NORWALK — A book urging sick people to question hospital protocols is a factor in the move to reform health care sooner rather than later, Dr. Ryan O’Connell said Wednesday. Patients simply knowing where to go for treatment is another factor, he said.
O’Connell was part of a three-doctor panel responding to Randi Redmond Oster, author of “Questioning Protocol,” at a morning meeting of the Connecticut Health Council in Norwalk on Wednesday. Redmond Oster’s talk, titled “The Patient is the Future,” centered on her experiences as the mother of a teenager with Crohn’s Disease who needed hospital care, and touched upon the impact of the Affordable Care Act on hospitals, market forces, and the need to adapt or go the way of Kodak, the now-defunct camera film giant.
“We need to figure out the fastest way to get there and I am here to help,” she said.
Redmond Oster said that part of her 18-year career at GE involved leading a team of professionals in designing electronics for stealth bombers. She applied the skills she learned as an executive to health care, suggesting simple techniques to improve patient experiences. For example: A preprinted diagram of the human body so a doctor can draw on it rather than scribble a bad sketch on whatever spare piece of paper that is around to illustrate a patient’s condition.
She produced charts, including one representing patient feedback in a comparison of hospitals. Connecticut did not excel; on most bars it was tied with other states and on some it was behind. It was not ahead in any area.
“If I had numbers such as these in GE that were in the ‘60s, ‘70s, and ‘80s, I would have been fired. Now, there are people sitting there right now and they are saying, ‘You know, Randi, you can’t compare healthcare to a business,’” Redmond Oster said. “But here is what I am going to tell you: the game has changed for your patients, for your customers. They are getting this information and, even bigger than that, the money is coming out of their pocket right now. And when the money is coming out of their pocket, they are asking more questions.”
She met with a struggling hospital two weeks ago, she said. People aren’t coming in because they know they will have to pay. People think that maybe, if they wait until October, they will have hit their deductible, she said.
“That is changing your game. That is changing the mindset and that is what we as a group have to see,” Redmond Oster said.
She rolled out business techniques she had tailored to healthcare use as possible tools to be used to improve patient experience. But it’s totally free just to say “hello” to someone when you see them in the cafeteria, she said. As a mom with a son who was hospitalized, she would have been very appreciative of a hug, she said.
“What is exciting is we are starting to have this conversation,” said Daniel Gottschall, who also was on Wednesday’s panel. “We are starting to talk about things that in reading Randi’s book, we took for granted . . . For the first time we are not only talking about the quality, we are starting to talk about the patient experience.”
“The old school was sort of geared around what was good for the doctor’s schedule rather than the patient or family,” said Dr. Peter Bowers. “I don’t think that is totally gone, but I think it’s better. I think one of the reasons why is, as people become exposed to cost . . . people are really beginning to ask.”
Audience member Sharon Gauthier RN/MSN, executive director of Patient Advocate For You, said the problems go beyond the interior of hospitals.
“We now have physician groups that are being bought by hospitals and part of that is now they are requiring physicians to see 28 to 30 patients a day. So it starts before they get to the hospital level even though we gain control of our patients, so to speak, when they enter the hospital. So we also have to address that, in an eight-hour day, to see 28 patients is huge,” she said.
Practices like that won’t keep people out of hospitals because doctors aren’t getting the information they need, she said.
O’Connell said he had worked under those conditions 10 years ago. “I don’t think anybody thinks that is the best-practice model,” he said, advocating for a value-based system rather than a volume-based system.
Stephen Glick, of the Chamber Insurance Trust (CIT), said 14 percent of the people who have signed up for insurance through the Affordable Care Act could not explain a deductible or co-insurance.
“The reality is people don’t understand. We need education. The institutions, our Access Health, did a great job in creating a product but they didn’t create a product where people understand what they bought,” Glick said.
He said people need to be taught the basic terminology of insurance.
“We have people who want to reverse their decisions and the problem is they can’t until January,” he said. “You have a liability of $6,350 and people didn’t realize that. They’re not going to the doctor. They are winding up going to the emergency room.”
Oz Griebel, president and CEO of the MetroHartford Alliance, agreed that there is a need for education as there are people who may be buying health insurance for the first time.
Redmond Oster said the feedback she has received is similar to people’s feelings about restaurants: if they complain, someone may spit in their food.
“We need to educate them so that they understand what their insurance is, because they don’t understand that and they are getting these bills,” Redmond Oster said. “The second part is we do need to help them understand how this system works. By helping and empowering them we are going to give them the tools that they need to reduce the time that they need with the providers.”
O’Connell said hospitals can do simple things, like allow nurses to contact doctors to try to reverse an order not to have any salt.
“There is some institutional inertia that prevents us from doing that,” he said. “We are in a watershed period when we are going from the old guard and just thinking about patient’s disease and making that disease go away. We weren’t caring what their family was going to think. We may not be moving as fast as we should be but I think that the market forces are going to drive us . . . Those of us who can do it well and move quickly and adapt will do well. Those of us who can’t will pay the price.”