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"Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

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26
Designing on Purpose Schwartz Center Speaker Series Donald M. Berwick, MD President and CEO Institute for Healthcare Improvement September 17, 2009
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Page 1: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Designing on Purpose

Schwartz Center Speaker Series

Donald M. Berwick, MD

President and CEO

Institute for Healthcare Improvement

September 17, 2009

Page 2: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Designing on Purpose

Integrate what?

Integrate why?

1. Begin with an exploration of purpose.

2. Then seek designs capable of achieving

that purpose.

Page 3: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

The IOM Roundtable

• “Overuse, Underuse, and Misuse”

• Quality Is…

“The degree to which health services for

individuals and populations increase the

likelihood of desired health outcomes and

are consistent with current professional

knowledge.”

Page 4: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

The Woods Hole Meeting - 2002

FIRST DRAFT FINAL VERSION

AIMS FOR IMPROVEMENT:

Safety

Effectiveness

Patient Control

Promptness

Efficiency

Equity

AIMS FOR IMPROVEMENT:

Safety

Effectiveness

Patient Centeredness

Timeliness

Efficiency

Equity

SIMPLE RULE #3:

“Patients have all the control.”

SIMPLE RULE #3:

“The patient is the source of

control.”

Page 5: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

“New Rules” for Health Care

• Care based on continuous healing relationships

• Customization based on patient needs and values

• The patient as the source of control

• Shared knowledge and the free flow of information

• Evidence-based decision making

Page 6: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

“New Rules” for Health Care

• Safety as a system property

• The need for transparency

• Anticipation of needs

• Continuous decrease in waste

• Cooperation

Page 7: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

“They give me exactly the help I

need and want exactly when I

need and want it.”

(John Wasson Modification…)

“They give me exactly the help I need and

want exactly when and how I need and

want it.”

IHI Measure of Patient-Centeredness

Page 8: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Deepening the Definition

• “The needs of the patient come first.” (Mayo Clinic)

• “Nothing about me without me.”(Diane Plamping)

• “Every patient is the only patient.”(Art Berarducci)

Page 9: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

My Proposed Working Definition

Patient-Centeredness:

“The experience (to the extent the

informed, individual patient desires it) of

transparency, individualization, recognition

, respect, dignity, and choice in all

matters, without exception, related to

one’s person, circumstances, and

relationships in health care.”

Page 10: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Eliot Freidson: Profession of Medicine

• A profession is a work group that reserves

to itself the authority to judge the quality of

its own work.

• Granted by society in return for an

assumption of:

– Altruism

– Specialized Expertise

– Self-Regulation

Page 11: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

The “Triple Aim”

Population

Health

Experience

of Care

Per Capita

Cost

11

Page 12: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Defining “Health”

The Extent to Which the

Body Can Heal Itself

Page 13: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

A Question

What do you want?

Page 14: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

A Question

What do you really want?

Page 15: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

A Question

What do you really, really want?

Page 16: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Try This…

Integrative Medicine is health care that

offers you the best shot at getting what

you really, really want.

Page 17: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

Page 18: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

Page 19: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

Page 20: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within

Care

Page 21: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within Care

5. Maximize Healing Influences outside

Care

Page 22: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within Care

5. Maximize Healing Influences outside Care

6. Rely on Sophisticated, Disciplined

Evidence

Page 23: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within Care

5. Maximize Healing Influences outside Care

6. Rely on Sophisticated, Disciplined Evidence

7. Use All Relevant Capacities – Waste

Nothing

Page 24: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within Care

5. Maximize Healing Influences outside Care

6. Rely on Sophisticated, Disciplined Evidence

7. Use All Relevant Capacities – Waste Nothing

8. Connect Helping Influences with Each

Other

Page 25: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Design of Integrative Care

1. Place the Patient at the Center

2. Individualize

3. Welcome Family and Loved Ones

4. Maximize Healing Influences within Care

5. Maximize Healing Influences outside Care

6. Rely on Sophisticated, Disciplined Evidence

7. Use All Relevant Capacities – Waste Nothing

8. Connect Helping Influences with Each Other

Page 26: "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

Defining “Health”

The Extent to Which the

Body Can Heal Itself


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