LETTERS TO THE EDITOR “patient activationda patient’s knowledge, skills, ability, and willingness to manage his or her own health and caredand help patients evaluate and participate in the care they will receive.” They further note that “activated patients are half as likely to delay care and are one-third as likely to have unmet medical needs.” Based on my 31 years of working as a perioperative nurse, educator, and manager, I agree that the patients who are actively involved with their care would benefit from the patient’s checklist that the authors proposed. Unfortunately, this is more than just presenting education to the patients to be involved in their care. This is important to nursing leaders because both the nurse and the physician may try to present data and facts to establish meaningful use to the patient; however, this does not ensure that the patient will identify the information as helpful and entice them to be involved in their care. Indeed, many hurdles may be overcome through repeated education and attempts to change patients’ attitudes toward their care and change their behavior. This is usually a very slow, difficult process in states where the citizens have numerous comorbidities and health issues. In the rural state of West Virginia, where the population is approximately 1.8 million, there are approximately 272,000 uninsured citizens (15%). West Virginia jockeys with a few other US states to be the highest per capita in the diseases of cancer, hypertension, diabetes, and obesity.1 Attempting to change the patient population to one of patient activation status via patient education and repeated visits to the medical provider still will not alter the culture of those who do not want to participate in their own medical decision making. Patient Activation MeasureTM may take many years to be integrated into daily patient care, whereas deaths from cancer, heart disease, diabetes, and obesity continue to occur as the patient safety checklist goes unheeded.2 Editor’s note: Patient Activation Measure is a trademark of Insignia Health, Portland, OR.
www.aornjournal.org
DAWN M. YOST MSN, RN, BSDH, RDH, CNOR PERIOPERATIVE SERVICES MANAGER OF NURSING OPERATIONS AND STERILE PROCESSING DEPARTMENT WEST VIRGINIA UNIVERSITY HEALTHCARE MORGANTOWN, WV http://dx.doi.org/10.1016/j.aorn.2014.02.003
References 1. Health status indicators. The Henry J. Kaiser Foundation. http://kff.org/state-category/health-status/. Accessed February 3, 2014. 2. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005-1026.
Author response. The letter author states an opinion that patients will not readily use a patient’s safety checklist, such as the example we included in our article. The author further states that simply making such checklists available to patients and educating them about their use may not result in patients actually using them and being more involved in their care. The author also is concerned that, despite our best efforts, some patients will not want to become active and informed participants in their care. My coauthors and I do agree that making patients become more involved in their care and having them actually change their behaviors is likely to be a very slow process. There is plenty of evidence that activated patients do show greater adherence to medications, a desire for a healthier lifestyle, fewer visits to the emergency department, and greater engagement with their health care providers. Changing the culture to encourage those patients who do not want to change will take time. It will require a multipronged approach by engaging not only the patient but also the patient’s family and the health care providers as well as health care facilities, employers, the government, and health insurance companies. Now that we introduced the idea of a “patient’s checklist,” we need to find ways to validate the concept by creating checklists that are appropriate for a particular setting, implementing them, and then conducting robust research to examine the effect on
AORN Journal j 457
LETTERS TO THE EDITOR
April 2014 Vol 99 No 4
patient and clinician perceptions, and, ultimately, on health care outcomes. Checklists designed specifically for patient use can promote patient engagement, leading to improved quality of care. As we argued in our original article, currently used strategies and tactics for enhancing care quality need to be readapted to involve patients themselves. For example, to assist care redesign teams around the world to generate patient safety checklists by using Atul Gawande’s Project Check template “Checklist for Checklists,”1 providers fill out and complete tasks along a standardized protocol during the clinical decision-making process. Although the aims of this intervention are patientcentered, the patient-focused decision-making process before the procedure and/or surgery has yet to be in the process map. The National Patient Safety Foundation has developed certain tools to improve patient engagement, such as the Universal Patient Compact,2 a Checklist for Getting the Right Diagnosis,3 and a Post-Discharge Tool for Patients,4 among others. However, there are currently few checklists in use that adequately address patient needs. In our article, we presented an idea for a new frontier in checklist development. We envision the existence of a multitude of checklists covering a wide range of health care settings, medical and surgical specialties, disease states, and other special situations in which patient activation might lead to better outcomes. Physicians, nurses, patient advocates, other health care providers, and administrators can take an active role in checklist development and patient engagement. This should be done by taking into consideration the patient’s cultural and socioeconomic factors to specifically
reach out to those patients who are least likely to become engaged. With increasing attention focused on the National Quality Strategy5 for high-quality, cost-effective health care, patient satisfaction surveys will be assessed to rate overall health care. This opportunity is an incentive for providers, physicians, and hospitals to use the patient’s checklist as a leading indicator for how well they do on such patient evaluations. Most important, providers can use these checklists as a method to gauge a patient’s understanding of an intervention, solidify the patient-physician relationship, and improve patient safety. RICHARD D. URMAN MD, MBA ASSISTANT PROFESSOR OF ANESTHESIA HARVARD MEDICAL SCHOOL STAFF ANESTHESIOLOGIST BRIGHAM AND WOMEN’S HOSPITAL BOSTON, MA http://dx.doi.org/10.1016/j.aorn.2014.02.004
References 1. A checklist for checklists. Project Check. http://www .projectcheck.org/checklist-for-checklists.html. Accessed January 23, 2014. 2. Universal Patient Compact. National Patient Safety Foundation. http://www.npsf.org/for-patients-consumers/ tools-and-resources-for-patients-and-consumers/universal -patient-compact/. Accessed January 23, 2014. 3. Checklist for Getting the Right Diagnosis. National Patient Safety Foundation. http://www.npsf.org/for-patients -consumers/tools-and-resources-for-patients-and-consumers/ checklist-for-getting-the-right-diagnosis/. Accessed January 23, 2014. 4. Post-Discharge Tool for Patients. National Patient Safety Foundation. http://www.npsf.org/for-patients-consumers/ tools-and-resources-for-patients-and-consumers/post -discharge-tool-for-patients/. Accessed January 23, 2014. 5. National Quality Strategy. Agency for Healthcare Research and Quality. http://www.ahrq.gov/workingforquality/. Accessed January 23, 2014.
The AORN Journal welcomes letters for its “Letters to the Editor” column. Letters must refer to Journal articles or columns published within the preceding six months. All letters are subject to editing for length and clarity before publication. Authors of articles or columns referenced in the letter to the editor may be given the opportunity to respond. Letters that are included in the “Letters to the Editor” column must contain the writer’s name; credentials if applicable; position or title; and employer’s name, city, and state. Please submit letters by e-mail to [email protected] and reference “Letter to the Editor“ in the subject line, or submit letters by mail to AORN Journal, Letters to the Editor, 2170 S Parker Rd, Suite 400, Denver, CO 80231-5711.
458 j AORN Journal
www.aornjournal.org
DAWN M. YOST MSN, RN, BSDH, RDH, CNOR PERIOPERATIVE SERVICES MANAGER OF NURSING OPERATIONS AND STERILE PROCESSING DEPARTMENT WEST VIRGINIA UNIVERSITY HEALTHCARE MORGANTOWN, WV http://dx.doi.org/10.1016/j.aorn.2014.02.003
References 1. Health status indicators. The Henry J. Kaiser Foundation. http://kff.org/state-category/health-status/. Accessed February 3, 2014. 2. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005-1026.
Author response. The letter author states an opinion that patients will not readily use a patient’s safety checklist, such as the example we included in our article. The author further states that simply making such checklists available to patients and educating them about their use may not result in patients actually using them and being more involved in their care. The author also is concerned that, despite our best efforts, some patients will not want to become active and informed participants in their care. My coauthors and I do agree that making patients become more involved in their care and having them actually change their behaviors is likely to be a very slow process. There is plenty of evidence that activated patients do show greater adherence to medications, a desire for a healthier lifestyle, fewer visits to the emergency department, and greater engagement with their health care providers. Changing the culture to encourage those patients who do not want to change will take time. It will require a multipronged approach by engaging not only the patient but also the patient’s family and the health care providers as well as health care facilities, employers, the government, and health insurance companies. Now that we introduced the idea of a “patient’s checklist,” we need to find ways to validate the concept by creating checklists that are appropriate for a particular setting, implementing them, and then conducting robust research to examine the effect on
AORN Journal j 457
LETTERS TO THE EDITOR
April 2014 Vol 99 No 4
patient and clinician perceptions, and, ultimately, on health care outcomes. Checklists designed specifically for patient use can promote patient engagement, leading to improved quality of care. As we argued in our original article, currently used strategies and tactics for enhancing care quality need to be readapted to involve patients themselves. For example, to assist care redesign teams around the world to generate patient safety checklists by using Atul Gawande’s Project Check template “Checklist for Checklists,”1 providers fill out and complete tasks along a standardized protocol during the clinical decision-making process. Although the aims of this intervention are patientcentered, the patient-focused decision-making process before the procedure and/or surgery has yet to be in the process map. The National Patient Safety Foundation has developed certain tools to improve patient engagement, such as the Universal Patient Compact,2 a Checklist for Getting the Right Diagnosis,3 and a Post-Discharge Tool for Patients,4 among others. However, there are currently few checklists in use that adequately address patient needs. In our article, we presented an idea for a new frontier in checklist development. We envision the existence of a multitude of checklists covering a wide range of health care settings, medical and surgical specialties, disease states, and other special situations in which patient activation might lead to better outcomes. Physicians, nurses, patient advocates, other health care providers, and administrators can take an active role in checklist development and patient engagement. This should be done by taking into consideration the patient’s cultural and socioeconomic factors to specifically
reach out to those patients who are least likely to become engaged. With increasing attention focused on the National Quality Strategy5 for high-quality, cost-effective health care, patient satisfaction surveys will be assessed to rate overall health care. This opportunity is an incentive for providers, physicians, and hospitals to use the patient’s checklist as a leading indicator for how well they do on such patient evaluations. Most important, providers can use these checklists as a method to gauge a patient’s understanding of an intervention, solidify the patient-physician relationship, and improve patient safety. RICHARD D. URMAN MD, MBA ASSISTANT PROFESSOR OF ANESTHESIA HARVARD MEDICAL SCHOOL STAFF ANESTHESIOLOGIST BRIGHAM AND WOMEN’S HOSPITAL BOSTON, MA http://dx.doi.org/10.1016/j.aorn.2014.02.004
References 1. A checklist for checklists. Project Check. http://www .projectcheck.org/checklist-for-checklists.html. Accessed January 23, 2014. 2. Universal Patient Compact. National Patient Safety Foundation. http://www.npsf.org/for-patients-consumers/ tools-and-resources-for-patients-and-consumers/universal -patient-compact/. Accessed January 23, 2014. 3. Checklist for Getting the Right Diagnosis. National Patient Safety Foundation. http://www.npsf.org/for-patients -consumers/tools-and-resources-for-patients-and-consumers/ checklist-for-getting-the-right-diagnosis/. Accessed January 23, 2014. 4. Post-Discharge Tool for Patients. National Patient Safety Foundation. http://www.npsf.org/for-patients-consumers/ tools-and-resources-for-patients-and-consumers/post -discharge-tool-for-patients/. Accessed January 23, 2014. 5. National Quality Strategy. Agency for Healthcare Research and Quality. http://www.ahrq.gov/workingforquality/. Accessed January 23, 2014.
The AORN Journal welcomes letters for its “Letters to the Editor” column. Letters must refer to Journal articles or columns published within the preceding six months. All letters are subject to editing for length and clarity before publication. Authors of articles or columns referenced in the letter to the editor may be given the opportunity to respond. Letters that are included in the “Letters to the Editor” column must contain the writer’s name; credentials if applicable; position or title; and employer’s name, city, and state. Please submit letters by e-mail to [email protected] and reference “Letter to the Editor“ in the subject line, or submit letters by mail to AORN Journal, Letters to the Editor, 2170 S Parker Rd, Suite 400, Denver, CO 80231-5711.
458 j AORN Journal
