Difficult, ongoing political debates about healthcare can make people feel powerless to affect change. Fortunately, there are many things people can do to make a difference.
Becker's tapped 10 industry leaders for 35 ideas on how patients, physicians, hospital leaders and policymakers can take action and positively contribute to healthcare today. Submissions are organized in alphabetical order.
Things individuals can do today.
Danielle Mitchell, MD, Candidate for Tennessee's 3rd Congressional District.
1. See a doctor! The first way to improve healthcare outcomes is by visiting a doctor and teaming up with someone who is truly interested in your well-being and will advocate for you. The ACA allows people to access these exact preventative services as well as acute care services. Preventing the crisis before it happens is the heart of positive healthcare outcomes and also reduces the economic and financial impacts our nation currently faces.
2. See a doctor who is invested in true prevention. True prevention should have a foundation in reducing the consumption of processed foods, exercising regularly, and investing in emotional well-being and sleep! With these four things in check, the burden of illness is often reduced and even avoided altogether.
3. Advocate for a system in our nation that gives everyone the opportunity to access healthcare. This can be achieved by electing government officials who are trained to care for you.
David Meltzer, MD, PhD, Director of the Center for Health and the Social Sciences and Affiliated Faculty in the Department of Economics and the Harris School of Public Policy, University of Chicago.
4. A problem many patients face is when they are getting care from a large number of doctors, they need to make sure they have a captain of the team. Find someone who is really going to take the lead in helping them coordinate their care and making sense of all the information and decisions and interventions coming in from many doctors.
One of the biggest problems we have right now is a healthcare system that is wildly fragmented. Often the sickest people are getting their care from many doctors who often don't understand all the aspects of the patient's problems and what the other doctors involved are doing. Try to find a doctor, often a generalist or at least a specialist, who is willing to function as a hub to help them bring it all together.
Rebecca Parker, MD, President of the American College of Emergency Physicians.
5. Volunteer with your local hospital. They need greeters, fundraisers, health fair workers, clothes for homeless, toys for kids and overall advocates. If you don't have time to volunteer, donate dollars. Most hospitals run on razor thin margins. Any help is much appreciated.
6. Learn CPR and first aid. It will save lives.
7. Understand your health insurance and ask your insurer questions. You're paying premiums; they should provide great coverage for primary care, emergency care and specialist care. Ask.
8. Realize that, in emergency departments, we must triage carefully during the busiest times. Sometimes there are ambulances coming in or leaving that you won't see. Also, if you start to feel worse, let your triage nurse know. Triage is the process of continual evaluation.
Peter Pronovost, MD, PhD, Senior Vice President for Safety and Quality, Johns Hopkins Medicine (Baltimore).
9. It's critically important you make sure to speak out when you have concerns. When you look at the bad things that happen in hospitals, in more than 90 percent of cases somebody knew something was wrong and didn't speak out or wasn't listened to. Patients have wisdom about their bodies that clinicians don't. Too often in medicine, we think the only domain of wisdom is how many years of experience you have in the field. But patient's experiential wisdom from living with the disease is often more important.
10. Get a second opinion for any concerning diagnosis or treatment plan. We know now diagnostic errors are one of the major causes of preventable harm. The science of how to measure them and reduce them is still immature. One practical thing to do is to get a second opinion. And if your physician is reluctant for you to get a second opinion, that would be a red flag.
11. If you're going to have a procedure, find out how many the physician and the hospital perform annually. There is overwhelming evidence that for virtually every procedure, the more you do the better the outcome. If your hospital or doctor does one or two or three of something, especially if it is high risk, I would be cautious about having your procedure there.
12. If you're going to have a major procedure, find out if your ICU is staffed by critical care physicians. The Leapfrog website provides this information. Your risk of dying if you're having high-risk surgery in the ICU is about 30 percent lower if you are treated by an intensivist in addition to your surgical team, rather than just your surgical team. Many patients don't even think to ask that.
13. Find out the hospital's ICU catheter infection rate. These infections used to kill more people than breast or prostate cancer. Years ago, we led a national effort [to raise catheter infection awareness], and now these infections are down by 80 percent across the U.S. And every type of hospital is able to do this, but some don't. What it takes to reduce these infections is showing you have a good quality management program because it requires leadership, declaring goals, a quality improvement infrastructure, accountability and transparency. Even if you're not worried about that type of infection, it's a "canary in the coal mine" measure — if a hospital has a low catheter infection rate, its a signal they've got a good quality program.
14. If you're leaving your health interaction, whether that's a hospital or a physician's office, make sure you're comfortable with your follow up plan. Before you leave, do a teach back or read back in your own words after listening to the doctor and explain your disease to them to confirm you understand it, explain your medication schedule, explain your follow up plan.
Things hospital leaders and physicians can do.
Bradley Hall, MD, President of the Federation of State Physician Health Programs.
16. Connect with your state's Physician Health Program. Almost every state in the U.S. has established Physician Health Programs. Such programs are based upon the concept that healthy physicians give the best and safest care. A PHP is a confidential resource for physicians and other licensed healthcare professionals suffering from addictive, psychiatric, medical, behavioral or other potentially impairing conditions.
17. Familiarize yourself with the PHP education and resources. One of the most important activities of a PHP is to educate physicians, healthcare administrators, hospitals and medical students regarding the prevention, early identification and treatment of addiction and other illnesses affecting physicians. Contact your PHP to gather resources for your medical staff. Many PHPs offer free or reasonable education about mental health issues that trouble physicians, including mood disorders, substance use disorders, burnout and work-life balance.
18. Establish a physician wellness committee in your institution. All medical institutions should have a wellness policy and program that promotes physician health. Some institutions are mandated to have these resources through law or credentialing agencies. Most state PHPs can assist with guideline development and wellness training among committee members within your institution.
19. Watch for signs of concern among your physicians and take action. Look for:
- Physical changes
- Behavioral changes
- Personality changes
- Workplace changes
- Life changes, including personal losses and decreased self-care
John Mach, MD, CMO of Evolent Health.
20. I offer these suggestions to primary care physicians. Don't wait for next year's patients to come to you. Go to them, go now and go in new ways. Predictive data modeling can show who will be hospitalized next year with accuracy that frequently surprises health practitioners and challenges their assumptions on where to focus population health outreach initiatives. Evolent's data regularly show the "frequent fliers" driving the bulk of a population's health costs this year aren't the same people who will be high users next year.
Next year's cost-drivers can be kept out of the hospital if primary care providers set aside time to follow predictive data's warning signs and build protocols that reach out to individuals preemptively. Find the woman who hasn't picked up her prescriptions and find a way to address the transportation, language or insurance issue holding her back from compliance.
Danielle Mitchell, MD, Candidate for Tennessee's 3rd Congressional District.
21. Support medical provider wellness programs. The burnout rate of physicians (as well as other medical providers) is more than 50 percent in most specialties. This speaks volumes of the stress our healthcare providers are under.
22. Encourage community leaders, including those from the medical community, to run for government office! Medical providers are often on the front lines and understand the needs you and your family have, which oftentimes goes beyond clinical care (i.e. the financial burden triggered by low wages that drive processed foods consumption, etc.). It makes sense to elect someone who understands and may even experience the same struggles you face.
Ram Raju, MD, Senior Vice President of Community Health Investment, Northwell Health (New Hyde Park).
23. We need to have a patient empowerment moment, so patients feel comfortable asking questions without being afraid. The patient will never be educated to understand the entire complexity of medicine, but they can be empowered to ask the right questions and demand value for their money and demand the best care possible.
Something we did was hand out buttons to all our physicians reading, "Ask me a question." We also had a program asking patients, "Do you know the name of your doctor?" rather than patients just knowing they're going to the cardiology clinic. That helps foster some connection and accountability. Another example is language barriers may impede people asking questions because they don't feel their language skills are strong enough, or they feel their accent is too heavy to be understood. So we work on giving them language interpreters so they feel comfortable to ask questions.
Rebecca Parker, MD, President of the American College of Emergency Physicians.
24. Get out in the community and sponsor education and outreach.
25. Offer volunteer and outreach programs that allow medical professionals to grow the pipeline. Start at college, high school and even elementary school. We need more healthcare personnel and together we can recruit the best talent. Being a medical professional is the best job in the world.
26. Do walking rounds on your staff, nurses and physicians. Ask them what they need to do their jobs. Being present; listening and trying to bring solutions to the bedside professionals goes a long way.
27. Look at systems for solutions, not individuals.
Things individuals can do at a policy level.
Barbara Bergin, MD, Orthopedic Spine Surgeon, Texas Orthopedics, Sports and Rehabilitation Associates (Austin).
28. Don't let lobbyists be involved in the process of healthcare legislation.
29. Everyone should have to pay a copay — even Medicaid patients. Even a $5 to $10 copay would save a lot of money [for healthcare providers].
Stephen Klasko, MD, President and CEO, Thomas Jefferson University and Jefferson Health (Philadelphia).
30. Government funding for academic medical centers should be at least partially based on reducing disparities in the community, not just what happens once a patient comes into your hospital. In Philadelphia, we have the greatest concentration of academic medical centers in the U.S., and at the same time the greatest discrepancy in life expectancies among zip codes.
Peter Pronovost, MD, PhD, Senior Vice President for Safety and Quality, Johns Hopkins Medicine (Baltimore).
31. We should demand that we have valid measures of how many people die needlessly in the U.S. If you were to ask how big a problem is safety or preventable death, the honest answer is — we don't know. The estimates still range from 40 to 400,000, and it's because we don't have a valid measurement system.
We have a valid measurement system for infections, created by the CDC. They should be supported to say, "Let's list the top 10 causes of preventable harm," and, "Let's develop valid ways to measure them and a valid way to count and share that number with the public."
32. The public should ensure the data hospitals report is just as accurate as their financial data. When any organization reports their financial data there are rules set by the accounting financial standards board. They have to follow standard accounting principals, the data are audited, the data are posted on EDGAR so anyone can see what you're doing. Then there's private sector reanalysis of those numbers.
In healthcare there are no rules for what you can report, there's no auditing. There are little glimpses when we do auditing that say the data quality is really bad. There's no public or common book of truths like EDGAR. When all these rating systems go to report cards, they vary widely. Of the top 5 reporting systems — including Leapfrog, Healthgrades, U.S. News & World Report — not one hospital was on all five, and 42 percent of hospitals were at the top of one report and the bottom of another.
33. Invest in quality and safety research. In the U.S. we have a fairly narrow view that biomedical research means finding new genes and new drugs. But how we apply those findings to approve care and optimize patient outcomes, called applied research or improvement science, is vastly underfunded. About two pennies of every dollar we spend on research goes to applied research. If we could apply all the vast knowledge we know, we could see vastly better outcomes, but we don't know how to do that.
34. Demand that annual data on the number of different procedures hospitals and physicians perform is listed on their website.
Roy Smythe, MD, Global CMO, Healthcare Informatics, Philips.
35. I would start with creating a list of health, wellness and disease outcomes that "matter" to providers and the general public. Then I'd restructure reimbursement such that providers are paid a base rate for provision of services, but a premium for high performance related to these outcomes. These go well beyond "readmission" and "patient satisfaction" to include things like survival rates for cancer, mobility, mental well-being, etc.