due to infections from reusing catheters. It’s also costly to Medicare which pays for several hospital stays each year that could be prevented if the program allowed Gilbert an adequate supply of clean catheters.

We can put the pieces together to solve Gilbert’s problems, Bisognano said, but we can’t just do it for Gilbert. We have to do it for everyone who struggles with Gilbert’s problem.  And we don’t even know what their problems are unless we take the time to ask and listen.
“In a lot of cases we can’t do anything about the burden of the disease, but we can do something about the burden of the treatment,” she advised.

05-18-2011 10:06 (EDT)