How and Why to Support a Culture of Patient Partnership Across the Care Spectrum

This past week I was sick. Not just the sick where you feel crummy for a couple of days and get better with some rest, but sick enough that I had to see a doctor—any doctor—because I couldn’t wait for mine to have an opening.

As I was called back by the nurse, I knew the familiar drill. First, a stop at the scale, then a check of my temperature, followed by a blood pressure reading. The weight check went fine. Since I reported having a low-grade fever over the past few days, when the nurse removed the thermometer from my mouth and read “98.2,” it came with a hint of accusation. Normally I would tell her that I usually run low, but I didn’t feel well and have found in the past that providers don’t always embrace my self-awareness as actual fact, so I opted to stay quiet.

Next came the blood pressure reading, which happens to be my specialty, as I’ve had high blood pressure since my pregnancy 11 years ago. As you might imagine, I am pretty sensitive to my readings. As the nurse put the cuff on, I eyed it, making sure it was the correct size and then went through my mental checklist—legs uncrossed, breathe normally, relax.

But just as she began inflating the cuff and I settled in to my “quiet place,” the rapid fire questions began. “When had my symptoms started? Have I had any congestion? Coughing? What have I taken for it?” I hesitantly answered. Once done with the reading, which was normal, I apologized that my answers were slow to come and explained that I knew that talking during blood pressure readings could make the results inaccurate. She looked at me, without expression, told me the doctor would be in momentarily.

Left sitting alone in the little office, I was proud of myself for having done what I knew was right, but couldn’t help feeling disappointed (and maybe even a little guilty) that my contribution had been met with disapproval from my nurse. While the rest of my appointment went OK, what continues to nag at me are the missed opportunities for patient engagement.

More and more there is emphasis on partnering with patients and families to improve the quality and safety of healthcare. We advocate for the use of patient/family advisory councils and patient/family partners on improvement committees but, most often, we talk about these interventions in the acute care or chronic care environment. What we miss a fair share of the time is putting an emphasis on promoting partnerships during the everyday well-visit and sick-visit interactions—the same visits that have the potential to build and support a culture of partnership and engagement across the care spectrum!

I have five small suggestions for providers that could help make each interaction with patients and their families a small step towards that culture shift.

1. If it’s a new patient, introduce yourself and ask the patient/family if there’s anything they would like you to know about them.
2. At the beginning of the appointment, ask the patient/family to share their goals for the visit and any concerns they hope to address.
3. Invite the patient/family member to interrupt at any time if they have any questions or concerns that come to mind.
4. When patients/family members share information, reinforce this sharing by asking follow-up questions or voicing agreement.
5. At the end of the appointment, ask the patient/family to tell you in their own words what they understand their next steps should be, based on what you’ve discussed together during the visit. 

The value added when patients and families are fully engaged partners in their care is immeasurable, but it requires a supportive environment. By putting thoughtful effort into setting the stage and reinforcing engagement at every patient encounter, providers are not only fostering partnership at each visit, but they are helping to shape future interactions between patients/families and all of their care team. It is these small steps that will shift culture and make meaningful partnerships between patients, families, and providers the new normal in healthcare.

Tara Bristol Rouse is the Director of Patient and Family Partnerships for the Perinatal Quality Collaborative of North Carolina and as a patient/family partner for NICHQ.