Coordination of Care: The Challenge of Our Times

Added on Mar 18, 2014

The findings of the recent Press Ganey analysis of patient loyalty offer useful insight beyond the seemingly intuitive observation that patients want physicians who inspire confidence. 

Certainly, the analysis has yielded a useful tool: a method for stratifying patients, providers, and even individual physicians according to the strength of commitment of patients to medical group practices. But, what have we actually learned?

In one sense, the findings are familiar. Research on patient experience has long showed that patients really care about what used to be called “bedside manner”—the way clinicians interact with patients, which shapes the confidence that patients have in them. Food and parking seem important at those moments when patients are eating or parking their cars, but patients have always been very aware that they aren’t going to doctors or hospitals for a dining experience. They are seeking medical care.

But the striking, and even stunning, take-home message from this analysis is the importance that patients place on how their clinicians are working together. Even if clinicians inspire confidence as individuals, the analysis suggests if patients do not feel sure that there is real teamwork among the people taking care of them they may leave the physician and practice.

This is something qualitatively new about our times. Patients have figured out that medicine has changed. There has been so much medical progress that no individual clinician can master it all. It takes groups of providers to deliver the best care, even for healthy people. The idea that one doctor can take full responsibility for meeting a patient’s health care needs is fading into history.

Now, it would be fabulous if yesteryear’s all-caring physicians were being replaced by close-knit, effective teams who remembered every patient’s issues and worries. But, that is not always the case. Terrific teams are the exception, not the rule. The result is something approaching a crisis in health care caused by a lack of care coordination.

The health care system accomplishes more each year, but that means more people are involved in care. This is a problematic dynamic. The particular crisis points for patients are hospitalizations and other episodes of care in which they cannot get a straight answer, where they have no idea what is happening next and where they have no reason to believe that clinicians are talking to each other. In my own practice, I can sense the fear in my patients and their families.  I know it is my duty to reassure them and actively demonstrate that we are working together on their behalf.   

It’s also an opportunity. If providers can earn patients’ trust that they are working together, that care really is coordinated, then their patients are going to stay with them. No one wants to contribute to poorly coordinated care. There is a sense of pride and professional satisfaction knowing that the care you provide allows patients to feel safe with their current care system. But this takes work. Real teamwork is an endless challenge. The physicians who earn the loyalty of their patients are those who rise to this challenge every day.