A psychological phenomenon called "moral self-licensing" may help explain how good deeds lead to bad behavior, like cheating. Photo by Santeri Viinamäki (CC SA 4.0)
Interest in person-centered care has grown exponentially in the last decade. More and more health care organizations have made patient-centeredness an integral part of their strategy. Many policy-makers, regulators, and payers reward or require efforts to enhance the patient experience.
I’m encouraged by this progress. But sometimes I get an uneasy feeling about it.
When I see hospitals doing things like measuring patient satisfaction instead of evaluating patient engagement, I wonder how far we’ve really come. Is all this talk about patient-centered care really leading to better outcomes for patients and communities?
One of the main ways health systems have attempted to involve patients is through Patient and Family Advisory Councils (PFACs). A hospital’s PFAC is composed of patients and family members who volunteer to work with staff to improve the care experience. Over the past few years, many health care systems have established PFACs. In fact, a Massachusetts law requires all hospitals to establish these councils.
In theory, PFACs could accelerate health care’s journey towards patient-centeredness by “changing the balance of power” and integrating the user into the forefront of health care design and practice. And I have heard wonderful stories of health systems that reoriented their focus and actions based on the meaningful engagement of PFACs.
Yet I fear that the existence of PFACs may also unconsciously allow health system staff members to think that being patient-centered is like an item you can check off a to-do list instead of an ongoing pursuit.
How Human Psychology Can Deceive Us
A fascinating phenomenon called moral self-licensing may offer some insight into the problem. According to the research, people are more likely to engage in problematic behaviors if they have previously done something they consider altruistic or “good.”
For example, in one study, participants who selected a woman for a consulting job were later more likely to suggest men were better suited than women for a stereotypically masculine job. Another study found that participants were more likely to cheat on a math problem when asked to remember a past moral action, rather than a past immoral action. I heard about this phenomenon recently on Malcolm Gladwell’s Revisionist History podcast (Episode 01 “The Lady Vanishes”).
I think it’s possible that PFACs allow health system staff to engage in their own version of moral self-licensing. Their brain sends the message: “We have a PFAC. We must be patient-centered.” Consequently, they fail to take full advantage of the perspectives of their PFAC members or the day-to-day perspective of users in their system. They settle for getting a minimal amount of their input.
Many PFAC members I’ve talked to say that staff members only ask them to do superficial tasks (like reviewing patient brochures or food menus) or involve them in meaningless conversations. It’s not that menus and brochures aren’t important, but if that’s all you’re asking your PFAC members to do, you’re not using this resource to its full potential. Great ideas, organizational energy, and goodwill may be going to waste.
How to Avoid PFAC Pitfalls
We would never assume that simply establishing a patient safety committee means we don’t have to be constantly vigilant about potential harm to our patients. Patient-centeredness requires similar dedication.
We should all be aware of the potential risk of our unconscious to fool us into thinking we’ve made more progress on patient-centeredness than we really have. Here are a few ways to avoid this trap:
- Raise awareness — Communicate to staff that having a PFAC does not automatically make your organization patient-centered. Highlight the risk of this unconscious tendency so people can guard against it.
- Have your PFAC do meaningful work — Expend organizational energy to engage council members in redesign and the sometimes difficult conversations about opportunities for improvement.
- Go beyond establishing a PFAC — Consider the many other ways to engage users in the design and engagement of their care. In IHI’s work on Always Events, we have seen organizations get creative about how to integrate the patient perspective into everyday work. For example, improvement teams chatted with patients in waiting rooms to get their ideas, put out a call to mothers of newborns on Facebook to identify priority areas, talked with caregivers visiting their loved ones, and tested “at the elbow coaching” with managers providing real-time feedback to point-of-care staff on how to engage patients. These dispersed efforts allowed staff to hear directly from those who may not be able to serve on councils.
When done right, PFACs can be powerful sources of change. I am hopeful that with some awareness, organizations can turn the will of these devoted volunteers into actions that advance the agenda we all share — a health care system that engages users in co-design and co-production to creates optimal health for all.
Christina Gunther-Murphy is an IHI Executive Director and oversees IHI’s Person- and Family-Centered Care Focus Area. She is faculty for the upcoming program, Co-Design College, which teaches participants how to involve patients in improving care.
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