The subtitle of the book, Humanizing Healthcare by Summer Knight, M.D., telegraphs the author’s main point, “Hardwire Humanity Into The Future Of Health.” That statement certainly begs the question of whether the sprawling, disjointed healthcare system can be infused with humanity and if providers can be persuaded and educated to be more compassionate. It is an even bigger ask for call centers and insurance companies to climb on board.
This is an ambitious undertaking, but Summer Knight contends that an all-encompassing electronic platform will save the healthcare industry and put consumers in the driver’s seat at long last. Everyone would be armed with an on-demand, seamless, interoperable communication platform. It remains to be seen if a powerhouse digital play can be designed with enough touch points – face-to-face, telephonic and virtual – to support authentic communication.. Without the caring communication advocated by Dr. Knight, even the most sophisticated technology will not change the rules of engagement.
The author envisions “healthfulness hubs” powered by digital care activation platforms (DCAPs) at sites of care supported by virtual and connected health mechanisms. The hubs would be person-centric and preference-based organizations to facilitate multi-party collaboration on treatment decisions. Preventive care, acute illnesses and injuries, and chronic conditions would all be included. Hubs are intended to move care into patients’ homes, their workplaces or even travel. Individuals could access their hub at any time wherever they happen to be. It is intended to support more interaction and dialogue rather than less, which is all too often the case with many “cost saving,” impersonal technology platforms.
Hubs aim to create a continuous digital network for patient health needs “when, where and how” consumers and their families want to connect with clinicians and care teams. If this is the future direction of healthcare, it raises a host of questions. Yet Dr. Knight’s sweeping vision is intriguing.
The roadmap she lays out is both highly technical and highly personal. She wants to upgrade the practice of medicine to be “more compassionate, comfortable, convenient and affordable for patients and their families.” This scope of Dr. Knight’s objective is even more aspirational than the Triple Aim.
Can a truly consumer-centric technology platform be designed with real-time access to compassionate caregivers? Can a scalable, cloud-based digital platform put ordinary consumers in the driver’s seat to deal with a contentious mix of providers, payers and suppliers -- particularly when patients want a wise, listening ear? Overcoming these challenges is especially important to seniors and patients whose preferred language is other than English. All these challenges are hard to fathom under the most optimistic of scenarios, yet the author lays out a detailed action plan to accomplish this feat in the course of 269 pages.
What seems to motivate Dr. Knight’s thesis is the belief that supporting patients with better technology and better information will lead to widespread consumer activation and better outcomes. She believes the most effective treatment comes from compassionate people working together. This calls for a therapeutic alliance between clinical care teams (including other professional staff) and the “home team” of patients and their natural support network of family, friends and volunteers. Pulling these roles and functions together is key because it empowers consumers to be in charge and at the center of decision-making rather than medical professionals.
Two factors that help bring patient management together at home and in the hospital are a digital platform that can be accessed at any time by the consumer’s personal and medical network, and live human interaction. While improved technology has the capacity to revamp and improve personal interaction, it must be experienced as effortless and efficient by consumers, providers and payer. However, it is the responsibility of the care team to actually practice compassionate communication as a means for bringing patients and physicians closer together.
A therapeutic alliance forms when a bond is established between the consumer and the care team, based on a sense of mutual caring and trust. The latter must be demonstrated as an integral part of a revamped technology platform. Trust improves adherence to care plans by getting all the care team members on the same page and communicating with each other.
Humanizing healthcare also suggests hardwiring humanity at every point in care. This means injecting compassion and empathy into the science of medicine and engaging consumers and their support network as part of the newly expanded healthcare team.
From her experience as a primary care physician, Dr. Knight recognizes that a person’s healing depends on understanding and acknowledging their emotional needs as part of the medical condition. This can be done by asking simple questions like “What are you most worried about? Are you comfortable? Is there anything occurring right now that is causing you fear?” To elicit a meaningful response, these questions should be conducted in person, by phone, or during a virtual visit.
As Dr. Knight notes, compassionate communication directly affects patients’ autonomic nervous system, breathing, and heart rate variation. It reduces stress, increases patient adherence, and supports the therapeutic alliance. In addition, an empathetic preoperative consultation improves surgical outcomes, better wound healing, requires less than half the dose of morphine, and patients go home sooner. Likewise, empathetic communication for diabetic patients improves glucose control. Even patients with terminal lung cancer with early access to compassionate palliative care have less depression, fewer interventions, and survive 30 percent longer. When primary care doctors provide patient-centered care, system costs go down by a third.
For all the talk of evidence-based outcomes, it is disconcerting that more providers do not acknowledge the evidence that empathetic communication is a pathway to better outcomes. Unfortunately, doctors are not trained or financially incentivized to do so despite strong clinical evidence.
The author believes that data and evidence are foundational building blocks that can transform healthcare. Yet the current healthcare system is locked in silos of claims systems, clinical EMRs, and pharmacy data depositories – none of which are readily available to consumers. The author points out that data must be made available to consumers and clinical teams “with a push of a button” when it is needed for critical treatment decisions at an emergency room or making critical treatment decisions that require a complete picture of the individual. This complements, but does not replace, face-to-face interaction.
Humanized healthcare is centered on the activated consumer rather than the current provider-centric model. That means providers and payers must cede responsibility and control over many aspects of decision-making. This entails empowering consumers with essential demographic, financial and clinical information that is not now widely available. Without it, “activation” and “engagement” will surely lag.
However, relinquishing control over decision making threatens the authority of physicians and the established pecking order of medical practice. It requires caregivers to more fully embrace the “art of medicine.” This entails vulnerability and the capacity to hear patients’ personal stories as an essential part of diagnosis, treatment and healing.
The doctor does not disappear in this new model, but moves upstream in order to focus on decisions and interventions that are especially complex such as treatment plans for chronic care conditions. Mundane and repetitive tasks will be taken care of by bots and AI capability, and with other professionals on the care team (nurses, therapists and health aides) practicing at the top of their licenses.
Transitioning to such a practice style is a decades-long process, which includes changing medical education. It is unlikely that Summer Knight’s vision and prescription will be embraced overnight, but it is an important roadmap for how to reconceptualize healthcare. It is by no means an incremental approach, and that is one of its strengths. Nor does it merely emphasize a new software platform as the next big thing. Rather, it makes a strong case for harnessing technology, which is already available, to reframe the role of medical informatics to support widespread access to information that matters most to consumers. It is a different approach to the practice of medicine..
It is hard to argue that patient engagement will improve without a fundamental shift in the role of consumers and their access to better information when they need it, and how everyone on their care team can use it. Without such a radical transformation, it is unlikely that a patient’s experience of medical treatment will improve, nor will patient outcomes.
Dr. Knight is indeed a visionary, but with both feet on the ground. She builds a compelling case that healthcare can be humanized through an information platform plus authentic human interaction. This brings everyone together for the common purpose of healing through more supportive communication. The electronic platform advocated by Dr. Knight bridges immediate access to information and facilitates dialogue and connectedness among care team members. By encompassing mental and behavioral characteristics as a continuum of care, it leads to whole person care. Integrated care advocates have championed this for decades.
Does it sound too good to be true? Maybe. But it would surely be a profound change for the better.
Digital health goes well beyond the technical aspects of how data is configured and flows. It offers a fully integrated platform that is available to consumers at multiple entry points that are user-friendly. The author does not shy away from explaining the inherently complex details of digital health integration. These capabilities include interoperability, smart computing (advanced analytics and AI), machine learning, remote care delivery tools, clinical and business process management, and value chain management.
In other words, human-centered design is inherently complicated and, according to the author, “improves the consumer experience while containing and reducing costs.” Dr. Knight contends many of the puzzle pieces are already in use.
The challenge is to accelerate system redesign with partners who are ready to step up and commit to a radical redesign effort. Even if such a platform is cost-effective in the long run, many healthcare systems are reticent to finance long term investments without a proven ROI. Health system administrators already face funding challenges and reduced reimbursement from payers.
This raises the question of where investment capital will come from to design and implement a team-based platform. It will take extraordinary leadership to marshal such capability, regardless of its benefit to consumers.
The author’s concluding comment is that “humanized healthcare is coming, and it will make the industry sustainable while boosting satisfaction and quality.” If so, it would be the realization of the Triple Aim, achieving better engagement, better outcomes and reduced cost simultaneously. That would be well worth the price and the resulting disruption of market forces that have resisted such sweeping innovation.
Peter Boland, Ph.D., is the President of Boland Healthcare in Berkeley, Calif.