Plenary Presentation, IHI National Forum on Quality Improvement in Health Care

December 4, 2003

What can we do to redesign the patient experience? IHI offers these seven challenges to you and your organization. They comprise promising hypotheses, some tested but none rigorously studied. If you decide to take on one or more of them, you will not be alone – you will join other courageous colleagues in an online community hosted by IHI. 

• Challenge #1: Give medical records to patients…no cost, no fetters, no conditions
  • The Institute of Medicine reminds us in its Crossing the Quality Chasm report that "growing scientific literature shows that informed patients participating actively in decisions about their own care appear to have better outcomes, lower costs, and higher functional status than those held in more passive roles." We propose measuring satisfaction (patient and staff) and the number of clinically significant corrections made to the record by patients and family members.

• Challenge #2: Put care protocols in patients’ hands
  • Patients equipped with protocols for their own care, such as those available from the Institute for Clinical Systems Improvement (ICSI), can become active partners in providing their own evidence-based care, and informing their providers when elements of their care are inadvertently missing or forgotten.

• Challenge #3: Test the FACCT ASK agreement with ten patients
  • Effective communication is at the heart of the healing relationship, yet studies show that patient-provider communication is fraught with obstacles, including time pressures and weak communication skills. One solution might be a tool like the newly proposed FACCT ASK Agreement, which supports communication between the primary care physician and patient by setting expectations early in the relationship.

• Challenge #4: Enroll 200 patients in How's Your Health
  • A simple idea – to have what matters to patients better assessed, managed, and made part of everyday work. Well-planned, patient centered services result in improved practice efficiency and better patient outcomes. Technology can help "patient centered" office practices identify and manage the needs of their patients. One tool is the online How's Your Health survey, filled out by your patients with detailed reports sent to you corresponding to the IOM's dimensions of care.

• Challenge #5: Put patients and families on redesign teams as co-chairs
  • A few courageous organizations are asking patients and families not just to comment on their care, but to help design it. As true partners in the design of care systems, patients can help guide us to innovative and responsive processes that we may never have thought of unaided.
  • If your organization has involved patients and families in the redesign of care please join the Patient Centered Challenges discussion group and share your experience.

• Challenge #6: Implement open visiting in ICUs, EDs, and Recovery Rooms
  • "I believe that it is rational, humane, and even, to a responsible extent, 'evidence based' to do away with visiting restrictions in critical care units entirely. At the very least, 'customization' to the specific requests of individual patients would be much more consistent with authentic patient centeredness than any blanket restrictive policy would be." -- Don Berwick
  • Click here to read more about open visiting and learn about the experience of systems that have taken up this challenge.

• Challenge #7: Implement shared decision making processes for conditions such as prostatic hypertrophy and breast cancer
  • Medical decisions should reflect of evidence and values. The decisions that best serve a particular patient often depend critically on the patient's own preferences. The treatment that is best for one patient may not be what is best for another who is in exactly the same situation.
  • The Foundation for Informed Medical Decision Making, founded by Dr. Albert G. Mulley and Dr. John E. Wennberg, is one source of tools. It has created a portfolio of videotapes and Web-based decision aids about decisions related to some of the most common and important medical conditions.