Contemplating Person Centered Care in the Expanding Continuum

This article was originally published by The Beryl Institute.

by Steve Shields

We know how it is. 

Anyone with a complex medical condition knows the feeling: Your doctor refers you to one or more specialists and therapists, and with each comes a new round of appointments to schedule, forms to fill out and recitations of your medical history, current diagnosis and the medications you’re on to a stranger focused only on one part of your total wellbeing.

None of the specialists or therapists seem to have communicated with your primary doctor or with one another. You’re on your own in navigating among the enclosed organizational silos of the medical industry where people, information and transparency seldom circulate beyond departmental or organizational boundaries.

So prevalent are these silos throughout the care continuum – hospitals, out-patient services, physicians, rehab centers and nursing homes – we’ve become numb to their existence. We fail to see how they prevent us from treating the whole person in a coordinated, integrated way.

We know what it takes; we just need to embrace a framework. Yet with the rise of Accountable Care Organizations and the Affordable Care Act, the healthcare system is calling for seamless integration among all these entities to bring costs down and quality of service up. And it’s starting to dawn on us that that seamlessness needs to extend from acute to post-acute to long-term care. But until we acknowledge that silos are a major impediment to integration, we will never restructure our organizations to achieve the level of person-centered care people want and deserve.

Failure to address the issue of silos is a consistent failure among many healthcare organizations that presume to undertake the cultural transformation to person centered care. Instead of reshaping top-down hierarchies to bring decision-making more to the point of service, many instead reach only for the low-hanging fruit, i.e. they stay in the traditional organizational structure while trying to create new models of physical design or iconic elements of person centered care. The roadmap is there; we just need to adapt it for the next wave.

A few long-term care organizations have made the difficult transition from top-down organizational silos to self-led teams and cross-trained staff on the scale of households, and they are a beacon for success. What they teach us is that the act of creating organizational change is far more than the positive outcomes for residents; it is the development of the mental muscles and change in chemistry among staff and management that results. It’s like a workout to prepare ourselves for the integration of the entire health care continuum because it’s the same thinking and driving principals that are required.

If we learn from those organizations, we have the potential to enable well-being in a comprehensive way while enabling those receiving our services to stay in the driver’s seat of their own lives. Imagine the ability for people to move from the doctor to the hospital to the specialists and therapist and, ultimately, to long-term care as if it were a coordinated experience with everyone tuned in to the person; that in accessing food, medication, therapy, doctor, transportation or whatever, you’re not doing it alone.

But if we don’t do the change necessary within our own organizations, the rest of the care continuum will encounter the same problems as have the low-hanging fruit pickers in long-term care. Seamless integration among all the components will be beyond our reach.

Steve Shields is the President and CEO of Action Pact Holdings, LLC with offices in Manhattan, KS, Atlanta, GA, Milwaukee, WI and Kolkata, India. Action Pact specializes in organizational transformation and repositioning, architectural design and construction, project development services, financial forecasting and strategic planning for the senior living sector. 

About The Beryl Institute: The Beryl Institute is the global community of practice and premier thought leader on improving patient experience in healthcare. The Beryl Institute serves as an independent, non vendor or provider-related community dedicated to bringing together the many voices, views and perspectives on improving the patient experience.

The Institute defines the patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.

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