Accountability. As children, we are taught that our actions have consequences and that we must be responsible for our own behaviors if we are to live as free and independent adults.
This simple life lesson has been shaping the healthcare landscape for some time now as hospitals, individual clinicians and other healthcare providers face increasing requirements to participate in Accountable Care Organizations and provide performance measures indicating accountability for patient outcomes—efforts that have successfully improved the quality of care for many. But what about the patients themselves?
“The greatest untapped resource in healthcare is the patient,” says Don Kemper, MPH, Founder and CEO of Healthwise, a non-profit organization with a mission to help people make better health decisions. “The time has come for people to ask more of themselves in managing their health.”
According to the authors of a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures, patient participation and engagement are integral to the success of any treatment plan–a position echoed by the American Medical Association and the Institute of Medicine.
So how can we, as consumers of healthcare services, be more accountable for our own care? The authors of the ACC/AHA report suggest that “the general framework of shared accountability is predicated on partnerships between patients and clinicians, in which patients play an active role in setting goals, making treatment decisions and assessing outcomes. Ideally, patients would be aware of what to watch for, contact their clinicians when symptoms arise, learn about their condition and what they can do to improve their health, implement agreed-on treatment plans and lifestyle changes, and follow up with their clinicians to assess outcomes and adjust the treatment plan.”
“Developing a trusted relationship is key,” adds Nancy Carteron, M.D., HealthWell board member, rheumatologies, and autoimmune disease specialist at California Pacific Medical Center in San Francisco and Associate Clinical Professor at the University of California at San Francisco. “Patients need to feel heard, but from a physician’s standpoint, the limited time they have with patients can make that hard to accomplish, especially for complex illnesses. It may require the provider to restructure its practice. And if the patient does not feel their best interest is being served, they should try another provider or system.”
Healthwise’s Kemper suggests that patients focus on “patienthood”—the self-management behavior that ensures we either give to ourselves or get from others the care we need to best manage our health risks and medical problems.
“Each of us falls somewhere on the continuum of patienthood,” Kemper says. “The extremes can range from annual tooth brushing to self-surgery, but most of us fall well in the middle. And for most of us, it’s possible to do more for ourselves, especially with the right information, tools and expectations.”
“We should feel accountable for asking questions anytime we don’t understand our options, anytime we think something may not be right with our care, and anytime we have an idea for how we might contribute to the care,” Kemper adds. “And we should be accountable for adhering to any self-care plan we have agreed to follow—or to report why we have veered away from it.”
Are you someone who has started to take more personal accountability for your own care? Tell us what you’ve done to be a healthier, more involved patient. Are you a healthcare provider who has seen an improvement in patient outcomes when the patient is highly involved in his or her own care? Share your stories with us in the comments section.