This post is the fifth and
final in an ongoing series
about patient- and
My first and only time in a hot air balloon was in Gallup, New Mexico. I lived in the Land of Enchantment for two years after my freshmen year in college. One year in December I decided to attend the Red Rock Balloon Rally that is held every year outside Gallup. A friend of mine discovered that volunteers who helped set up the balloons could be given a ride by the owners of the balloon. We quickly signed up and I soon found myself riding in a woven wicker basket several hundred feet in the air.
My entire perspective changed once I reached such a high altitude. I could see the tops of the beautiful red rock formations and the countless sage brushes surrounding them. At one point we silently floated above a herd of horses that calmly munched on desert grass. They never looked up. Beyond the horses I could see miles and miles of New Mexico scenery including the city with buildings and homes, interstate highway 40 with cars and trucks, and almost the entire canyon with various flora and fauna.
Once we landed, I helped fold the giant envelope ("balloon”) which consisted of large nylon panels sewn together. The basket, which seemed so light in the air, was now heavy and unwieldy. With everyone working together, we managed to place it back in the trailer hitched to a large truck. At this point, I realized that my perspective had returned to normal and yet felt different at the same time. I had experienced an amazing aerial view of the gorgeous desert landscape and now I was back to my normal 5’7” altitude. But in my mind’s eye I could picture how everything seemed to be connected together and how small I was compared to it all. My perception of the world had changed.
|When you can see the forest for the trees you get the big picture|
I have had similar "high altitude” experiences since then, and, no, they did not involve mind-altering substances (I know that’s what you were thinking! Who needs drugs when you have systems theory?). The first time I learned about systems theory in graduate school is one experience that comes to mind. Also, putting together this blog series has been another one. When you can see the forest for the trees you get the big picture; you notice the interconnectedness of everything around you. That can be an exciting and humbling sensation all at the same time. Learning about how strong and large of a movement patient- and family-centered care has become in recent years has been both enlightening and daunting to me. How exciting it is to discover new allies who advocate for patient and family welfare! How formidable it must feel to implement such impressive change at a large hospital! To end this series, I want to share just a few thoughts I have had since interviewing Rachel, Bonnie, Licia, and Joana.
Patient Advisors play a significant role in the model of patient- and family-centered care (PFCC) that the Institute of Patient- and Family-Centered Care (IPFCC) supports. I cannot think of a more effective way to promote patient and family voices than to include them in patient care, new employee training and orientation, and planning committees, to name a few. What this strategy suggests is that non-hierarchical, collaborative relationships facilitate optimal care and that both patients and health professionals can bring their own expertise to the table. New communication technology will continue to improve this collaboration between patients/families and physicians (Click here for an example).
Patient Advisors seem to create a culture of "we/together” as opposed to "me/them” and this change can happen on all service levels (housekeepers, nurses, physicians, administration, etc.) such that patients and families really feel like stakeholders in a hospital system. The great thing is that it seems the inclusion of Patient Advisors comes at little to no cost and may even lead to cost savings (reducing medical errors, increasing recovery time, improving discharge experience, and perhaps even reducing number of re-admissions). Although there are probably shortcomings to this approach, none really come to mind right now. As Rachel Biblow-Leone from Philadelphia says in the first post, "Family-centered care can seem like common sense, but we know common sense is not always commonly practiced”.
That quote brings me to my second thought. How does one elicit such important change on both an interprofessional level (one on one) as well as on a large, system-wide level? The ladies I interviewed all seemed to agree that it is easy for health professionals to feel defensive when they are asked to collaborate more with patients and families. That is part of human nature especially when a person is satisfied with the status quo (homeostasis anyone?). I even asked myself these questions: How collaborative am I? How often do I empower patients and families in their own health care? How can I encourage my colleagues to practice PFCC?
It seems then to me that implementing change requires a certain degree of humility because you are inviting people to see their work a different way, to be willing to succeed and fail together in figuring out what improved care looks like at your organization. In addition, leadership is integral as well. Licia Berry-Berard at Darmouth told me how she and other like-minded colleagues implemented change on a small scale and then worked hard to help others, including hospital leaders, catch the vision. Bonnie Nicholas at Thunder Bay told me that change began at the top with the CEO and the Chief Nursing Executive calling for a new care model. In both examples, change was ultimately effective because hospital leaders became involved. Change can start from the bottom or the top, but eventually leaders must catch the vision of PFCC for organization-wide change to happen. Otherwise, change stays local and restrained.
I am not a narrative therapist but I do believe in the power of stories, metaphors, and analogies because they are basic tools for learning and expression. Stories have been around nearly as long as human beings have been and they are integral to our collective wisdom, history, and sense of humanity. I was impressed to hear how integral stories became in creating a new culture of care at these hospitals. The stories told by patients and family members resonate with hospital leaders and bring a perspective that statistical data cannot replicate. How do we use stories in our clinical or educational responsibilities? How can we pair stories with strong strategic initiatives and outcomes?
Finally, I wonder how PFCC works in primary care. The goal of this series was to highlight hospitals that provide PFCC but I am left wondering what would this model look like in primary care? Most of my experience has been in primary care and I am passionate about the roles that primary care physicians and behavioral health providers play as frontline health professionals. Although the IPFCC model may look a little different in primary care, I imagine that the principles would remain the same: patients and families should be partners in their own care; families are essential to the health and recovery of patients (Click here for a link). In fact, the Patient-Centered Medical Home model is a model that is designed to facilitate patient-provider collaboration in primary care, implement behavioral healthcare and care management, and involve patients and families in quality improvement. It would be interesting to see how these models compare with each other.
In the end, it is encouraging to find new friends in the movement to put patients and family members front and center in healthcare. It also amazing to reach a new "high altitude”, to see the incredible change that others are making in this field, and to recognize that we are partners together in making change (parallel processes, isomorphism anyone?). I guess you don’t always need a hot air balloon to see the big picture.
|Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.|