Putting the patient first: The missing link to patient-centered care

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Jun 27, 2019

Last November, University of Utah Health published survey results in which 80% of respondents admitted to lying to their doctor about health information. Respondents reported fear of being judged for things such as smoking, having an unhealthy diet, or driving without a seatbelt, so the information went unsaid. When a patient sits on an exam table in a doctor’s office, numerous health and behavioral concerns run through their minds, yet when the doctor walks into the office and asks, “How are you feeling?” patients often say, “I’m fine.” 

Simply put, it is hard for patients to speak openly and honestly with their doctors, or other healthcare providers. 

The inability to hold an honest conversation with one’s doctor is just one sign of a health system not fully serving patients. From fear of being judged, to feeling rushed through the office as providers seek to see as many patients as possible, most primary care does not provide sufficient space for patients to speak their minds and share their concerns. It also does not give providers with enough time to understand how their patients’ individual behavior—which influences 40% of one’s health status—is impacting their health. If patients cannot, and do not feel comfortable opening up to their providers, and providers don’t have time and space to fully grasp their patients’ circumstances, the latter can’t effectively improve the health of their patients. This disconnect is why many providers are working on more patient-centered approaches to care.  

Patient-centered care aims to put patients back at the center of the healthcare conversation. It seeks to make patients’ circumstances, including their cultural values and socioeconomic status, the impetus behind all health decisions, rather than the provider’s schedule and the pressure many providers feel to see as many patients as possible. It also focuses on shared decision-making and collaboration between provider and patient.

Efforts to make care more patient-centered are becoming more common and it’s promising to see more patients included in the care process. One application that providers are embracing is telemedicine, which enables more people to seek care on their own time and in their own setting through virtual consultations. Health coaches or patient navigators, who help patients navigate the healthcare system and better understand care processes, are another example. But there is much more to patient-centered care than simply providing greater care access and guidance, for example, physical and emotional comfort, respecting patient values and socioeconomic status, and the inclusion of family members when desired. To truly put patients at the center of care, providers need to understand patients’ circumstances and priorities so they can help their patients manage their own health. That’s where Jobs Theory comes in.  

Putting the patient first

Jobs Theory explains that everything people consciously choose to do (including doing nothing), they do to make progress according to their own priorities, in a particular set of circumstances. We call this progress a “Job to Be Done” and it motivates individuals to search for solutions. Based on this insight, the theory asserts that the way to unleash patients’ potential to better manage their health is not to try to get them to prioritize health goals over the jobs they’re already striving to do. Instead, it’s to understand those jobs, and help patients accomplish them in ways that enhance their health, rather than detract from it. 

Take a woman in her mid-twenties, who travels for work three weeks out of the month. Working and travelling constantly has taken a toll, and she has gained a lot of weight in a short amount of time. Constantly ordering takeout has made her lethargic, and by the time she gets back to her hotel after work, or back from trips, she doesn’t have the energy to work out or do much of anything. And since she’s not home most of the time, she doesn’t have a primary care provider. She wants to try to explore where she travels more, and when she is not travelling she wants to be more present and active with her friends and family. While she undoubtedly has many jobs that she is “hiring” for, let’s focus on one: have a life outside of work.

Looking to practice patient-centered care, a provider might use telemedicine for their consultations. This would enable her to connect with her healthcare team from wherever her work takes her, which is a huge step towards centering her care around her needs, yet on its own barely addresses her Job to Be Done. Telemedicine would not help her provider understand that she is too tired to work out, or that her job leaves her feeling socially isolated but with little energy to go out with friends and family when she is home. If her provider isn’t fully aware of her circumstances and the priorities driving her decisions, would her care truly be patient-centered?

In contrast, a jobs-based approach would put more focus on understanding the progress she’s already trying to make—her Job to Be Done—and craft solutions that would actually help her achieve her goals and, ultimately, stay healthy. For example, her provider might recommend she sign up for a walking tour of whatever city she travels to, and suggest ways to improve her sleep so she has more energy to spend with friends and family. By putting her goals and priorities front and center, and making her the crux of all health decisions, she truly becomes the central focus of her own healthcare.

In trying to create an effective and impactful health system, open and honest communication from both sides is vital. Patients do not want to feel that they are nameless, faceless people in a crowd, and providers cannot effectively do their jobs with partial information. To truly fulfill the goals and the tenants of patient-centered care, healthcare professionals need to better understand the circumstances in patients’ lives, and design solutions based on their goals and circumstances. That means crafting solutions and practices that do not merely provide medical care, but address patients’ lives overall.

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in healthcare, including new approaches to population health management and person-centered care delivery.