Healthcare Hiring: Can Continuity of Care Reverse the Decline in Life Expectancy?

Life expectancy in the United States declined in 2015 for the first time since 1993 due to increases in the usual suspects: heart and respiratory diseases, and diabetes. Gaps in continuity of care combined with poor preventative health measures, insufficient mental health care, and increasing obesity rates are singled out as primary underlying causes.

A female and male healthcare provider talking to a female patient

Continuity of care equals quality of care over time. It is the process by which patients and their physician-led care teams cooperatively engage in healthcare management that is of high quality, is cost-effective, and saves lives. The patient experience is at the core of continuity of care and each of the probable causes for the decline in life expectancy.

Experiences that leave patients feeling truly cared for and competent in their ability to contribute to their own health helps nurture trusting and cooperative relationships between professionals and patients. These experiences are the pathway to continuity of care.

The Patient Experience

Indeed, positive patient experiences go beyond patient health and engagement to generate referrals and improved financial outcomes (increasingly important with the trend toward value-based care and reimbursement). This synergy begins with primary care providers such as doctors’ offices, clinics, and urgent cares. They are the point of entry to improved patient health and the source of the largest difference in outcomes and increases in preventative care.

Making quality care and the patient experience the focus of hiring and engagement initiatives builds these synergies and increases the rate of  early diagnosis, buy-in to preventative care, and improved financial outcomes.

Online Patient Reviews

During 2016, my Teammates and I have completed a study of over 1,000 online patient reviews of primary care providers: from doctors’ offices to urgent cares. The stories and narratives written by patients, combined with their numerical ratings, demonstrate the power of the primary care provider-patient relationship to improve continuity of care.

The goal of our study was to understand the drivers of a patient’s intention to return and refer the care provider to others. We looked at patients who indicated in their reviews that: “I will tell my friends and family to seek care here – and will return in the future.” What we discovered has significant implications both for patients and care providers. Specifically, patients who provide a 5-star rating (on Google, Healthgrades, Yelp, or Facebook) are 10 times more likely to say they will return and refer.

Here are some examples of 5-star patient experiences:

I sincerely believe that if it had not been for Dr. X’s and her team’s thoroughness and communication, we would still be here scratching our heads and racking up the medical bills.

I’m used to long waits for medical appointments (even after you “held your place in line” for a certain appointment time) but they are almost always on time. They sent my prescription to my pharmacy right away so I was able to get my medication quickly. I will definitely remember this location! I appreciate how quickly I got to see a doctor and his promptness and care in diagnosing and treating me. He also gave me a detailed “action plan” showing me the drugs I was being prescribed and everything they did at the clinic, including my vitals. I don’t think I’ve gotten that from other clinics before.

These narratives, and the hundreds of 5-star reviews they represent, show how specific behaviors by care providers and support staff directly engage patients in their own care and treatment.

Your Vision For Care

Healthcare leaders have found targeted care and service initiatives to be effective in improving health outcomes.  Example: to reduce readmissions within 30 days of an initial hospital stay, healthcare systems review charts and data to determine the patients most likely to return.  This group receives consistent communication and visits from home health aides to ensure medications are taken, follow-up clinical visits are attended, and they have access to the resources they need to recover.

The challenge is to create a strategic and overarching vision to guide practices like the one for reducing readmission.  A vision sets the direction for the patient experience:  this could include making patients feel competent in their ability to improve their wellness, and building their relationship and trust with care providers.  To be successful, this vision must be supported by strategies and practices that reach the goal of reduced mortality and improved health through prevention and continued care.

Any vision for care starts with the team. In turn, the team starts with who you hire.  Each position makes a unique contribution – from providing care and treatment to ensuring timely communication.  To hire people who can consistently deliver your vision for care you must first define the behaviors and processes that are needed to achieve your vision of the patient experience.  What qualities (e.g., abilities, values, skills, and personality traits) do you need in each position to provide a patient experience that will lead to continued care and improved health?  Developing care paths, or intended patient experiences for specific conditions, can also elucidate the tasks, processes, and behaviors your team needs to consistently deliver – and the necessary qualities you should consider in the hiring process.

By starting with the vision in mind, our solutions for hiring people with the potential for meeting expectations have helped our customers reduce turnover by over 50% and increase supervisor ratings of care providers for compassion, care, and accountability. As Patagonia founder, Yvon Chouinard, famously said, “Profit is what happens when you do everything else right.”  Meaningful improvements in health outcomes, and the functioning of our healthcare system, can only happen if you do everything right, starting with the quality of the people you hire.

Next Steps

To learn more about how to align your hiring process with your company’s vision for care, check out this video of Tom DeCotiis, Corvirtus Co Founder, and Janet Burns, CEO of Sunny Vista Living Center as they discuss how they achieved this goal.

Resources

Why are so many Americans dying young?  The Atlantic.  December, 2016.

U.S. life expectancy declines for the first time since 1993. The Washington Post.  December 8, 2013.

What is ‘continuity of care’?  Journal of Health Services Research and Policy.  October, 2006.

Reducing hospital readmissions: lessons from top performing hospitals.  The Commonwealth Fund.  August, 2011.

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