The New Health Care Consumer

Twenty nine percent of the new consumers formerly had no connection with a health care delivery system at all, he said. “That’s a significant percentage of people who have no idea about health care because they’ve been disconnected from the delivery system as a whole. What does this mean? It means that there are some great expectations of this new consumer. They’ve bought cars, houses, clothes and do everything as a traditional consumer, but this is new to them.”

The trending term in health care is achieving the triple aim. That includes: improved patient experience, reduced cost and improved population health. He asked the group of 120 social workers gathered at the conference what good does it do to patch up a patient just well enough to go home when that patient will likely develop complications and have to be readmitted.

Increasingly because of the ACA and other factors, reimbursement rates are being tied to how well health care organizations are able to deliver. “Achieving value is about giving power to our patients, communities and families and letting them know that they are partners with us in this delivery system model. They are partners with us on their wellbeing. They have to be. As social workers, we know this clearly. We know that intrinsically. That’s the work that we do. For many others, though, it’s a foreign concept.”

How Leaders Can Encourage Diversity In The Workplace

Gunn said there are several key components to hospitals and health care professionals being better at adapting to change.

1. Shift attitudes

"Medicine doesn't think of medicine as a service industry, and I say medicine today is just as much social work as it is medicine."

One key to successfully adapting to change is breaking down silos and institutional boundaries. The words, “that’s not my job” should not be allowed in an organization, Gunn said. “The letters behind your name is an acknowledgement of who you are and what you know, but it shouldn’t be the limitations of what you do for the patients or the customers that you serve. Period.”

2. Close the gap on disparities in care

“This is going to kill us if we don’t kill it first.”

Gunn cited the 2002 Institute of Medicine report “Unequal Treatment” that studied health disparities in America. It found that people of color receive lower-quality health care than whites do, even when insurance status, income, age and severity of conditions are comparable. It also found major disparities in many key diagnostic areas, including cardiovascular disease, cancer, stroke, kidney dialysis, HIV/AIDS, asthma, diabetes, mental health and maternal and child health.

3. Reduce barriers to care.

“There are certain zip codes where per 1,000 people, there are 10 physicians. Then there are other zip codes where per 1,000 people, there isn’t a physician at all.”

4. Increase the diversity of staffing and training on diversity

Providers need to be available who are culturally and linguistically connected to patients in a way that care-delivery barriers go down. Diversity should be set as a leadership competency, he said.

Gunn said progress has been made in the area of diversity and inclusion, but 14 years after the 2002 IOM report, there still are disturbing trends emerging. A study done at the University of Virginia Medical School College of Medicine in 2015 of residents and fourth-year medical students found that nearly 50 percent of all the residents in this study thought that it was possibly true, probably true or definitely true that African-Americans’ skin was thicker than white skin so they feel less pain. The same response was given on the question if African-Americans’ blood coagulated quicker and they feel less pain.

“I didn’t want to believe it but this was a national study that was published this year. There’s inherent bias in many professionals even about basic physiological facts. We still have a lot more work to do on disparities. These disparities cost us $57 million a year, according to some researchers at Johns Hopkins University.”

Given that the demographic changes show no signs of slowing down, health care professionals have to pay attention.

According to the U.S. Census Bureau, people of color will rise from 38 to 56 percent from 2016 to 2060, a 47 percent change; those who are foreign born will go from 42 million to 78 million, an 85 percent change; and those speaking a foreign language at home will go from 21 to 30 percent, a 43 percent increase.

“How can you possibly deliver a value-based, quality health care experience to patients you don’t know, and you don’t understand? That’s the challenge before us as service providers. So how in this increasingly complex environment do we deliver these great experiences in our organization?”

Creating A Culture Of High Reliability

Gunn said hospitals are adopting what’s known in the business world as high reliability principles. For health professionals, this translates to collecting REaL or racial, ethnic and language data on its “consumers”; improving the cultural competence of providers, staff and leaders; diversifying the clinical team to reflect patient population; addressing health care disparities; and promoting understanding of global health.

“I’m 6-foot 5, about 265 pounds and born and raised in Southeast. If I walk into a doctor’s office, there are certain things my doctor should always check because of my lifestyle and cultural connections to the South,” he said, ticking off conditions such as blood pressure, heart disease and diabetes. If it’s a man from Nigeria, there would be different questions to ask.”

Global travel has changed the landscape of how we practice medicine, he said. “Do we as practitioners in the U.S. even know what the five most common diseases of the world are. I tell you that most care providers do not. You have to improve the cultural competency of the entire staff.”

Cultivating cultural sensitivity externally and diversity of staffing internally leads to innovation in an organization. The more different people you have around the table trying to solve problems, the faster you get solutions, he said.

This is a framework that leaders need to understand in today’s world that continues to change rapidly. “As you can see from the numbers, our world is getting more and more diverse. And it’s not just race and gender. Age matters too. Millennials’ whole view of the world and value system is different from older generations. They have different expectations.”

For example, many young people give health care organizations horrible patient satisfaction scores. A primary culprit: lack of good Wi-Fi. “You’re laughing,” Gunn said, responding to his audience’s reaction. “But this is for real. You have to build the kind of experience that people want.”

The way Apple stores are set up are the perfect example of being aware of and catering to consumer expectations, he said.

“These principles are not new, but they are new to health care. If we want to change the game and innovate and get patients to a place where they are in complete control of their health, we need to lead innovation for a changing world. Social workers have always been at the forefront of leading for a changing world. We need to be that place again in health care.”