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Melissa Stratman

09 Oct, 2018
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Melissa Stratman

09 Oct, 2018
Follow Coleman!

Coproduction of Healthcare Services?

In the article Coproduction of healthcare services (BMJ Quality and Safety Sept 16, 2015) the authors explore the challenges and possibilities in the relationship between efforts to improve patient outcomes in healthcare and true patient engagement.  The thought-provoking article explores a variety of related concepts including the less popular although accurate view of health care as a service. The authors explore, among other things the difference between health care as following relieving or enabling service logic and the implications of the patients’ role as an end user or receiver of services.

The portion of the article that resonates most with the patient-centric approach to DPI™ is the phrase ‘negotiating visit agendas’. Brilliant. So often in our consulting work as Coleman Associates we hear nurses, MAs and providers understandably grapple with ways to limit the patients’ seemingly never-ending list of needs. And, the language we often hear used and the default scripting is always the same—agenda setting. This tiny but powerful language change around negotiating the agenda ties to a more rich, holistic and patient–centeric understanding that agendas ought to be negotiated, rather than binding the patient into a limited agenda – one that is believed to fit well into the commonly accepted but often controversial 15-minute visit slot.

In an aside on the cramp that providers feel around overly limited time with the patient….  we find in Primary Care Redesign that the length of the appointment has very little correlation with the patients needs and should be viewed more as a rough approximation rather than a rule to enforces or a slot time to be defended. In true team-based care the Patient Care Teams, not just the providers provide services that are of value to the patient thereby easing the burden on the provider and loosening the noose of confinement that the schedule time slot holds.

Furthermore, visit negotiation acknowledges the inherent expertise and control that the patient has in their own health care and seeks to establish priorities that meet the needs of both patient and provider. The Coproduction of healthcare services from by M. Batalden, P. Batalden, P. Margolis, M. Seid, G. Armstrong, L. Opipari-Arrigan and H. Hartung is an interesting and very thought-provoking article about the true co-production of health care and worth the read.

https://qualitysafety.bmj.com/content/25/7/509

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