What can I do to humanize health care?

Zeev Neuwirth: ©Zeev Neuwirth

There is no doubt that American health care is in crisis. Tens of millions of Americans are in medical debt. Hundreds of thousands are injured or die each year from avoidable health care errors and hospital-acquired conditions. Insurers categorically deny patients the appropriate treatment and medications in a misguided approach called “prior authorizations.” Employers have been asleep at the wheel for decades, allowing the system to unnecessarily jack up the costs of health care.

The U.S. is the only developed nation in which life span is decreasing, and we have, by far, the worst disparities in health care and health outcomes. Burnout and demoralization amongst clinicians and staff now adversely impact nearly half of the American health care workforce.

If we are to solve the dire dilemma in American health care, it is clear that the approach will have to be radically different from those we’ve taken to date. Over the past decade I’ve been studying visionary leaders who are thinking and acting differently. There are replicable lessons we can learn from these divergent leaders – approaches that we can adapt and scale. Below are three foundational principles and three examples we can learn from to humanize healthcare.

• Build trust. If you’re not actively and intentionally building trust, then you're fostering distrust. When people talk about trust, I ask (1) How are you defining it? (2) How are you measuring it? (3) How are you operationalizing it?
• Address health inequities and disparities. The immediate goal is to eliminate inequities in health care and disparities in health outcomes. What we must do is replace all of the systemic ‘ism’s: racism, sexism, ageism, ableism, classicism – with humanism - and again, operationalize and systematize it.
• Resource and expand primary care. The evidence is overwhelmingly clear. More preventive primary care in a community leads to greater health and lower costs. Primary preventive care is fundamental to achieving any effective and sustainable health care system. This also includes attending to the emotional, relational, and psychosocial aspects of an individual’s life.

There are several examples of these principles in action. Unbeknownst to most, the Veterans Administration (VA) has become one of the most innovative and transformative epicenters leading the way in humanizing health care delivery. It’s also the largest health care system in the US – with approximately 150 hospital centers, 1,400 ambulatory care centers, and over 400,000 employees providing care to over nine million veterans annually.

In 2016 the VA instituted a “Trust Index.” Quarterly, they send out a survey to measure veterans’ perception of the value being delivered to them by the VA. The survey has three statements – each measured on a five-point Likert scale – that address ease, effectiveness, and emotion, plus an overall trust statement.

1. Ease - “It was easy to get the care or service I needed.”
2. Effectiveness - ”I got the care or service I needed.”
3. Emotion - ”I felt like a valued customer.”
4. Overall trust - “I trust VA to fulfill our country’s commitment to veterans.”

The VA publicly reports their trust index results quarterly (va.gov/trust), breaking down results by gender, race and other demographics. This transparency clearly adds to the trust they’re building with their employees and patients.

When they first began the survey in 2016, they discovered that only 55% of veterans trusted the VA, which they felt was unacceptable. In response, they used the insights they gained from this and other surveys, and launched numerous patient-facing initiatives as well as efforts amongst clinicians and staff to improve trust. As of Q4 2023, their score had improved to over 79% – best in class compared to other public and private sector healthcare delivery systems in the U.S. Their goal is over 90%. In order to reach that percentage, they have already begun mapping out veteran patient journeys and creating personas that capture the pain points, challenges, and bright spots for veterans as they utilize the VA.

The VA has also launched a national Whole Health Initiative (https://www.va.gov/wholehealth), which has been extensively studied. Its goal is to provide more holistic wellness care, complementing traditional clinical and social care. The program is based on decades of research demonstrating that non-clinical factors play a significant role in the health outcomes of individuals. These factors include issues such as housing, financial stability, employment, education, transportation, nutrition, sleep, stress, relationships, and neighborhood and environmental safety. What’s fascinating is that this program also addresses issues such as loneliness and an overall sense of purpose in one’s life – factors now known to contribute not only to emotional and mental health but also to physical health and longevity.

The VA Whole Health program is multi-faceted and operationally complex, but it boils down to two essential questions which, I believe, other organizations can adapt and apply immediately. First: “What is most important to you in your life right now?” And second: “What can you and we do to assist you in achieving or attaining what’s most important to you in your life?”

The final example comes from a provider organization called ChenMed, whose focus is to provide VIP care to older patients who have either Medicare Advantage or are dually eligible for Medicare and Medicaid. ChenMed has been recognized as one of the best provider organizations in the country, with demonstrably superior quality, safety, health outcomes and experience scores.

Dr. Faisel Syed is a practicing internal medicine physician and clinical leader at ChenMed. One day he noticed the way he and his team were describing some of their patients. For those who work within provider practices, you’ll be familiar with the term “walk-ins.” The term has a negative connotation because patients who walk in without an appointment disrupt the schedule. It’s a term that does not elicit a lot of warm, fuzzy feelings from providers or staff in a clinic setting.

Syed recognized that it was also a somewhat dehumanizing term, not in keeping with the overall mission and culture at ChenMed. He reminded himself, his colleagues, and his staff that these patients were calling or coming in for an immediate appointment because they had an urgent medical need. So he asked his staff to change the term “walk-in” to “person in need.” It was nothing more than that, but that subtle shift changed everything for the team. It established a renewed sense of empathy, compassion, and kindness.

I applaud anyone who is asking themselves, “What can I do to humanize health care?” I would suggest that rather than trying to boil the ocean, start small. Start by talking about it. Start by asking questions that challenge the status quo and the incrementalism that has taken over healthcare delivery. Start by sharing examples of humanism in your practice and organization. Start by making your workplace more humane for clinicians and staff. Start by noticing the words you use.

The most important thing is not to allow the system to overwhelm, dismiss or demoralize us. Each of us is a leader – no matter what our role is – and we all need to be leading a humanistic transformation in American health care delivery.

Zeev Neuwirth, MD, (zeevneuwirthhealth.com) is a health care executive, author and nationally-recognized thought leader. His second book, Beyond The Walls: Megatrends, Movements, and Market Disruptors Transforming American Healthcare was published in September 2023. He has over 15 years of experience in leading enterprise-wide programs and developing innovative, forward-thinking strategies. Dr. Neuwirth produces and hosts the popular podcast series Creating a New Healthcare. He speaks and consults to healthcare systems, boards, medical societies and national associations.