Simplifying health care systems, with patients in mind

Man speaks enthusiastically.
Michael Bleich, Ph.D., director of the Langston Center for Innovation in Quality and Safety, discussed the barriers to patient-centered health care. (Photo by Tom Kojcsich, University Marketing)

Health care systems are notorious for being complicated and difficult to navigate. The Langston Center for Innovation in Quality and Safety seeks to clarify, simplify and address these complexities.  

Established in 2015, the Langston Center is a partnership between VCU Health System and the Virginia Commonwealth University School of Nursing. Named after retired nursing dean Nancy Langston, Ph.D., the center continues her legacy by advancing science to improve patient care.

Langston Center Director Michael Bleich, Ph.D., who has authored more than 100 scholarly publications on health care systems, talked with VCU News about the barriers to patient-centered health care and how the Langston Center aims to create more innovative and effective systems.

Why was the Langston Center created? What need does it aim to fill?

At the time the Langston Center was developed, several National Academy of Medicine reports addressed issues facing health care today including death due to medical error and the complex work environments. One of the most significant reports was “Crossing the Quality Chasm,” which set the standard for 21st-century health systems to be safe, effective, patient-centered, timely and equitable.

These reports, frankly, shocked the country and were a wake-up call for health care leaders and providers, who have normalized the risk associated with caring for people.

Health care is dangerous. Health care is unpredictable. Health care pursues new treatment alternatives, which may add risk. And health care is expensive. The Langston Center gives voice to these realities.

Most care today is delivered in a patient-sensitive manner, meaning that providers account for cultural, socio-economic, personal preferences and other considerations that foster relationship-centered care.

However, the design of what is called patient-centered care processes remains dominantly based on provider preferences, technology availability and other conveniences that depersonalize patient care.   The Langston Center is a strong advocate for process design that elevates the human experience of those receiving health care.

Our goal is to champion health care that embraces a culture of safety, adherence to preferred practices and vigilant awareness of what is at stake for providers, patients, families and the community at large.   

Part of the mission is to create patient-centered solutions. What are the three most critical problems affecting quality and safety today? 

One problem that affects quality and safety, from the patient perspective, is the sheer number of care providers and support staff that interact with the patient and family. A symptom of this is the number of care coordinators required to navigate the staff and patient experience, some of whom will have but a single encounter with a patient or vice versa. 

A second patient-centered issue comes in the form of hyper-specialized providers who are highly trained and invaluable individuals, but few are trained to consider the bigger picture of what is transpiring with the patient, including how medical treatment will improve or detract from the patient’s quality of life.  

Lastly is information. If the wrong information gets into the record or is irretrievable in an efficient manner, then insurance can be impacted and clinical outcomes can be missed. Electronic medical records often create noise through disorganized data that has the power to be informative but isn’t because it isn’t available graphically.

In the care of my own mother with advanced Parkinson’s disease, a provider convinced my dad that my mom, nearing death, needed cataract surgery. The outcomes for the surgery were exceptional, but what it did to her disorientation and cognition destroyed a good part of her remaining life.

What are some examples of patient-centered solutions?

Patient-centered solutions are those that account for the holistic impact of disease treatment. Patient-centered solutions have regard for the individual’s overall quality of life, personal sensitivities and family engagement.

It provides a balance between treatment options and what the patient and family can accommodate financially, the burden of care on other family members and more. 

Engagement in decision-making is a key patient-centered solution. Accommodating a patient’s preference for life — and death — options is a patient-centered solution.

Then there are the heroic efforts that we read about: The marriage that was arranged to be held at the hospital, the dying patient’s wish to be with a cherished pet, allowing and celebrating the life journey, respecting cultural differences. These are examples of the extent to which providers will go to deliver patient-centered solutions. 

What is the Affiliates Scholars program? How does it fit into the mission of the Langston Center?

Think of the group as an interprofessional think tank representing varying specialty areas that range from design and human factor experts, program and product evaluation specialists, experts in the use of quality tools and techniques, individuals training in health care ethics, and many other perspectives — all in one room.

We hope that about 20 affiliate scholars who share a passion for innovation, quality and safety will come together to create a learning community to address the most perplexing issues faced in care delivery.

In addition to the affiliate scholars program, the Langston Center hosts several other initiatives that build community around safety and innovation. These initiatives include a mentorship program for undergraduate nursing students, a virtual forum where participants from around the world discuss global strategies to improve health outcomes and an innovation grant that gives faculty and student innovators an opportunity to design, test and evaluate product or technology prototypes that could improve quality and safety.

Who benefits from the work being done at the Langston Center? How?

First and foremost, the Langston Center’s efforts benefit the patient, the front-line consumer of health care.

Additionally, we train individuals in quality and implementation science and influence care delivery systems and how they are designed. 

Last, but not least, we want to serve as a forum for interprofessional practitioners. Health care is a team sport. We are embracing emerging principles linked to new economy thinking, and to survive the shifting economy, health care must ride the new surf.

We intend to help proactively write the script so health care can thrive in the next decade, and we’ll do it in the name of innovation, quality and safety.  

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