Balancing clinical performance with patient care
Clinical Performance
Improving clinical performance without losing focus of what really matters to your patients
In brief:
- Metrics and clinical performance measurements are the rage in healthcare (and other industries).
- As important as clinical performance is — and it is very important — pharmacies can benefit by looking beyond measurement.
- The Institute for Healthcare Improvement suggests asking patients what matters to them.
- By understanding what matters most to patients, pharmacies can engage in shared decision making and behavioral counseling.
Healthcare has become fixated on measuring quality and performance, and this focus on measurement has also permeated retail pharmacy. However, while striving to perform well and achieve key metrics, providing truly patient-centered care requires understanding what really matters to patients.
“Measurement” and “clinical performance” are now essential for retail pharmacy success
In the past decade, a key trend in healthcare has been the focus on measuring quality and performance, with a growing linkage of payment to performance. Consider this headline from just the past few months:
And the emphasis on measurement and performance has also become a key part of daily life for retail pharmacies. Just a few examples include:
- Medicare Advantage plans want to work with top-performing pharmacies that help them achieve good Star Ratings, which affects plans’ compensation. (See Star Ratings Explained.)
- Plans are creating preferred pharmacy networks based on measures of pharmacy performance. (See How Narrow Network Are Changing Pharmacy and 4 Big Trends Transforming the Business of Pharmacy.)
- Pharmacy compensation is being tied to measures of performance. (See Health Plan Starts P4P Program for Community Pharmacies.)
- Pharmacies have tools, such as EQuIPP™, that provide data on quality performance.
But measurement is not all that matters
The focus on metrics, data and analytics is not just a trend within healthcare, as use of dashboards, benchmarking and measurement is common in all industries. Yet, amid this focus on measurement, one of America’s most prominent health advocacy organizations, the Institute for Healthcare Improvement (IHI) — a huge supporter of quality measurement — is championing a simple and powerful concept: Understanding what truly matters to patients.
IHI’s perspective is that prescribers often focus on “What is the matter with you?” This question leads to a conversation with a patient about symptoms and diseases, as opposed to larger questions of what is most important to patients.
Understanding a patient’s symptoms and medical condition is certainly important, but IHI’s view is that patient-centered care is about starting with what patients prioritize and care about the most.
An IHI example: The ROMEO Club
A blog posting on IHI’s website1 illustrates what it means to ask and understand what really matters to a patient.
The blog post described Mr. Smith, a 74-year-old widower who lived alone with no family in the area. Mr. Smith had stage IV heart failure. Historically, healthcare professionals would ask Mr. Smith about his symptoms (the “What’s the matter?” question) and would learn he had gained fluid and weight, aggravating his condition. The typical response would be to suggest a diuretic and a low-sodium diet, and if Mr. Smith didn’t adhere, to deem him as noncompliant.
However, when Mr. Smith was asked what is most important to him, he said his first priority was to attend weekly meetings of the ROMEO (Retired Old Men Eating Out) Club. At these gatherings, which Mr. Smith cherished, he would have his favorite meal of a hamburger and fries, loaded with sodium. This would cause him to retain fluid and gain weight.
Instead of labelling Mr. Smith as noncompliant, it was understood that eating out weekly with his friends was what mattered most. Recommendations were made to adjust his diet the day before, the morning of, and the evening after the ROMEO Club to accommodate his favorite meal.
Engaging patients in shared decision making
The idea of asking patients what matters to them, and the example of Mr. Smith and the ROMEO Club, show that when providers know what matters most to patients, it impacts the care that is provided.
With that in mind, tips for pharmacists include:
- Ask the question. Especially for customers with chronic diseases who require frequent refills of multiple medications, pharmacists are encouraged to go beyond just filling prescriptions and asking about side effects. Ask and understand what really matters to these important patients.
- Engage in shared decision making. With an understanding of what really matters to patients, have a discussion with patients about various options available to them.
- Provide behavioral coaching. McKesson’s Pharmacy Intervention Program (PIP) is a tool that assists community pharmacists in supporting patients through targeted, personalized behavioral coaching sessions. These coaching sessions build stronger relationships with patients, deepen loyalty, improve outcomes, and can be a source of additional revenue for pharmacies.
The idea is not to diminish the focus on performance metrics, which are crucially important, but for patients with chronic diseases, to go beyond treating the disease to understand what really matters to each patient.
For additional resources see:
- The Institute for Healthcare Improvement’s page on “What Matters.”
- Mayo Clinic’s Shared Decision Making National Resource Center, which has a wealth of aids and resources.
- McKesson’s Pharmacy Intervention Program, which is part of McKesson’s pharmacy-based services.