Humane health care outcomes by creating therapeutic alliances [PODCAST]

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“In fully-humanized health care, I envision patients as clients, with doctors as part of the health care team in a role more akin to expert consultants and skilled proceduralists. The consumer is empowered in the network to drive his or her own health — taking the central role rather than the physician.

By continuously humanizing health care and creating therapeutic alliances, we gain one more benefit. We enlist the efforts of the client’s natural support network, a free army of caregivers to reduce the load on our overburdened health care system. But to be effective, the support network will need engaging and actionable information. Together with providers, they will help individuals integrate multiple modalities in their journey toward healthfulness.

Therapeutic alliances not only would reduce costs by sharing information with people in a way that encourages them to take more responsibility for their own health, but they would also reduce the dehumanization rampant in health care today.”

Summer Knight is a family physician and physician executive. She is the author of Humanizing Healthcare: Hardwire Humanity into the Future of Health.

She shares her story and discusses her KevinMD article, “Humane health care outcomes by creating therapeutic alliances.”

This episode is sponsored by Tradeoffs, available on your favorite podcast platform.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Summer Knight. She is a physician executive, and she’s the author of the book Humanizing Healthcare: Hardwire Humanity into the Future of Health. There’s an excerpt from that book on KevinMD, and that’s titled “Humane health care outcomes by creating therapeutic alliances.” Summer, welcome to the show.

Summer Knight: Thanks, Kevin. Thanks for having me.

Kevin Pho: So we’ll get into your book and article in a little bit, but first off, can you just share your story and journey to where you are today?

Summer Knight: Before we even start, I just want to thank so many people in your audience, clinicians, physicians, for the amazing work that they’re doing, recognizing how this journey on COVID has been such a challenge for so many people, and remembering why so many of us have gotten into health care, which is to serve people. I just want to share some gratitude for that.

For my background, I wear three main hats. One of them is that I’m super passionate about humanizing health care. As you can see, I wrote a book about that. I also wear a hat around a not-for-profit called One Humankind, where all the royalties for that book go.

And then from a career perspective, as you shared, I started my career as a firefighter paramedic and then became a doctor, from the interactions I had with the emergency room staff and their motivation to me to try and reach for the doctor stars and practice medicine. Then I became the chief medical officer for the state of Florida, as well as built a number of different health care facilities as well as digital health businesses, and have also been an executive at a provider and a plan. And now I’m a consultant, so I’m really working on care delivery transformation and things that really humanize health care.

In this book, I indexed on the health care consumer and a new definition of that health care consumer. But I would also say, as I start out with my first remarks, that maybe even more than the health care consumer, today we need to be humanizing health care for our fellow clinicians, physicians, and staff people.

With the book, I have heard from a number of folks that every person pursuing a career in health care should read the book. I think that’s because, although I started out writing a business book, I ended up sharing excerpts of my own life. I am also a patient with a chronic and complex condition, and I’m also a sandwich generation caregiver, so I have experience caring for elderly people both in my own home as well as remotely.

And then also, unfortunately, what I talk about in the first chapter of the book is the journey that my youngest son and I had when he was diagnosed with a very aggressive and rare type of cancer. We indexed more on the experience that we had, which, unfortunately, many times created challenges for him around healing, because we as a health care system really wanted him to conform with the way we think about patients, rather than allowing him to be a 13-year-old boy with a tragic diagnosis and allowing him to kind of live and grow through that experience. So the first chapter is extremely personal, and I’ve been told a number of times that it causes people to not want to put it down.

Kevin Pho: So when you talk about humanizing health care, what exactly do we mean by that?

Summer Knight: There are many themes in the book, and we start out by talking about the three-plus-one drivers that have been changing health care over the past 20 years. So that is the consumerism of other industries, not health care. It’s around the change in technology in other industries that health care has been late to pick up, and then as well as the regulatory changes that have occurred. And then, the three-plus-one: Then came COVID, which really put a spotlight on health care and then created a number of what we call seven health care trends.

So we go in to talk about a number of themes, but the core theme is really around vulnerability. Right now, in our vernacular, we talk about the triple aim, the quadruple aim, the quintuple aim. But when we lay it all out, it really gets to the point of how vulnerable people feel when they’re in the health care system, and that can be anywhere from being confused and not being sure about the information that they need to help make decisions.

We go into six different phases of activation for patients. And what does that mean, right? Because we experience the gamut of individuals that we work with, from those who come to you completely prepared, they’ve got their data, et cetera, to those with whom we might share a diagnosis, and the next time we see them, if we see them, they might not even have registered that they have this diagnosis. So we go through that.

But the core is: How can we create therapeutic alliances? Therapeutic alliance, as I’ve defined it in the book, is a bond between the health care consumer and their health care team, as well as that consumer’s natural support network of family, friends, and volunteers. That therapeutic alliance and bond is based on a mutual sense of caring, a core goal toward health optimization, and trust.

You’ll notice there are a couple of things I added in there that we normally don’t talk about too much in health care, which is that natural support network and how important that network is. I focus quite a bit on how leveraging this free army to help us on those health care journeys could be extremely compelling, not only from a healing and adherence-to-plan perspective. But also, when you look at the data on the amount of resources that families spend and that employers actually will lose due to the presenteeism and absenteeism of employee caregivers, the numbers become astounding, and they actually are a significant percentage of the entire overall health care spending in the U.S.

Kevin Pho: Now, talk about what the situation is now. You talk about an ideal of therapeutic alliances in your book, so give us a hypothetical case study of what the situation is now and what we need to do to bring that situation to the ideal therapeutic alliances that you talk about in your book.

Summer Knight: I index on and spend some time talking about what humanizing health care means, and I break it up into a framework we’ve created. The framework includes that when we make significant changes, we have to think about the impact to the individual. The individual would be that health care consumer or patient, the clinician, and those relationships that occur.

Then, also, from an organizational perspective, that’s number two on the framework. When we’re humanizing health care, how does it impact strategy? How does it impact the way that we invest going forward? How does that impact people, processes, and technology in our operations? And then the third one is the impacted ecosystem. That could be a community, or that could be nationally. It could be going out there and trying to change rules and regulations, et cetera. So we spend quite a bit of time talking about that humanizing health care framework.

Then I give a pretty in-depth description of what the next-gen health care delivery system of the future could look like. Obviously, that’s more of a futuristic prediction, but one that is steeped in quite a bit of research and experience. What we named it, in chapter five, is the Healthfulness Hubs. It really indexes on the consumer’s experience through that process, in that they have an ability, depending on where they are around those six levels of activation, to have a continuous connectivity experience digitally with their care team. Now, that doesn’t mean that they’re constantly talking to their doctor, because we go into that more specifically as well. But they’re continuously connected digitally.

Then, as the need arises for different types of care, we surface different virtual health use cases, and those could run the gamut from everything from more of an AI-based urgent care experience, and many people learned about that and experienced that when we first learned about COVID, all the way to hospital at home, where we’ve gotten more approval to do more types of experiences in hospital at home. And then, of course, in person as people need to, but with more of a service to the individual health care consumer, thinking about them as a client at the top of the pyramid. So that would be a combination of home visits and mobile clinics, and then moving into retail and potentially centers of excellence for specific, higher-need care, where they need to go somewhere where there are specialists.

And then we also talk about how in that new care model, there’s a very different workflow for the care team. There’s space to really allow clinicians who feel that that’s an important part of their work-life balance to be able to, number one, have time for compassion with the patients that they’re dealing with. And we just don’t; in an RVU, fee-for-service situation, it’s very challenging to do that.

But it’s also to reconfigure the team in a way that the individuals who are seeking care may have more interactions with more of the support team, like a guide, a care coordinator, a care manager, rather than putting all of that emotional energy on the physician. And that then allows the physician to move more upstream by being able to deal with more chronic and complex conditions, but also by using AI and machine learning to, first of all, take off the plate task-oriented items that could really move into the background, which are really frustrating for clinicians, and then also by using more cognitive support for decision-making and for moving through the vast amount of data. There’s just so much data coming forward for clinicians that it’s really difficult, or I should say impossible, for each of us to be able to keep up with the massive amount of information that’s out there.

Kevin Pho: So I think certainly your model sounds appealing, but as you know, with our current health care system and our current payment system, there’s a lot of inertia. So what actionable things need to happen in order to get from where we are now to the ideal model that you described?

Summer Knight: I would break it up into two pathways. There’s incremental change that organizations can take, and then there is pretty transformational change. With those organizations that are doing the transformational change, we see that it’s coming in as disruptors, so different from our traditional institutions that we’ve been used to. We’ve been warning for many years, “Hey, these disruptors are coming.” Well, they’re here and participating.

For more of the traditional organizations, though, we are seeing a pretty significant lean-in and openness to how we can transform the care that we’re delivering, because we just have more demand than supply, and we need to create efficiencies. Because of the COVID situation, fee-for-service was really a challenging environment for many providers, and so moving into a value-based relationship, the value of that to the providers has become more obvious from that experience. Of course, there are still so many unknowns, but we really are moving in that direction as a nation.

So what we’re seeing some organizations doing is to stand up kind of a dual care delivery system, if you will. Now, that’s really expensive to do and challenging, and the tipping point that we’re seeing is when organizations are around 40, in the low 40 percent of value-based care, that they are starting to make the plunge to leaning into that alternative care delivery system.

Since I wrote the book, I’ve also really been having a number of conversations with health plans and digital health organizations, as well as some providers who are just saying, “I’d love to do this, but I can’t afford it,” which is a very real fact, right? We’re talking about building a new infrastructure on digital rather than all the bricks and mortar that we’ve been doing up to this point. To do that requires a significant capital infusion and expertise that most clinical providers don’t have.

So I’m seeing real interest in creating a demonstration project that would be open door, all comers, where it’s cloud-based and it’s available for different digital health organizations to be part of this purpose-driven platform, in order to really show the rest of the community what we can do with a digital-leaning-first approach. That’s very exciting, and I’m excited to be part of that evolution. We were playing with some names for that. You know how we have “health care”? We’re talking about, maybe it’s more a purpose-driven “care plus health” ecosystem for people to be part of.

Kevin Pho: We’re talking to Summer Knight. She is a physician executive, and she’s the author of the book Humanizing Healthcare: Hardwire Humanity into the Future of Health. Summer, from the perspective of an individual primary care clinician like myself, what do we have to look forward to realistically in the next, say, three to five years?

Summer Knight: I think in the next three to five years, we’re going to continue to see the incremental changes happening in primary care. However, because of disruptors, and because of projects similar to what I just shared, we are going to see new care delivery systems coming out, and it’s not going to be one-size-fits-all. I think you can read my book and think that that might be interesting for a certain subset of the population, but maybe not everybody. But we will continue to see these care delivery models roll out.

And I think we talk a lot about what consumers they are appropriate for, but I don’t think we spend enough time talking about what types of clinicians are going to be attracted to these new models, and I think that’s something that we need to really be aware of. So I would just say, as your audience is thinking about their careers and what they’re interested in doing, begin to think about: Are there other models that you’d like to practice in? Is there something that might light you up? And then begin to look for those models, because they are either out there or evolving and looking for clinicians to participate.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Summer Knight: I think I’d go back to the fact that we all chose health care to care for people and to serve people, and it’s such a noble career. And we had to work hard to get there, even when we chose it. So many people tried to choose it, and they didn’t make it. In the tough times of COVID, I guess, just remembering that every single day you are a hero, and that people are burnt out. People are retiring early.

I guess I would just leave it with a big group hug, and just, it’s tough, and we have to support each other. Our situation is, I think, demoralizing for so many people, and sad, and I just want to send lots and lots of energy and care and compassion to everyone on the front lines.

Kevin Pho: Summer, thank you so much for sharing your time and insight, and thanks again for being on the show.

Summer Knight: Kevin, thanks for having me. It’s such a pleasure.

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