Conversations with Leaders in the
Field of Patient-Centered Care
One of the ways Picker Institute supports patient-centered care is by recognizing people in healthcare who have made significant contributions to achieving patient-centered care worldwide.
Dale Shaller, MPA
“Conversations with Leaders in the Field of Patient-Centered Care” is a regular feature that highlights people who have promoted patient-centered care in their work or through their organization. This Conversation is with Dale Shaller, one of the architects of Picker Institute’s new Always Events™ initiative.
Dale Shaller is the principal of Shaller Consulting Group, a health policy analysis and management consulting practice based in Stillwater, Minn. He has devoted nearly three decades to the design, implementation and evaluation of healthcare quality measurement and improvement programs, with a special focus on listening to the voice of the patient and promoting methods for engaging consumers in managing their health and healthcare.
His work on measuring and improving the experience of patients and families has been based in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program funded by the U.S. Agency for Healthcare Research and Quality. He has served as a member of the Harvard and Yale CAHPS research teams for 10 years, working on patient experience survey design, measurement and reporting issues. He has directed the National CAHPS Benchmarking Database since its inception in 1998 and is a co-author of The CAHPS Improvement Guide and other articles related to strategies for improving the patient experience.
Mr. Shaller currently serves as chair of the Patient Experience Committee for the Aligning Forces for Quality program funded by the Robert Wood Johnson Foundation. He has been a principal investigator on several projects funded by Picker Institute, including a series of case studies documenting factors contributing to high-performing patient- and family-centered medical centers. He also has written a series of reports on consumer decision-making in healthcare and was a founding developer of the TalkingQuality website that provides practical guidance to developers of health care quality reporting tools for consumers. He has served on many national health care advisory panels and is a frequent writer and presenter on health are quality and patient engagement strategies. He received his B.A. from Kalamazoo College and holds a master’s degree in public affairs from the Humphrey Institute of Public Affairs at the University of Minnesota.
As an independent consultant, you have the opportunity to work on a wide variety of projects. What excites you about working on the Always Events™ initiative?
What excites me about Always Events™ is that this is not really a research project. It is fundamentally about action—about mobilizing healthcare organizations to implement the tools and strategies and methods that we know can work to advance patient-centered care. I have thought for some time that we don’t need any more case studies or guidebooks, but rather a powerful set of incentives to motivate action. Always Events™ has the potential to spark this kind of action. At heart it is an organizing strategy, a political lever to raise awareness among patients, providers and policymakers about the kinds of experiences that should always happen as patients interact with the healthcare system.
In developing the Always Events™, Picker Institute is focusing initially on communication and care transitions. Why are these areas uniquely important to patients and families?
Time and time again we see the biggest failures in the healthcare system falling into these areas. Communication is at the heart of care; indeed, it is at the heart of all successful, functional relationships. It is the same with patients and their caregivers.
One of the most critical points of communication occurs when patients move from one provider or care setting to another. Complexity requires coordination, but coordination is what the United States healthcare system does least well. There are some coordinated national efforts underway to improve care transitions, and the Always Events™ initiative may help to promote more widespread use of the tools and strategies being developed.
Picker Institute and other organizations have been championing patient-centered care for many years, but patient-centered care is still not a widespread reality. How does the Always Events™ initiative differ from prior efforts? Why do you think it will be more successful?
The Always Events™ initiative is different because it is not about research but about motivating action. It also turns a well-known patient safety concept referred to as “never events” into something positive. Our interviews with experts, as well as focus groups and conversations with patients and frontline caregivers in the exploratory phase of this initiative, consistently revealed support for the positive aspect of Always Events™. There is widespread enthusiasm for an initiative highlighting the significant advances that organizations can make in the patient experience through changes in behavior rather than infusions of capital. The Always Events™ initiative has the potential to galvanize focus around the kinds of experiences that should always happen for patients and families and to create a shared set of expectations for excellent patient-centered healthcare.
Do you think it is realistic for any organization to achieve 100 percent performance of an Always Event™? If not, why set that as the goal?
It’s definitely a stretch goal. Ideally, all of the Picker Principles should always be a part of every healthcare experience. Clearly, this is not realistic. But it may be realistic to focus on a more limited set of Always Events™ that are concrete and measurable, with specific behaviors to make these experiences happen. Then we can say, “Yes, we are going to make sure these things happen all the time for all patients.”
Healthcare staff members often express frustration at the volume of things they are expected to do, as well as the frequent addition of new tasks. How can healthcare organizations successfully engage their teams in implementation of Always Events™?
The focus on the positive may set this strategy apart from the other types of expectations, requirements or checklists that staff just check off. This could be a rallying point around positive action. Always Events™ also may highlight and celebrate things that many staff members already routinely do and challenge others to follow their lead.
Based on your work with successful patient-centered healthcare organizations, what do you think are the necessary foundations for an organization to succeed in implementing Always Events™?
We know high-performing organizations have several factors in common. First among them is leadership, including at the very top levels of the organization. Flowing from that is a strategic vision, clearly communicated throughout the organization from the C-suite to the frontline. Next is a real commitment to partnering with patients and families, as well as to creating a work environment that reinforces and rewards positive behaviors by staff and clinicians. If you add the ability to measure progress and results with reliable valid metrics, then you are on your way to implementing and sustaining processes and strategies that will achieve Always Events™.
How does the Always Events™ initiative relate to other significant issues affecting healthcare, such as health reform and the implementation of CMS’ pay-for-performance system?
Health reform presents a variety of other opportunities to integrate Always Events™ into innovations in both payment and delivery, including consumer engagement strategies, accountable care organizations and the patient-centered medical home. The new Center for Medicare Innovation may be a possible incubator for application of Always Events™.
The serious reportable events, often referred to as “never events,” are a specific list that was developed by the National Quality Forum. Why are the Always Events™ more open-ended?
We hope the open-endedness will stimulate creativity and innovation. The list of things that should always happen is quite long. We want to find innovative ways for organizations to implement what we know works. Hopefully, the strategies will be replicable and transferrable to a variety of Always Events™. Being open-ended at the outset is a smart strategy to encourage out-of-the-box thinking and experimentation.