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Should patients be accountable for poor health choices?


Why care and communication must be a two-way street with patients, providers

ManasIn 2009, legislators across the country held town hall meetings to discuss the Affordable Care Act (ACA). The dialogue was heated, regardless of party affiliation, and politicians were often put on the spot when asked if they had read the proposed law in its entirety.  

I attended my share of these meetings, and on two occasions, I spoke one-on-one with the host senators. During these conversations, I pointed out that the ACA contained a major flaw: It lacked true accountability for the patients it meant to protect.

For example, if a Medicare patient with congestive heart failure is discharged from the hospital with a prescription and instructions for following up fails to adhere and is readmitted two weeks later, the hospital is financially penalized and the patient suffers no disincentive.

Overcome personal barriers to address patient accountability >>

Active dialogue is key 

The example above demonstrates the long-standing dilemma of actively engaging patients and families in their care, and with consequences-positive and negative-for that engagement. At Sacred Heart and St. Joseph’s Hospitals in western Wisconsin, we have been moving along the continuum from traditional patient satisfaction to patient experience and, most recently, to patient and family engagement. Each method of care is different: 

Patient satisfaction: When putting forth effort to gain patients’ satisfaction, the focus tends to be on providing for the patients with them being passive recipients of care. At the extreme, it may even seem that the concerned is more with entertaining them than it is with diagnosis and treatment. Care is a series of individuals wandering in and out of the room, each with a task to complete.

Patient experience: The interaction of caregiver and patient is frequently still one-way, but with engagement, we grow more concerned with the overall physical environment. Care progresses beyond ensuring patient happiness levels and providers are more likely to work together for the greater good of the patient.

Patient engagement: Communication is a two-way street and patients are expected to answer questions, not just ask them. They become an integral part of the care team and speak up when they don’t understand something or don’t feel comfortable. Care extends to the family members and includes discussions regarding when  the patient is home, rather than focusing on their discharge.


Despite the importance of all three, patient engagement will have the most significant impact on clinical outcomes. One important way we have advanced from patient experience to engagement is through the Bedside Shift Report. When nurses hand off the care of a patient to their counterparts  on the next shift, they conduct these conversations in the patient’s room, with the patient and family member actively involved in the dialogue.

We hope to engage our patients further by allowing them access to their medical records via an online patient portal. As part of meaningful use stage 2, a minimum of 5% of patients must agree to sign up with the hospital’s provided portal and access it at least once during the subsequent three-month period.

Since 2009, the ACA became law without my advice being taken. With the lack of built-in patient accountability, it is now up to all of us in the industry to instill the need for patients to become more actively involved in their care. Patient engagement will continue to be a driving force behind the successful care delivery of tomorrow. 

Julie S. Manas is president and CEO of Hospital Sisters Health Systems (Western Wisconsin) and president and CEO of Sacred Heart Hospital.

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