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The Baton

March 6, 2011
by James L. Holly, M.D.
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A pictorial representation of the genius of patient-centered medical home

“The Baton” is a pictorial representation of the patient’s “plan of care and the treatment plan,” which is the instrument through which responsibility for a patient’s health care is transferred to the patient. Framed copies hang in the waiting room of SETMA II and will soon hang in all pubic places throughout SETMA’s clinics. A poster copy will be hung in every examination room. The poster declares:

 

Firmly in the providers hand

--The baton – the care and treatment plan

Must be confidently and securely grasped by the patient,

If change is to make a difference

8,760 hours a year.

 

The poster illustrates:

 

1. That the healthcare-team relationship, which exists between the patient and the healthcare provider, is key to the success of the outcome of quality healthcare.

2. That the plan of care and treatment plan, the “baton,” is the engine through which the knowledge and power of the healthcare team is transmitted and sustained.

3. That the means of transfer of the “baton” which has been developed by the healthcare team is a coordinated effort between the provider and the patient.

4. That typically the healthcare provider knows and understands the patient’s healthcare plan of care and the treatment plan, but that without its transfer to the patient, the provider’s knowledge is useless to the patient.

5. That the imperative for the plan – the “baton” – is that it be transferred from the provider to the patient, if change in the life of the patient is going to make a difference in the patient’s health.

6. That this transfer requires that the patient “grasps” the “baton,” i.e., that the patient accepts, receives , understands and comprehends the plan, and that the patient is equipped and empowered to carry out the plan successfully.

7. That the patient knows that of the 8,760 hours in the year, he/she will be responsible for “carrying the baton,” longer and better than any other member of the healthcare team.

The genius and the promise of the Patient-Centered Medical Home is symbolized by the “baton.” Its display will continually remind the provider and will inform the patient, that to be successful, the patient’s care must be coordinated, which must result in coordinated care. In 2011, as we expand the scope of SETMA’s Department of Care Coordination, we know that coordination begins at the points of “transitions of care,” and that the work of the healthcare team – patient and provider – is that together they evaluate, define and execute that care.

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Comments

Thanks for a terrific, detailed series of posts, which elaborate the baton "systems thinking" process. You have elaborated that providers must stop, think and explicitly ask the patient is they are capable of carrying the baton, as is.

As HCI blog readers may recall from my recent post on Ethics and Meaningful Use (tinyurl.com/EthicsMU), my dad was recently discharge from a hospitalization where he was confined to bed for four days and was too sick to eat. And, no, he wasn't fed some other way. What the doctor and care team planned was to discharge him home, not realizing that he was too weak to return to activities of daily living. With a bit of aggressive advocacy, his baton was redefined to a transfer to rehab for muscle re-building and focus on the goal of carrying his own baton as quickly as he was truly capable.

In Larry's other posts, he details the work that SETMA and its foundation have put into attention to making the baton right for the patient. I agree with your take, Mark. Their work is inspiring. 

"The Baton" and the systems thinking that it captures make it a wonderful metaphor for care planning. Larry, have you learned anything new recently from Peter Senge on the application of systems thinking to healthcare delivery?

Six of SETMA staff attend the Re-think health Realizing Better Health, Better Care and Lower Cost Through Systems Leadership workshop sponsored by the Society for Organization Learning. This group was founded in 1999 by Peter and others My first reflections on this workship are posted on the front page of our website. \

I will writing more on the workshop but the following are some of my initiial thoughts:

During the workshop the fundamental schematic for understanding healthcare transformation was the following structure which was depicted by three boxes, each a progress from one to another:

· Health
· In Need of Care
· In Care

Except for those who are born with congenital or genetic abnormalities everyone starts life essential in a state of health. Most people, during their life, progress from that state to a state of needing care because of the loss of their health and final into a state of receiving care. The phrase "healthcare" has been intentionally avoided here as the care we are receiving is more aptly defined as "illness care" or "disease" care Ideally, those who are "in care" would be moved back to a state of "health," but most often are simply returned to a state of being "in need of care."

Considerable attention to a definition of "health" was given. It was generally accepted that most often when we talk about "health," it is defined in terms of the absence of illness or disease. That description was rejected, and, it was determined that "health" referred to a "state of well being which involved physical, emotional, mental, and spiritual balance in life". The "disease" model of a description or definition of "health" was rejected because we could all name prominent and non-prominent people who while they had serious illnesses or disabilities would nevertheless be described as healthy.

Determinants of Health

In this context, we affirmed the statement above that, "80-90% of factors that are determinants of our health are NOT directly connected to health care delivery." If that is the case, what are the determinants? Without doubt, education is at the root of "health." This is not because of the cognitive function of education, i.e., that people with the most education or intellectual capacity are the healthiest. Being informed allows choices to be made which sustain or support heath. Unfortunately, many people get their "information" from advertisements which are entrepreneurial without regard to the health of those who are being affected by the content of ads.

How you judge the place of personal freedom and public responsibility will be affected more by your political philosophy than by science but virtually everyone agrees there is a place in public policy for the protection of those who are not yet mature enough to make rational health choices. Public policy has dictated the limitation of cigarette and alcohol advertisements from media principally directed at children. The future of health education will involve more discussions about sugar, salt, transfats, processed foods, preservatives and other "food products" which are contributing to the loss of health. Where the balance is between personal freedom and public health policy will continue to be debated but there is little debate over the fact that currently the reality is "out of balance."


Thank you so much for this post, Dr. Holly. Sometimes, the most fundamental things tend to be forgotten in health care, and continuity of care is one that is consistently forgotten in most patient care organizations. Your visual metaphor of the baton is perfect. I remember in physical education class in junior high running relay races, and the natural tension around passing the baton (and so often, ping it). You reminded us once again how central the patient's understanding and participation in care must be in order for that care to be successful!
Mark

Thanks Larry. Your posts and your comments are a real treat.

Sounds like the root of health isn't education in this framework. It is intelligent or informed discipline.

James Holly

CEO, managing partner of the Southeast Texas Medical Associates (SETMA) in Beaumont

James L. (Larry) Holly, M.D., After completing his medical education, James L. (Larry) Holly, M....