Expert urges more focused patient care

James Conway was blunt about it.


"We killed Betsy at Dana-Farber" Cancer Institute in Boston, he said, referring to Boston Globe health reporter Betsy Lehman, who was overdosed with extremely high amounts of chemotherapy.

Conway, a former chief operating officer at Dana-Farber and a leading advocate for listening to patients and families, spoke Wednesday at the Patient-and-Family-Centered Care Annual Conference at Georgia Health Sciences University.

In 1995, when Lehman died, "we didn't disclose errors," Conway said, nor communicate well with patients and families. Her death resulted in a number of front-page articles about her care, however, and the institute's board and leadership "used this tragedy to take this organization to a very different place," Conway said.

Now an adjunct lecturer at Harvard School of Public Health and a senior fellow at the Institute for Healthcare Improvement, he spoke to medical students and residents about improving care by communicating better with patients and families.

A key part of that process is transparency and openness with patients, particularly when there is an adverse event, Conway said.

"Errors don't erode trust," he said. "The way we act after them does."

It also means working with patients and families, which Medical College of Georgia Hospital is renowned for, and recognizing their importance in the care, Conway said.

In some places, the patients and families are urged to write about their care in their own medical records; others allow all patients to have access to their physical medical records, he said.

"It's their record," Conway said. "It's their care."

Interns in the internal medicine residency program at GHSU take a patient-and family-centered course in which, among other things, they deal with patients with end-of-life illnesses, said Dr. David Fallaw, a member of the internal medicine faculty.

"One of the most difficult aspects of medicine is actually breaking bad news," he said. "We're problem solvers, and there are some problems we can't solve, unfortunately."

More than improving understanding, involving patients and families improves patient safety and the quality of care, Conway said.

"What we've learned in the nation since we kicked off the nation's patient safety journey is a whole bunch of stuff that used to happen has now been eliminated," he said.

It is becoming not just a good idea but also a requirement for hospitals to provide patient-and-family-centered care.

In Massachusetts, for instance, state law requires hospitals to have a patient and family advisory council that reports to the board, Conway said.

Health care reform would bring about value-based purchasing, in which patient satisfaction will be one of the major variables determining a hospital's reimbursement, he said.

"So hospitals, not only for the aspirational reasons and the competition reasons but the financial reasons, are being driven in a much greater way to figure out, 'How can I optimize the experience of the care?' " Conway said.