More than anything, Willie needed a place to pee.
Elaine needed help walking.
Willie is homeless; Elaine is affluent. They both needed someone to listen to them and help them find solutions to their most pressing everyday challenges. That’s called “co-production of care.”
When Willie found out he had congestive heart failure, his doctor put him on beta blockers with diuretics.
The medications made Willie feel better, but there was one problem: Because of the diuretics, he had to urinate more often. Being homeless, he had no place to go, and he didn’t want to urinate in public.
Willie is not an easy character. He’s eccentric and moody. To be honest, he scares people sometimes.
Fortunately, a nurse practitioner named Kathleen listened to Willie. She realized that, although he had many needs — housing, food, transportation — he really needed a regular place to urinate. She offered to let him use the patient restrooms at the hospital.
That simple act of compassion changed Willie’s life. He began coming to the hospital regularly for more than just the bathrooms. His health improved. He got a girlfriend and began living a more “normal” life. We think he even has a job now.
Elaine would have benefited from someone like Kathleen helping her. At 84, she suddenly lost her ability to walk. She had resources — not only money but access to an array of services. But neither Elaine nor her family knew how to access those services, and her health care providers were not helpful. In the end, Elaine and her family wound up “producing” their own care to help Elaine adjust to her new disability.
Co-production is a different kind of health care than we’re used to in the United States. It’s when a patient and health care provider are equal partners in determining what types of services will meet that patient’s most important needs, as defined by the patient, and then implementing their plan together.
In co-production of care, service plans could include providing the patient with access to a bathroom. Or helping an elderly woman with mobility problems figure out how to cope with the stairs in her home.
Unlike Elaine, Willie and Kathleen are both participants in a study that Hennepin County Medical Center is conducting with Radboud University Medical Center in the Netherlands to learn more about co-production of care by comparing health and social services integration in both countries. The Robert Wood Johnson Foundation, through the Charities Aid Foundation of America, is supporting this joint exploration.
Specifically, the study is assessing the experiences of patients with congestive heart failure who, because of their illness, need social supports to stay healthy and avoid being hospitalized. These patients have a range of needs, from housing and transportation to informal help from family members and neighbors. We want to know whether and to what extent these supports are being integrated with patients’ medical care, and how that affects not only their health but their own involvement with their health and their ability to carry out everyday activities such as cooking, cleaning house, and getting around.
You might ask: Why partner with a hospital in the Netherlands to do this study?
Like other developed countries, the Netherlands spend significantly more on social services than the U.S., which spends more on medical care than any other nation. And yet these other countries, including the Netherlands, have far better health outcomes than the U.S. We think that the greater emphasis these countries place on social supports and service integration may be part of the reason why.
In short, we hope to learn from our colleagues in the Netherlands about how to foster co-production of care — and, ultimately, better health — here in the U.S. After all, we share the same goals and many of the same challenges. By deploying our resources differently, we may be able to achieve results more in line with those of other countries.
Already, we’re seeing a great need for co-production of care from our interviews with patients here. Many patients don’t know how to ask for the help they need, especially if it doesn’t fit the traditional medical paradigm. And these aren’t all patients struggling with homelessness or other problems related to poverty; some are affluent people like Elaine, while others are people who consider themselves middle-class but because of changed circumstances find themselves in need of services and supports that they don’t know how to access.
For health care providers, co-production of care is a lot about listening, without judgment and without assuming they know what’s best. On a deeper level, it’s also about integrating the medical with the social aspects of health care — not only to improve patients’ health but to help patients live their lives the way they want to.
We can do a lot to relieve patients’ suffering and improve their lives by listening to them and engaging with them to solve their everyday challenges in conjunction with their health issues.
As Willie’s and Elaine’s stories show, the answers may be far different than we expect, and we can’t find those answers without listening first.
Sylvester Jones is a communications executive and playwright. Laura C. Leviton is senior adviser for evaluation, Robert Wood Johnson Foundation.
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