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Patient, Family-Centered Care at Veterans Affairs Hospitals


 

The journey toward patient and family centered care (PFCC) has been one of the hallmarks of early twenty-first century healthcare transformation. The Veterans Health Administration (VHA, including all of its VAMC hospitals) understands the critical importance of PFCC and has fully embraced—indeed, extended—its tenets as a core foundational structure going into the future. As full participants in the collaborative VHA care model, hospitalists and collaborating care teams are enhancing best care/best treatment practices with PFCC modalities.

Transformation is not new to VHA. Starting in the late 1990s, the organization expanded from a hospital-based, specialty care-only institution to one that adopted primary care in a wheel-and-spoke design: a centralized medical center with surrounding community-based primary care clinics. This brought about the infrastructure necessary to create the fully integrated national network that is VHA today. The current PFCC transformation aims to grow VHA a step further by restyling the culture of VHA care to a model that completely focuses the system around the needs of the veterans. VHA’s Blueprint for Excellence, a prescient guiding document for VHA transformation today, explains that the direction to Whole Health encompasses “support for both care needs and health into a coherent experience of veteran-centered care that maximizes well-being.”

Hippocrates is quoted as saying that we “cure sometimes, treat often, and comfort always.” This is true today. We rarely cure, but we can offer treatment with maximal comfort during a hospitalization, assisting our patients in returning to the health they had established prior to their admission.

The Whole Health program is the sum of patient self-care; personalized, proactive, patient-driven care (PPPDC); and environmental (relationship and community-based) care. The VHA is serious about PFCC: In 2010, the organization created a top-ranking office, aptly named the Office of Patient-Centered Care & Cultural Transformation (OPCC&CT); the office reports directly to national leadership and has as its founding objective the support of this latest transformation.

The VHA’s ambitious adoption of PFCC and the Whole Health program involves fully embracing PPPDC. VHA partners work with each veteran to create a personal health plan (PHP), supported by health coaching, motivational interviewing, and other clinical tools, as a living document aimed at optimizing health and well-being; best practice, evidence-based disease intervention and management provide the chronic and acute care needs.

A veteran’s PHP, essentially a mission and goal-planning document, is founded on what matters most to the veteran and on the aspects of the veteran’s health that are keeping him or her from meeting current and future life goals. Hospitalist providers, including those at VHA, academic, and private sector hospitals, can use the essence of the PHP to guide inpatient care. It is powerful to ask each of our patients what matters most to him or her, to understand a patient’s situational life goal. To partner with patients, helping each one to focus on and realize a pressing individual goal, not only centers us but humanizes an often destabilizing and stressful time for our patients.

Hippocrates is quoted as saying that we “cure sometimes, treat often, and comfort always.” This is true today. We rarely cure, but we can offer treatment with maximal comfort during a hospitalization, assisting our patients in returning to the health they had established prior to their admission. Hospital medicine providers and hospital-based teams act as a safety net, caring for our acutely ill patients, working with them to bring them back to their baseline, and getting them back on track to be able to enjoy what really matters to them, their “mission” at the moment. PFCC and PPPDC provide the culture and tools to meet our patients’ goals.

The VHA’s number one strategic goal has been to provide veterans PPPDC. Hospitalists and hospitals have adopted—and will continue to adopt—practices that move toward this goal. PFCC is at its essence patient empowerment, and its primary benefits are enhancement of patient safety, quality of care, and patient satisfaction. PFCC is one innovation necessary to reach the “triple aim” all healthcare systems strive toward: better health, better care, better value.


Dr. Steinbach is chief of hospital medicine at the Atlanta VAMC and assistant professor of medicine in the division of hospital medicine at Emory University School of Medicine in Atlanta.

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