DaVita Medical Insights

Kidney Patient-Centered Quality of Care, Part III: Key Participants Who Contribute to Quality Program Success

Whether operating a single dialysis facility or a large multi-facility organization, successful deployment of quality programs requires the full participation and support of patients, the facility care team and physicians. Without a common vision and passion around improving the lives of patients, achieving this goal is quite elusive. It is worth summarizing below how this can be accomplished across these key participants.

1. Patients

Patient engagement and empowerment are essential elements for achieving the best clinical outcomes. Programs that empower patients can support this endeavor. For example, DaVita’s Empowering Patients Program (EPP) uses cognitive, behavioral and mindfulness techniques to help patients adjust to dialysis and enhance their coping skills and encourage self-care. Initial results of the EPP have shown a decrease in missed treatments and overall improvement in self-reported quality of life.

2. Interdisciplinary Care Team

Beliefs can drive behaviors, which can lead to results. It is important to inspire the care team with shared mission and values, to build a community environment, to promote fulfillment and to encourage the team to care about each other just as much as they care for their patients. Extensively training the care team on the “why” of important clinical initiatives rather than just the “how” can cause them to be the strongest advocates of ways to move up the quality pyramid.

Achieving collaborative care and great outcomes can be accomplished by working through an integrated team in the facility, implementing necessary corporate functions, continuously improving and innovating, and ensuring that the facility includes not only great people but great teams. Most importantly, the best outcomes can be achieved through an intense focus on patients and their individual needs. When care teammates shift from simply pursuing metric goals to focusing on patients’ happiness and well-being, and recognize that they have the ability to help add meaningful moments to patients’ lives, they can be motivated to give the best care possible.

3. Physicians

Physicians serve as medical directors—leaders of the interdisciplinary care team—as well as attending nephrologists caring for individual patients in facilities. Engagement of these physicians is essential and can be enhanced by extensive peer support from:

  • Corporate physician leaders with content expertise and national recognition in their respective areas
  • Local group medical directors, who are practicing nephrologists who serve as liaisons between corporate medical leadership and the nephrologists in the trenches

Engaged physicians are a key to patient-centered, collaborative care. In order for attending nephrologists to fully engage, it’s important that their experience when seeing patients in a facility—or when interacting with other parts of the organization—is always of the highest quality. To optimize the physician experience, there needs to be physician-led teams that relentlessly pursue clinical excellence and consistently strive to deliver high-quality outcomes and promote patient safety. It is important for dialysis organizations to:

  • Earn the trust of their physicians and build confidence through mutual respect, transparent processes, clear communication and strong, reliable teams
  • Create and honor physician leaders who empower their patients and teams and who are leaders in their professional and personal communities
  • Foster fair, collaborative relationships that are rooted in a shared vision, sense of team and mutual success
  • Develop the right roles, tools and processes to improve quality of care, reduce burden and maximize productivity
  • Empower physicians to engage in development of protocols, policies and procedures that ensure physician autonomy in decision making while optimizing clinical outcomes

An important focus of the latter area is to develop tools that help physicians achieve the clinical outcomes they want for their patients while making the ever-increasing burden of practice a bit more tolerable. Additional tools and support for providers through clinical IT at the point of care, enhanced communication tools such as secure messaging and telemedicine and clinical information sharing through Health Information Exchanges are also important.

There are two key approaches that could help physicians and care teams support patients in reaching the top of the quality pyramid. These will be discussed in the next blog post.

Upcoming post: Part IV: Future Approaches to Delivering Care

Some of the content of this post has been previously published. Source: Delivering Better Quality of Care: Relentless Focus and Starting with the End in Mind at DaVita. Allen R. Nissenson, MD. Seminars in Dialysis, Volume 29, Issue 2. © 2016. Publisher: Wiley-Blackwell. [Link to original article].

Allen R. Nissenson, MD, FACP, FASN, FNKF

Allen R. Nissenson, MD, FACP, FASN, FNKF

Prolific author and renowned authority on kidney disease, Allen R. Nissenson, MD, is chief medical officer at DaVita Kidney Care and emeritus professor of medicine at the David Geffen School of Medicine at UCLA, where he has served as director of the dialysis program and associate dean. Dr. Nissenson is also co-chair of the Kidney Care Partners Quality Initiative. Dr. Nissenson served as a Robert Wood Johnson Health Policy Fellow of the Institute of Medicine from 1994–1995 and worked in the office of the late Senator Paul Wellstone. He is a former president of the Renal Physicians Association (RPA), served on the RPA Board of Directors as a special advisor to the president and is a former president of the Southern California End-Stage Renal Disease Network. He is the author of more than 700 scientific papers and the editor of two dialysis textbooks, one in its fourth edition and the other just released in its 5th edition. Dr. Nissenson earned his medical degree from Northwestern University Medical School and is the recipient of various awards, including the AAKP Medal of Excellence award, the Lifetime Achievement Award in Hemodialysis and the National Kidney Foundation “Man of the Year” award. Twitter: @DrNissenson