It’s the time of year when we like to look back, and look forward.
We set goals. We assess where we’ve been, where we are, where we’d like to be.
But in health care, assessment and evaluation has a decidedly harder edge.
One nurse manager in a physician practice told me, in passing,
“I’m kind of answerable to two major inspections this coming month. It’s trying to be on top of that, y’know? What used to be the pharmacists only checked on your meds, this guy’s looking at your hand sanitizer, the wipes patients use, y’know it’s unbelievable…He picks on the weirdest things to look at they used to never look at before. He’s upping the ante every time he comes.”
She talked further about the time and effort it took to prepare for these ever-changing inspections and the related reporting. Time away from her patients and the primary tasks of her role. She implied these assessments were micromanaging the practice.
I’m telling you this story because, a few months back, I started a series called 5 steps to improve your patient education. I promised to take a closer look at each of those 5 steps. So far I’ve written about eliciting patient background knowledge; how you handle your medical knowledge; and being clear about your goals for the patient education encounter.
Today, this is about assessment. Specifically, I’ll give you a way you can increase the chances you’re assessing what matters when it comes to patient education.
Business models and productivity metrics
For good or not, healthcare is being driven by business models and productivity metrics.
Many argue that increased accountability measures have taken time away from improving the quality of care—and to questionable ends. A CMS administrator recently commented that:
“We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”
Similarly, a recent op-ed piece pointed out how the metrics may not even be helping the patients they are (ostensibly) intended to benefit:
“[C]onsider a patient thinking about knee replacement surgery. By looking hard enough, he or she could probably find out how often a facility’s patients get antibiotics before surgery, contract infections from surgery, or return to the hospital due to complications after surgery. But he or she is highly unlikely to discover whether those patients walk better a year later.”
Even in the midst of this measurement mania, meaningful evaluation is possible. And it can give you and your patient the feedback you need to make the most of your time together.
The basic purpose of evaluation
We evaluate and are evaluated in many ways, and for many reasons. However, the purposes of evaluation and assessment can be boiled down to this:
wanting to know something about the past, the present, and/or the future.
Put another way, we assess to learn what has happened, what is happening right now, and/or what the next steps should be.
This part is easy enough. It gets complicated from here.
Evaluation = what is valued
Consider the act of evaluation as an indication of what is valued.
That is, we interpret results or actions according to what we value.
Yet it seems value is a word we’re hearing a lot these days in healthcare. What kind of value? Value to whom?
In the press release quoted above, CMS Administrator Seema Verma acknowledges that this ambiguity is a problem: “We need to move from fee-for-service to a system that pays for value and quality – but how we define value and quality today is a problem.”
What’s more, large-scale assessments tend to assess what’s easy to assess–which may or may not be what’s valuable to know. See the above example about the knee replacement. The data was gathered, but it was not directly applicable to what was most valuable to the patient—being able to walk better.
Are you measuring what’s really valued by you and your patient?
Goals = values
Your goals are a statement of what you value. What you are willing to use your time and effort in order to help bring about.
What it is you’re really after.
I’ve written about patient education goals before. Your goals may include your facilitating your patient’s understanding of, and ability to negotiate, the health situation they are in.
Here are three variations on a question you can ask to get some clarity on your primary patient education goal:
- What are you hoping this person will learn in their time with you today?
- What do you want this patient to be thinking about after your interaction is over?
- What do you want your patient to be able to do, believe, or understand—better, more, or more often than they do now?
Asking these questions helps your goal for the encounter to be clear to you. But what are the patient’s goals for this educational encounter?
What does your patient value?
Learning someone’s goals isn’t a ‘one and done.’ It’s a process that can benefit from multiple kinds of questions. Here are variations on a question you can ask to understand more about your patient’s goals:
Today we’re doing x, y and z…
- What parts of this are you most interested in learning about today?
- Which parts of this matter most to you?
- Which parts of this are you most concerned about?
- What would you like to know more about?
Whatever kind of education you’ve planned, make room for your patient’s goals.
Tie your assessment to your goals
So how do you make it more likely you’re evaluating what you and your patient value?
Attach your assessments to your goals.
That’s why I’ve spent so much time talking about getting clear on your goals.
Goals are statements of what you value, what you’re willing to put your time and energy and resources toward. Beyond that, the values and beliefs of the interpreter influence the purposes for which evidence is used.
So rather than quizzing patients on the material, return to your goals. Yours, and your patient’s. You could repeat your goal, and invite the patient to repeat theirs.
Making measurement count
I’m inviting you to be conscious of what effects of your patient education should be studied. I’ll close with some thoughts about how these outcomes can be measured.
There are many ways to measure progress toward a goal. This is a good thing, because people and their goals will vary. Here’s some food for thought:
- In terms of your patient’s goals, you might ask one question: “What progress have we made toward your goal?” Then you can note what they say, and look for patterns across patients.
- In terms of your educational goals, if there were only 1 or 2 things you could get specific feedback on, from your patient, what would it/they be? You could even try out these requests on colleagues first.
And remember, the focus is: Are you measuring what’s really important to you and to your patient?
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