Added September 12, 2018

1. Give Patients a Clear Path to Health and Wellness

According to a Harvard Business Review study accomplished over six years, patient to care provider communication is the largest factor contributing to patient complications and readmissions.

“Findings from our [HBR] research using six years of data from nearly 3,000 acute-care hospitals suggest that it is the communication between caregivers and patients that have the largest impact on reducing readmissions. In fact, the results indicate that a hospital would, on average, reduce its readmission rate by 5% if it were to prioritize communication with the patients in addition to complying with evidence-based standards of care.”

Receiving care can be an overwhelming and frequently confusing experience. A patient might not even know why they are at the hospital or to what extent the hospital is required in their care. This new experience can be frightening and leave the patient shell-shocked, wanting to leave as quickly as possible.

The goal of treatment isn’t to leave the patient dazed and confused. It is to enable the patient to enter the care facility, receive treatment from the care team, get educated, and have all the resources they need to adopt care when they return home.

The first step to ensure the adoption of care when the patient returns home is to give patients a clear path to health and wellness.

Treatment that results in health and wellness requires that the patient is able to see into their stay at the hospital the end goal of the treatment. When a patient feels like they are being blindfolded at the hospital; going from person to person and room to room, they are unable to be totally mentally and physically invested in their treatment. Giving a patient a clear path into their care requires the care facility to make an extra effort at communicating with their patients. Some ways they can achieve this include:

• Clearly, communicate the reason for being at the hospital
• Begin by outlining the specific goals and milestones needed for discharge
• Articulate what the patient should aspect while staying at the hospital
• From the beginning introduce all care providers and build a relationship of trust
• Enlist patients in being active participants in their care

2. Create A Culture-Centered on The Value of the Patient

According to the Journal of Safety, there are between 210,000 and 440,000 preventable medical related issues each year. These issues can be brought on by poor procedures from the care team. They are preventable and create unnecessary harm to the patient.

It is difficult, or near impossible, to give patients a clear path to health and wellness without having the care team on-board focused on value-based healthcare. Treatment mistakes, complications, and unnecessary readmissions can be overcome by creating a culture centered on the patient. It requires a team to think in terms of the value they provide verse the number of patients they are required to take care of.

Valued based healthcare focuses on the end goal of the treatment. Which is to get better, permanently. To make this change, the care provider would need to become a patient coach designed to teach the patient how to stay healthy at home when they the ones primarily responsible for their care.

3. Get Patient Buy-In

To ensure care adoption, patients need to be on-board. Giving a patient the ability to take the lead in their own care is empowering. However, it can be frightening as well. To get patient buy-in, a care team needs to put the patient in the driver seat from day one. If the patient depends on the doctor, and everything is taken care of for them, they will always depend on their doctors and care team.

On the other hand, when a patient is taught and shown the path they need to take for health and wellness from the beginning of their treatment; and then given enough space to start leading out on their own, they have a higher chance of supporting themselves after discharge.

Here are a few things you can do to give the patient control over their care and health:

• Give the patient some say in their care plan
• Allow the patient to see success when following their care plan
• Communicate the mental and physical consequences of failure to adopt a care plan
• Get and keep the patient enthusiastic about their care plan

4. Prepare Patients for the Transition of Care

In a survey accomplished by ScienceDirect, 53% of survey respondents “reported that a patient of theirs had experienced an adverse event” during the transition of care.

The greatest risk of not achieving care adoption for a patient happens during the transition of care. When a patient gets discharged from a behavioral health facility or moves from long-term care to home or acute care to home there is a period that the patient is left in the dark. This period is critical for a patient in making sure they take everything they have received from their care team and implement it in a way that keeps them healthy.

To ensure care adoption, care teams must prepare patients for the transition of care.

According to Mary Naylor, PhD, RN, FAAN and Stacen A Keating, PhD, RN, providing care transition coaching is linked to lower adverse events, higher satisfaction with care, and lower rehospitalization rates.

“A multidisciplinary team at the University of Colorado Health Sciences Center in Denver tested an intervention designed to encourage older patients and their family caregivers to assume more active roles during care transitions. An advanced practice nurse (APN) served as the ‘transitions coach,’ teaching the patient and caregiver skills needed to promote cross-site continuity of care. Coaching began in the hospital and continued for 30 days after discharge. A randomized, controlled trial found that patients who received this intervention had lower all-cause rehospitalization rates through 90 days after discharge compared with control patients. At six months, mean hospital costs were approximately $500 less for patients in the intervention group compared with controls”

• Transitional Care: Moving patients from one care setting to another, Mary Naylor, PhD, RN, FAAN and Stacen A Keating, PhD, RN

By preparing patients for life after the hospital and giving patients the coaching and education needed, can create a smooth transition home without any care gaps. This process can put patients in the driver seat as they enter the post-discharge home setting.

5. Support Patients at Home

To ensure care adoption, care can’t end upon discharge. After discharge, at home, is where the rubber really meets the road. Patients who have been coached that they are going to be responsible for their care at home and moving forward will enter the home setting mentally prepared to manage their own health.

There are many ways the care team can continue to support the patient while at home:

1. Provide the patient with on-going care plan support
2. Continue to communicate with the patient
3. Get the patient’s family involved
4. Show the patient positive results

Hospitals and behavioral health facilities are looking to see patients stay healthy. Through a focus on value-based healthcare and putting patients at the center of their care, care teams can give patients the direct and indirect support to completely adopt care.