Patients are not passengers


Health care safety efforts have long focused on improving the behavior of providers and improving the systems of care. A proven model of safety is in the airline industry. There are undoubtedly many parallels between airline safety and health care working toward common goals. This work should continue in both industries to ensure the safety of the people they serve.

The airline safety model, though, can only look at health care patients through the lenses of satisfaction and service. Patient satisfaction, while important, is just a piece of a complex health care problem. For example, passengers on a plane like to follow the route. So, airlines provide renderings of the flight via active map technology and pilot announcements. This parallels the patient portals popular in health care. Like passengers, patients are provided with information that is interesting but not terribly useful. An airline passenger can no more direct the path of the flight than a patient can determine what tests to order next.

Health care safety experts have considered airline industry models since the mid-1990s. Safety in health care has been at the forefront since the 1999 Institute of Medicine report “To Err is Human.” Health care is not appreciably safer today than it was when the report was published. What can be done? Adopt a new metaphor: the driver model.

Patients must be included in the decision-making process of their health care. Patients need to be recognized for who they are — drivers of their own care. Drivers receive data that is converted into useful information. Drivers are aware of the clear and easily understood rules of the road. They also understand their journey, stops along the way and detours — should they become necessary.

Real-time lab data, imaging and the like are commonly available to patients through portals. But patient portals are like warning lights in a car. A warning light alerts the driver that something is wrong. Conditions have caused a failure.

In the case of a car, it is up to the mechanic to determine what caused the mechanical failure and the driver may not know why the light activated. Similarly, the health care provider must determine the sequela of an illness. The patient may have access to their labs and other data but do not indicate relevance.

Gauges, on the other hand, provide real-time information and allow trending as events unfold. Take for instance the temperature gauge. It begins in the cool position and then arcs up to a midpoint of normal. The speed at which it rises and the place the needle usually rests become a part of the normal operation of the vehicle and are familiar to the driver.

Let the temperature gauge deviate from normal, and the driver is likely to notice. Consider the needle rising above its usual midpoint and then quickly drifting down only to rise again a short time later. This action in and of itself may not ever trigger an overheated indicator, but it does provide valuable feedback that something is wrong with the cooling system.

Patients, too, need to have their health information presented in easily readable and understandable formats. Patients must have a better system so they can meaningfully participate in their care.

It is not that health care providers do not have policies and processes designed to inform patients. They do. And it is not that there is a lack of data. There is more than enough data collected on patients. The fundamental problem is how providers/clinicians share information and how data is turned into information for patients to understand and share with others.

Patient portals are useful but not complete. A better portal design with the end-user in mind is in order. Providers/clinicians need to do a better job converting data into information in a way that makes maximum sense to the consumer. View patients as drivers of their health care and work to provide them with relevant and useful information.

Christopher Noll is a nurse and risk manager.

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