Relationship-Based Care: are we there yet?

Relationship-Based Care: are we there yet?


I was honored this week to attend the Digital Transformation of Patient Care Summit in Philadelphia, sponsored by the Canadian Consulate. I spoke at length to an interesting physician expert, Dr. G from Brazil. His hospital was building a relationship-based care (RBC) model into their strategic organization vision. Dr. G was curious to know about my experiences with relationship-based care models, stories of success and challenges here in the US. In brief, the RBC model is “implementing a care delivery system that supports knowing the patient as a person, great collaboration among clinicians, and smooth transitions among caregiver” – thus, the patient-provider connection and experience are at the core of RBC.  My personal responses and reflections with Dr. G are captured below:

Question 1: What’s your experience with the RBC model? Has it worked?

Pediatric Exemplar:  Almost 20 years ago, we used primary care nursing care model at CHOP which is the contemporary RBC framework of today. We interacted with the Social Worker, family, patient, Pharmacy, Cardiac Surgeon, Cardiologist, Home-care, Dietary and other providers all in the spirit of sharing and caring, with the patient at the center. When implemented in the purest fashion, the RBC model is truly healing at the core, and encompasses patient respect, caring, sharing among the interdisciplinary team members.

Lack of Integration:  Despite the positive provider and patient feedback reported when using the RBC model, both the US and Canada both have challenges in implementing it. In the purest form, physicians may not be employed by the actual hospital organization.  Physicians in Canada are salaried by the government and may need to cover various hospital locations.  Physicians in the US may not be owned by the hospital either, and outside practices may cover multiple facilities. Thus, providers may move from location to location each week to cover the medical, surgical and other services within a large hospital system.  Patients, unfortunately, may not have a consistent care team member during their hospital admission, which impacts the spirit of RBC connected framework to demonstrate success.

Question 2: What are some key elements for building the RBC model?

Resources Needed: The idea of creating “relationship-based care” is critical to the success of the US healthcare system. The model can be transformational and supports the Triple Aim goal which is to simultaneously improve population health, improve the patient experience of care, and reduce the per capita cost – thereby, delivering the best care. However, the main challenge involves allocating proper resources to support this critical mission and professional duty in nursing and medicine. How can organization leader’s budget money towards this model of care when units are under staffed and under resourced? June 2, 2015 a provoking article was published in the New York Times by Robbins who discussed the challenges that healthcare leaders currently face. Robbins points out the gaps in delivery care due to budget constraints which negatively impacts nurse staffing numbers, resulting in not enough dedicated unit resources, putting patients and families at risk of harm/injury.

Value of Caring:  In the RBC model, caring is valued – the “art of caring”, patient advocacy, team collaboration all collectively come together to seek the best interest of those we serve, the patient.  My concern, as nursing leader and quality expert, is a growing wicked problem in healthcare – how to support the unit needs, allocate proper funding resources, and align the budget with organization line items determined by the hospital Chief Financial Officers?  I told Dr. G, the real challenge is…how to make RBC an enterprise-wide vision in the midst of realistic budget cuts, to make this model a success?  I am still at a loss for the right answer.

Lean into Diversity: Embody cultural diversity as a life-long journey. Live and practice cultural competency at home and in the work place. Globalization of people and understanding what matters to their culture is essential to bridging our differences and making us a harmonious nation of 1 people. We no longer live in small little discrete villages, but in a wonderful global melting pot of shared ideas which brings hope, innovation and change into healthcare. Respecting and understanding patients and families bring shared meaning in our care delivery system, showing respect for the person and their beliefs, which translates to trust and better patient engagement and outcomes.

Question 3: So, are we there yet?  I think the answer, Dr. G, is YES and NO. The spirit of the patient, family and provider is clearly embodied in the relationship-based care model, even back in the days of Florence Nightingale. But the challenge, moving forward, is for hospital and policy leaders in the US and abroad to deploy the necessary resources and support at the frontline of care. Let providers do what they do best, that is – care for the patient in a respected, connected, valued, and holistic way to bring meaning and purpose to the patient experience one day, one patient at a time… for ZERO PATIENT HARM.

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