Mission: Impossible? Transforming Patient Behavior to Improve Results

By Marshall Steele, M.D. and Judy Jones, M.S.

“Good morning, Mr. Briggs. Your mission if you decide to accept it is to … this recording will self destruct in 30 seconds.” As young people, we loved this show Mission: Impossible. The sound track was exhilarating. Doing something impossible – what a challenge – what excitement! And they always succeeded. Impossible? Nothing is impossible. And then it was our turn.

Mission: Impossible Part 1 – 1995 Transforming Physician and Hospital Behavior

For the past 20 years, we have been actors in this “Mission Impossible” saga. It stared like this. Good Morning Dr. Steele, Mrs. Jones. Your mission if you decide to accept it is to improve healthcare doing more with less…this recording will self destruct in 30 seconds.

We accepted the mission in different ways. Where to start?

Dr. Steele: Between 1995 and 2005, my journey was at my own hospital. As an orthopedic surgeon, I along with my partner Steve Faust and considerable hospital support started the mission of transforming physician and hospital behavior to create system of care. It started with total joint replacement and then spine surgery. The mission, as we saw it, was to improve clinical quality, improve profitability, greatly enhance the patient experience, and lower costs.

Judy Jones: My journey began with creating a standardized and consistent care plan for bariatric, and then orthopedic, patients. Fortunately, I found a company called TVC that provided tools and materials to hospitals and physicians for their orthopedic patients that would do that. I subsequently joined TVC.

Success in both cases would require first convincing a group of independent minded physicians to work together closely. First, they would need to transform from individual performers who made every decision independently into a standardized system of care where they shared decision making with other physicians and nurses, physical therapists, case managers, etc. Second, these physicians and the equally independent hospital administrators would need to begin to trust one another and become partners not adversaries. Mission: Impossible? No.

In both cases, we succeeded in accomplishing the goals of higher quality, improved profitability, and better experiences. Hospital volume skyrocketed along with profitability. So much so that I, Dr. Steele, was then offered the position as Medical Director of Surgical Business Development. The same principles that we used in orthopedics and spine were successfully applied to other specialties. This transformed the hospital from a community-based hospital to a regional destination center. We grew from six operating rooms to 26.

In 2005, the mission expanded, together we founded the company Marshall | Steele to implement this system of care in more than 300 hospitals with thousands of physicians. Our team helped physicians transform themselves from individual performers to leaders of a system of care. Hospitals began working closely with their physicians to develop a common vision and system of care for their patients that enhanced patient and family experiences, improved outcomes, and lowered costs. We succeeded again, so much so, that the company was acquired by Stryker in 2011 and renamed Stryker Performance Solutions.

However, unlike the TV series there is no firm ending to the story. Like a TV serial, it is an ongoing journey that never ends. However, there is a new story and a new episode. Mission: Impossible 2

Mission: Impossible Part 2 – 2015 Transforming Patient Behavior to Improve Results

In 2015, we received this message. Good Morning Dr. Steele and Mrs. Jones. Your mission if you decide to accept it is to improve healthcare by getting patients to transform themselves from being passive participants in their care to active participants. Whoa, you must be kidding. This makes the Mission: Impossible Part 1 seem trivially easy.

Transform Patient Behavior – that’s a real challenge. Patients for years been passive wanting to be treated and cured. While we in the medical profession have always understood that patients have responsibility in this endeavor, we have often been unsuccessful in getting their participation. In fact, indications are that compliance with physician’s treatment plans is only at 50 percent. This is especially true when it requires change or participation by them such as smoking cessation or weight loss.

We saw this quote in a Health Pad article from November 2015: “If patient engagement were a drug, it would be front-page news, and malpractice for doctors not to use it.” We accepted the mission. The first step in any mission is understanding the problem at hand. The real problem we believe is not that patients are resistant, but that medical care is treated as an event. Too much information is provided in too short a period of time. This can be overwhelming to a tense patient and family. More importantly the “WHY THIS IS IMPORTANT TO ME” is often missed. To make things worse, in between visits there is little or no connection with any of the providers.

Success will require transforming patients from passive recipients into active participants. Medical care cannot just be an event. It must be an ongoing conversation. We need to focus on using the “2 T’s” which will change healthcare dramatically in the next few years: technology and transparency. Technology can be used to create this connectivity. We found a technology company was doing this. For instance, lets take a patient that needs total joint surgery.

Here is how the process works for joint replacement surgery – an elective, scheduled procedure:

After being scheduled for surgery, patients receive an email from their physician 30 days preoperatively instructing them to register online. Their responsibilities are outlined for the next 30 days leading up to surgery. The goal is to prepare the patient for surgery and to achieve a great result. Frequently before surgery, the patient is notified of the specific tasks that are to be accomplish. Periodic emails are generated based on patient compliance to remind them of their responsibilities. This includes such things as identifying a coach to assist both pre and post-surgery, watching short educational videos, practicing their exercises, reading written information, and answering questions about themselves, their health, and the materials. They can even ask questions that will be answered by the physician and/or staff.

All this information is categorized and evaluated by the technology in the system on a daily basis for outliers or non-compliant patients. Transparency is achieved by sending this information to nurse navigators as daily yellow, orange and red alerts as required. Yellow and orange alerts are handled by email reminders. Red alerts may require a phone call from the nurse or perhaps the physician to resolve.

The connectivity doesn’t end there. For 90 days post- operatively the patients and family are connected to their physician and to the nurse navigator. There are videos and written material on exercises, expectations for recovery, and potential complications. In addition, there are questions to answer to assure understanding. Again, based on responses and compliance an alert system allows for transparency and appropriate follow- up.

The early results of using this technology to create connectivity and transparency to inform our providers are encouraging. The very important human touch is not lost but is used more appropriately. Patients feel more connected and cared for. 91 percent of patients reported this technology interface positively impacted their experience. 90 percent said that it improved their outcome and was easy to use, 100 percent reported that it increased their peace of mind and would recommend it to friends. 92 percent of patients went home in 1.6 days with zero readmissions. Estimated cost reduction per patient was slightly over $1,000.

With bundled payments looming as the new reimbursement system puts hospitals at risk, achieving these results are essential. Using technology and transparency to connect with our patients will help avoid the complications that lead to emergency room visits and readmissions. It will reduce length of stay while avoiding costly post acute care stays. It has been proven that all of this can be done and the patients are happier and more satisfied.

We are just in the first episode of this series but as stated above the early results are encouraging. Mission: Impossible Part 2 – Transforming Patient Behavior to Improve Results Can Succeed!!!!!

For more information about VOX Telehealth and its orthopedic platform, the OrthoCare Program, please contact [email protected].