You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.
Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).
SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.
Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.4
It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.
Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.
Dr. Frost is president of SHM.
- Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
- Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
- Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
- Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.