December 7, 2015

 In The Messenger

RightCare Action Week Wrap-Up
By Margie Coloian, MSJ, and Kim DiGioia, MSPH


Shattering expectations and advancing our cause

Thanks to more than a thousand participants around the country, RightCare Action Week was a huge success, exceeding expectations and reaffirming the mission of the RightCare Alliance. From California to Maine, from Fergus Falls to Fort Worth, you and your colleagues conducted story slams, overuse counts, house calls, in-depth conversations with patients, snapshots for our photo campaign, “What RightCare Means to Me,” and more. Clinicians and non-clinicians stood with the Alliance to demonstrate just how much better healthcare can be. Here are some stories from the week.


Letter from the leadership
By Vikas Saini, MD and Shannon Brownlee, MSc

Last spring, when we began planning our first RightCare Action Week, we gathered the staff and asked for suggestions for activities that clinicians and non-clinicians could take on during the week. We were looking for actions that would be meaningful and call attention to a better way of care delivery. While we came up with some great ideas, we worried that few clinicians would participate. After all, who can take time out of their busy schedules to do something that hasn’t been done before and had no track record?

Once we created a dedicated RCAW web site and put the word out, we knew there was keen interest out there and that the first RCAW would be a success. During RCAW, we received updates from dozens of individuals, telling us about their fantastic, moving, provocative activities ⎯ most of which we never envisioned just a few months ago.

We have our partner organizations (whose combined network audiences nears 2 million) to thank for getting the word out about RCAW. Kudos to the Institute for Healthcare Improvement-Open School, American Federation of Teachers, National Patient Safety Foundation, Informed Medical Decisions Foundation, National Physicians Alliance, American Medical Students Association, and Primary Care Progress. We especially want to give a hearty thanks to our funder, Robert Wood Johnson Foundation.

A year ago, we had no idea how deep the interest for RCAW ran or how important it would turn out to be. Now we know this was just the first year salvo in the fight for better care for all Americans. Watch this space for announcements of RCAW 2016, which promises to be bigger, more powerful and even more fun for participants.


Short phone calls from doctors at Jamaica Hospital mean a lot to patients

At Jamaica Hospital in New York, more than 50 primary care doctors and residents reached out to patients with an unexpected telephone call that surprised both patients and doctors. Physicians asked their patients two questions: (1) “Would you please share something you’ve always wanted me to know that I have never asked you about?” and (2) “In your opinion, what is one thing that would help patients get the right care they need and deserve in our current healthcare system?”

Doctors reported that their patients were touched by the calls. Many patients said they had nothing new to say, but some admitted that they had lied in the past. The call gave them the opportunity to open up, doctors reported, especially about psychosocial topics. In one moving conversation, a wheelchair-bound patient screwed up the courage to asked her doctor if she would ever walk again.

The physicians also found the calls rewarding. Many were astonished at how surprised their patients were by such a simple gesture, and by how uncomfortable they felt reaching out to patients in this way. But the general sentiment was that this was a simple, valuable exercise. In the future, patients at Jamaica Hospital can expect to get more calls from their primary care doctors.


What we learned from the Listening Booth
By Aaron Stupple, MD and Vikas Saini, MD

Americans must demand better healthcare delivery. That’s what we came away with after a fact-finding mission in Boston neighborhoods for RightCare Action Week. Our goal was to listen to what members of the public really think about their own healthcare. We took our Listening Booth, comprised of a small table, a pair of chairs, and a banner, to South Boston, Everett, Boston Common, and Jamaica Plain to show that listening matters, that health professionals and the public can talk to each other about what good care should be.

Here’s what we found: Most people think about coverage when asked about healthcare and wonder why we don’t have a simpler system, like single payer. In general, participants were happy with their care and coverage. Most people like their doctor, as long as they can access him or her when needed. There was concern about being able to find a doctor who can get the diagnosis right. Only occasionally was there worry about too much testing and over-prescribing.

But what surprised us was the number of people who were concerned about the same specific dysfunctions in the system that experts have identified as central problems.

For example, fragmentation was a recurring theme. One homeless man who managed to kick a substance abuse problem had to trek for an hour to the other side of town to keep seeing the PCP he first met at a halfway house. A veteran, with two years of active duty in Iraq, sprained her ankle in one of last year’s snowstorms. She drove herself to the nearest emergency department where the VA used to have an attached clinic, only to find the site closed. She was seen in another ER, but her care there was not covered by the VA because there was no fracture. Now, nine months later, she is getting dunning notices for $500.

Many lamented the rate of turnover of primary care doctors. Nate in Jamaica Plain was angry. “I wish I could keep the same doctor for more than one year. Every time I go in I see someone else. One says do this, one says no, no, do that. Then they leave.” Others complained about the loss of their doctor to concierge practices and patients who can pay more.

Some of those who were pleased with their own care were upset about the plight of others. Costs seemed to be the biggest worry. Brian noted that Medicare itemizes its bills allowing him to see the full charges from providers: “We’re all paying for (healthcare).” Even those who had manageable copays noted that Medicare pays only a portion of what providers charge and some worried that the mismatch meant that their doctors might stop caring for them.

White or black, homeless, or rich, people were almost unanimous that at the heart of what we do¾the intimate one-on-one encounter between doctor and patient¾a genuine trusting relationship matters enormously.

How much did our Listening Booth help to change healthcare? To make a real difference, we have to know what matters to our patients and our communities. If we are going to fix healthcare, we need a healthy dose of democratic conversation. More doctors, more nurses, more people have to start talking about what’s right and what’s wrong in our system. We all must ask¾and then we have to listen.


Nearly 300 sign pledge for antibiotic stewardship; a letter to patients informs about flawed quality metrics

Two enterprising initiatives for RightCare Action Week came from the RightCare Alliance newly formed councils, the Pediatric and Primary Care councils. The Pediatric Council wrote a provider pledge around antibiotic stewardship. Alan Schroeder, MD, a pediatrician from Santa Clara, CA and Shawn Ralston, MD, a pediatrician from Lebanon, NH, spearheaded the effort, calling overuse of antibiotics “a threat to public health.” They disseminated the pledge, which also includes a short reminder sheet of 5 “rights” for good prescribing, via several pediatric group lists. Clinicians from many specialties signed to show their support.

In an open letter to the American public, the Primary Care Council highlighted flawed quality metrics. These metrics, they wrote, do not allow “us to work with you to determine what matters most to you in your care nor to help you adopt healthy behaviors that improve your quality of life. Many of the current ‘quality’ measures distract your healthcare professional from giving you the care you need.” The letter explains that better quality metrics could improve access and shared decision-making, and the signatories invite patients to work with them to improve the way we measure doctors’ performance. Sixty providers signed the letter.


Harvard Public Health students query the community

Roxbury Crossing is a busy subway station in Boston, right down the street from the Harvard T.H. Chan School of Public Health. Every day at lunchtime during RightCare Action Week, passersby saw students from the school manning a “RightCare Photo Booth.” The students asked anyone who would stop for a moment to talk to them about what the “right healthcare” means.

The students are members of the Student-Community Action Partnership, or S-CAP, which is taking steps to fight the “ivory tower” status quo. The group has pledged to “think collaboratively, listen deeply, and act purposefully.” They felt compelled to participate in RightCare Action Week by asking local community members what matters to them in healthcare.

Over the course of five lunch hours, 53 people stopped by the booth to talk about healthcare. Responses to the prompt “RightCare to me means…” ranged from “personable doctors” to “accessible, free, equitable, simple” to “compassion” to “automatic human right!!”

Kudos to the students of Harvard T.H. Chan School of Public Health!


St. Louis hospital EM residents uncover patients’ ‘worries’

For RCAW, the emergency medicine residents, led by chief residents Alicia Oberle, MD and Maia Dorsett, MD PhD, at Barnes Jewish Hospital and Medical Center in St. Louis, MO, asked patients what worries them most. The answers were often not what they expected. One patient’s biggest worry was that he would “be killed in the streets,” and another worried that “I’m never going to know what’s going on with my heart because I keep getting multiple stories.” In addition, the two led a breakfast discussion during the week with other residents and faculty on what right care means in the emergency department, and they provided an overview of the drivers of overuse.


Residents lunch with patients at UC Denver

Chief residents Emily Gottenborg, MD and Natalia Roldan, MD at University of Colorado Hospital instructed their residents in the Department of Medicine to do something unconventional during the first 15 minutes of their regular noon conference instead of the usual CXR/EKG read. They asked residents to (1) Share a patient’s personal story/social history tidbit (“Get to know your patient” model) and (2) Share an example of overuse leading to harm on their team¾for example, CT abdomen ordered that would not have changed management, with subsequent AKI requiring additional day of hospitalization for contrast-induced nephropathy concern/monitoring. On the last day of RightCare Action Week, residents and medical students were given a free hour and had lunch with their patients. Rodan said, “We don’t get to focus on things that mean the most to the patient or help us get to know them better.”


Students and health professionals reflect on RightCare at UVA

At the University of Virginia, nursing student Jane Muir, RightCare Action Week captain and Young Innovator Program grantee, gathered 55 students in an auditorium “to learn about and discuss right care for patients through a laid-back and enjoyable clinician storytelling event.” She reports: “Clinicians used humor, theatrics and creative narrative to relay their experiences in avoiding harm and providing compassionate care. Students and clinicians were able to come away from the event with new ideas about what right care means to them.”


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