I had a wonderful career in health care administration. For 30 years, I had the opportunity to work with people in hospitals who were both intelligent and compassionate — the combination of which led them to health care. I loved being involved in taking care of people and facilitating life-saving services including open heart procedures, emergency room operations, as well as NICU and PICU services.
Health care in the United States is complicated. Some argue that it is not a “health” care program, but instead a “sick” care program. We, as a system, tend to focus on the treatments and surgeries and medicine required once patients are diagnosed with a condition, as opposed to preventative measures people can take to keep them out of the hospital in the first place.
I recently read — and am now using in the health care administration classes I teach at Idaho State University — a book called "The Long Fix." The author, Dr. Vivian Lee, is a physician and health care CEO. She has seen medicine as a patient, as a loved one of a patient, and as a physician and leader in a hospital setting. In her book, she articulates the problems of today’s health care world, and, refreshingly, offers suggestions to patients, providers and policymakers alike that will improve health care both on a personal level and on a national level.
I could speak to each of those groups and their capacities for change, but today I’d like to focus on patients and what they can do to both improve their own care and ultimately change the health care system. The Centers for Disease Control and Prevention suggests that 20 percent of our health is attributable to our health care providers, while 30 percent is our health behaviors, 40 percent is our socioeconomic factors, and 10 percent is our physical environment. For the vast majority of us, not much can be done about our physical environment or our socioeconomic factors. But our health behaviors? We can change those. And while we can’t be held responsible for what our health care providers do, we can oftentimes choose those providers. Would selecting one hospital over another make a difference? Would one open heart surgeon have a better chance of success with our upcoming operation than another?
Oftentimes, patients do not know how they can be more engaged with their own care — or even that they should be more engaged in their own care. They are often overwhelmed with the complexity of the system and do not know where to start. In "The Long Fix," Dr. Lee suggests that taking action starts with small steps, including “do(ing) what you can to keep yourself and your family healthy, such as making sure you eat, exercise, and sleep as well as possible.” She also suggests that patients see their primary care physician regularly for screenings, vaccinations and both physical and mental health check-ups.
Dr. Lee recommends that patients use applications and websites to conduct research about the hospitals, doctors and health plans suggested to them, and to use that feedback in their decision-making process. She suggests to patients that they “use trusted online web tools like Leapfrog or Medicare’s online hospital compare tool to look at the safety records of hospitals and physicians,” and to be proactive in “demanding to know how much you likely will have to spend for every hospitalization and every test or drug you have to have.” A patient has the right to know upfront costs, to understand what their insurance will cover, and to understand what it costs each physician to provide their care as opposed to how much is charged to the patient by the hospital.
Patients also have the right to understand every procedure, every test and every medication recommended to them. Each patient should be confident and comfortable in asking questions of their doctors and nurses. Patients are sometimes intimidated by the training and expertise of medical professionals, but they need to realize that they have a bill of rights as a patient. Taking charge of their care, asking as many questions as they need, requiring financial information upfront, and following up after procedures by providing feedback and reporting mistakes are crucial to ensuring patients receive the best care possible.
Dr. Lee writes, “Take responsibility for your health, engage in your care, and treat your doctor like your partner. Share with your clinicians what matters to you … (and) think of the feedback you give as a chance for the learning health system to learn from you.”
I interacted with countless patients in my position as CEO and saw both ends of the spectrum: those who were prepared with questions, confident in the care they wanted, and able to advocate for themselves or their family members, as well as those who were unaware of their options, fearful of the environment, and uninformed of the medications and steps they needed to take to improve their health. If we can fall on the prepared, confident side of that spectrum and take charge of our health care, we can not only ensure the best outcome for us personally, but we can also do our part to help facilitate the changes we need for the “long fix” of health care.
Doug Crabtree is a professor of health care administration at Idaho State University's College of Business.