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What’s wrong with ‘patient-centered care,’ and how to get it right

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May 18, 2017

In a 2001 publication entitled Crossing the Quality Chasm, The Institute of Medicine sounded an urgent alarm about quality shortfalls in American healthcare, and proclaimed “patient-centered care” a critical part of the solution. Since then, an entire generation of industry leaders and clinicians has come and gone, yet care still largely revolves around physicians.

Care quality is defined by clinical terms , which are critical in helping physicians improve clinical outcomes, but shed no light on whether care actually improves patients’ lives, by their own definition. Care delivery is centralized in giant, labyrinthine hospitals that make it easier for physicians to do their jobs, but saddle patients with the stress and expense of navigating to, and through, an intimidating landscape. And as physicians pack their patient panels to offset falling reimbursement rates,appointments have become increasingly rushed, forcing some patients to choose between withholding pressing questions, and assuming the uncomfortable role of “tough customer” to demand the time they need.

This physician-centricity is not merely a clinical quality risk factor, or a stressor for patients. It fundamentally undermines patients’ ability to partner with the system to better manage their own health. With health behaviors having the largest impact of any health determinant, including either healthcare or genetics, the system cannot continue to squander the significant healing power that individuals themselves possess.

Innumerable talented and well-intended providers have sought to address the problem, but miss the point by focusing on improving patients’ engagement with, or adherence to the system’s traditional acute-care goals and processes. Building on the words of Sir Sam Everington, a British physician and leading healthcare innovator who was knighted for his services to primary care, patient-centered care is “…not about what is the matter with a patient, but what matters to patients.” Providers must reinvent care goals and processes to align with patients’ own aspirations and circumstances. But how?

With the help of sound theory.  The Theory of Jobs to Be Done tells us that people don’t actually want what marketers are selling. They want progress in a particular set of circumstances, and seek products, services and experiences that help them do that “job.” For example, nobody wants a vacuum cleaner or Bollywood dance lessons, per se. But someone might hire these solutions to (respectively) create order in a chaotic home, or reduce risk of Alzheimer’s Disease through active learning in old age.

Further, winning solutions do the job in a way that fits with people’s values, social context, and real-world circumstances. So a man aspiring to a more fulfilling career is unlikely to hire a master’s degree in history if he believes academia is frivolous, if his husband is unsupportive, or if he’s worried about juggling studies on top of caring for his elderly mother.

In healthcare, Jobs Theory provides important insights as to why, in the moment of choice, people opt for or against healthy behaviors–say, sitting down to pay bills instead of stepping out to walk the dog, or taking up smoking instead of meditation. Armed with these insights, providers can design health solutions that people will hire because they do important life jobs for them, and make it as easy as possible to act in the best interests of their health.

Two very different organizations implicitly taking a jobs approach to healthcare illustrate its potential in the industry. At Aware Recovery Care, a start-up operating in Connecticut and New Hampshire, success in addiction recovery isn’t just sobriety. It’s helping clients achieve the health and self-control needed to define and achieve their life ambitions.

Aware’s multidisciplinary team of clinicians and counselors works with clients in the comfort and privacy of their own homes, helping them address not only the biological aspects of addiction, but also its impact on their relationships and social welfare. As reported by Kaiser Health News, Aware’s year-long program costs about the same as a couple of months in a traditional inpatient program, but achieves approximately twice the sobriety rate.

In the United Kingdom, the 30-year-old Bromley-by-Bow Centre aims to help residents “build up the skills and confidence they need to progress in life.” Located just outside London in one of England’s most deprived boroughs, the Centre is home to a primary care physicians’ practice (where Sir Everington practices), a church and a café, as well as over 100 locally-owned social enterprises offering residents everything from job training and financial counseling to child-care and low-rent art studios.

Physicians and social advocates in the Centre use its many community touch-points to get to know residents’ Jobs to Be Done, connect them with health and social services that address their problems, and tap their passions in a way that serves their aspirations and community. Despite high poverty and other extreme challenges to health and social welfare in the population Bromley by Bow serves, outcomes for patients at its primary care practice meet or exceed national averages.

America’s rising care costs, aging population and raging chronic disease epidemic are putting unprecedented pressure on our physician-centric, acute-care healthcare system. To help surmount these challenges, healthcare innovators can use the Theory of Jobs to Be Done to discover what matters to people, and develop care models and processes that will unleash their potential to improve and manage their own health.

 

As Senior Research Fellow for the Christensen Institute, Rebecca’s research focuses on business model innovation in healthcare delivery, including new approaches to population health management and person-centered care.