Friday, January 27, 2017

Healthcare Professor’s Near-Death Patient Experience Opens Doors for UNO Student Research into Person-Focused Care


Donald Zimmerman thought he knew a lot about health care. For 33 years, he’d worked as a heath care policy researcher, professor and teacher. But it wasn’t until nearly three years ago, when he underwent surgery to halt an aneurysm and ended up in the intensive care unit of his local hospital for 43 days, that he had a regrettable awakening: Clinicians need to do a much better job valuing the patient as an actual person.

Person-Focused Health Care Management“As I lay there day after day,” Zimmerman writes in his new book, Person-Focused Health Care Management (Springer Publishing, 2017), “I slowly became convinced that the difference between the ‘official’ clinical story of those providing my care and ‘my’ personal story of how this care was actually being experienced was not just an issue related to my particular situation, but reflected a much deeper problem, deeply rooted in the very workings of the health care system itself.”

Zimmerman, who joined the University of New Orleans in 2015 as professor and director of the new undergraduate program in healthcare management, has now blended his patient experience with research through a new collaboration with University Medical Center New Orleans.

Over the next several months, four undergraduate students in Zimmerman’s healthcare management program will be researching how clinicians can better communicate with patients in ways that ensure the patient feels listened to, cared for and appreciated. And the project will start with asking patients what they want their caretakers to know about them.

“This is actually a big deal,” said Peter DeBlieux, chief medical officer at UMC, a principal investigator on the project. “In academic medicine, no one has ever asked the question, ‘What do patients want providers to know about them as patients?'”

Zimmerman’s students—Claire Milazzo, Elizabeth Wesley, Bailey Ford and Sheila Oddo—will begin by conducting four focus groups of five to seven patients being treated at UMC in the intensive care unit, the medical-surgical unit, the emergency room and the ambulatory clinics. The goal of the focus groups is to get a better sense of what information patients feel they most want their clinicians to know about them—information Zimmerman says can both help doctors and nurses relate to them as human beings rather than just as patients with medical needs.

The second phase will put the undergraduate students in face-to-face contact with hundreds of acute care patients at UMC. Using sample questions that they will formulate in response to the feedback they get in the focus groups, the students will administer the questionnaire to a sample of 400 UMC patients. The idea is that clinicians will then be able to draw on the information patients share to help affirm their recognition that the patient is not only a patient—she is also, for example, Sarah’s mother, Ben’s wife, Gloria’s child. She is a chef, a lawyer, a teacher, a graduate of Warren Easton High School.

DeBlieux said he envisions some of this information about a person being posted at the patients’ bedside so that it paints a picture of personhood whenever anyone from the hospital comes in contact with the patient.

“Instead of you being Ms. Catalano, who is the diabetic, hypertensive patient in Bed 3112,” DeBlieux said, “you are the Saints fan who has a large, Catholic family. And so we have commonality and I might talk to you and I say, ‘You know what? I’m an only child. I wish I had a large family.’ I think it changes both sides. It allows me to view you as a person and it allows you to feel that I’ve acknowledged you as a person and not a disease.”

Zimmerman said he’s excited to see what the research will show in terms of health outcomes for patients whose interactions with medical staff include these more personal interactions.

“If we know that this patient prefers to be called Bob and if everyone knows he has a wonderful relationship with Cindy, his wife, it can change how we interact with him and how comfortable he feels in his care,” Zimmerman said.  “It makes sense to ask, ‘Hey, how ya doing?’”

Zimmerman said his hospitalization, which included another 17 days recuperating after being moved from the ICU, did leave him grateful for the doctors and nurses who kept him alive. But he said he it also changed him, leaving him feeling stripped, in a sense, of his personhood.

“Similar to posttraumatic stress disorder, I knew that I had been thoroughly beaten up but had little understanding and very few painless memories of exactly who or what had done the beating,” he writes in his book. “But I also knew that the value of answering my questions about what had happened to me was just something that was likely happening to almost everyone who has their ‘personhood’—their living sense of self—systemically reified and ‘reduced’ into the limited role of ‘patient’ within the U.S. healthcare system.”

Zimmerman’s recovery and subsequent research now seeks to shift the lens of health care management from looking at the patient as the center of the care to looking, as he put it, “at the real person locked inside that social role by the highly complex and multidimensional institutions that deliver health care.”

For students in UNO’s growing undergraduate health care management program, the research project marks an unusual, hands-on opportunity to be involved in cutting-edge work relevant to their future careers.

Junior Claire Milazzo is a former nursing student who says she transferred to UNO’s health care management program after becoming disenchanted with the lack of personal connection she saw happening between hospital clinicians and their patients.

“I felt that we were treating them as a disease,” she said. “I went to nursing school because I liked people and I wanted to treat them as people. But it was the complete opposite. We were treating them as room numbers.”

Bailey Ford, a junior from Gautier, Miss., said that she and her fellow students were immediately interested in Zimmerman’s work and asked if they could have a hand in assisting in the research. Most nurses and doctors want to feel they are helping patients, Ford and Milazzo said, not that they are asking them to check their personhood at the doors of the hospital. But the structure of the health care setting too often makes that difficult. The students said they hope this research project helps.

DeBlieux said he is excited to partner with UNO, especially giving the University’s undergraduate health care management students an intimate look at the inner-workings of the hospital. And he said that Zimmerman’s personal experience combined with his professional understanding of health care made him a perfect person with whom to collaborate.

“His ideas and my ideas are sympatico,” DeBlieux said. “It’s a great opportunity to partner. It’s a great partnership with UNO and the hospital.”

In addition to Zimmerman and DeBlieux, the investigators include Gloria Netzer, associate professor at the University of Maryland School of Medicine, Nathan Neilson at Tulane University Medical School and Bruce Hurley, emergency medicine physician at UMC.

Zimmerman joined UNO from the University of Maryland University College, where he was professor and director of the health care administration program. He has also been associate professor and executive director of the Center for Healthcare Management Studies at Fairleigh Dickinson University in New Jersey. Before that, he worked as a health policy researcher and analyst at the Research Triangle Institute, George Washington University and the Center for Health Policy Studies.

Read More

UNO Undergraduate Program in Health Care Management
Undergraduate Health Care Management Students Get Inside Look at University Medical Center
University Medical Center New Orleans
Donald Zimmerman