With our healthcare system depleted, how will we teach America self-care (in 2023)?
By Linda von Rosenvinge
As our nation attempts to pick itself up and walk away from the COVID battlefield, we can see the toll it has suffered. COVID spurred a pervasive physical and mental health crisis in the United States, but it has also precipitated a financial and operational crisis among our most important healthcare institutions.
In 2020 a shift from employer (private) insurance to public insurance cost hospitals an estimated $95 billion in annual revenue. Forrester Research predicts “patient volumes, high-deductible health plans and commercial insurance rates” combined with “an economic downturn and costly consumer behaviors” will spike hospital bankruptcies.1 Reimbursements for doctors who see Medicare patients will be cut by up to 8.5 percent in 2023. Doctors warn this may prevent seniors from getting vital health services.
The status of patient care and education
Human toll on the healthcare workforce. Even before COVID we saw a growing gulf between healthcare demand and clinician supply. Then COVID hit. HCPs were forced to learn new skills and tools under intense pressure. They endured a high burden of personal risk, navigated ethical dilemmas, shouldered profound responsibility, shattering fatigue, and isolation. Staff burnout rates and mental health problems soared. More than 20 percent of our healthcare workforce left medicine, and more than 10 percent have been laid off.
Healthcare system frailties. This depletion has made timely patient access to care difficult. In many therapeutic areas, a care backlog persists as we begin 2023. Our mental health community also faces workforce shortages, creating long patient wait times for therapists and leaving many patients untreated. Heavy administrative burdens steal HCPs’ time and energy away from patient education in all care settings.
Pushing care into the home. COVID pushed much patient care into the home as hospital beds and HCPs’ time were engulfed by COVID patients. Much care will likely remain here, due to cost benefits for payers and patients’ preferences. Some elderly and remote patients will benefit from a shift to telemedicine and a hospital-at-home approach, but jeopardies exist for others. For example, the shift in hospice care from facilities into the home during COVID created an outsized burden on family caregivers, undermined patient “quality of death”, and traumatized families.
Who or what will replace the nurse? Traditionally nurses have played a central role in both patient self-care education to counter low health literacy in vital areas like hygiene, nutrition, and lifestyle, as well as in condition-specific education and patient self-management. With nurses overtaxed, patient education is in critical condition.
Literacy and skills. To develop successful strategies to boost self-care, we must consider where we are starting. More than 36 percent of adult Americans have basic or below basic health literacy skills, an imperative for initiating and sustaining self-care skills.
In a 2020 study, the Mayo Clinic found that poor health literacy is more prevalent among older adults and minorities. The self-care tasks these populations most struggle with are those they most need: preventative care, managing chronic health conditions, and understanding instructions related to medications and procedures.
How do we develop solutions?
These developments have created unprecedented pressure on patients and caregivers to perform self-care. This highlights a sobering possibility-that outcomes going forward may depend on patients’ ability to understand their health more deeply, and successfully learn and implement self-care skills.
Self-care is not new, but it is newly urgent. We must ask ourselves if we can afford not to execute self-care education more vigorously. For example, we know that strategies that enhance self-care of patients with heart failure reduce both mortality and use of the healthcare system.
When cometh technology. “Can’t we turn to technology to help?”
Prior to COVID, some in healthcare foresaw a future in which technology (including artificial intelligence) replaces some of the work of clinicians. Accenture predicted that “by 2030, up to 10 percent of existing patient-service demand will be met via self-care,” and that “25 percent of current healthcare tasks will be automated.”2 COVID accelerated the adoption of some technologies: i.e., biometric and wearable devices, at-home diagnostic tools, remote patient monitoring, and telemedicine. These technologies hold promise as tools in shared and self-care, but patients will need to learn how to use them. Patients with lower technological savvy and/or a disability face barriers here.
A system-wide endeavor for better self-care. Instituting self-care as a pillar of our healthcare system will necessitate action from all healthcare stakeholders and entities, ideally in a co-ordinated crusade. An effective roadmap might focus on the following actions:
- Understand where patient education is most needed to improve outcomes
- Identify how we can best teach self-care and shared care with appropriate customization
- Define the role of digital solutions, automation, remote learning, and AI
- Identify which interactions with patients carry an imperative for education. Transform them from healthcare transactions (a visit or procedure) into educational opportunities
Entity roles in elevating self-care
Who does what to boost patient education geared toward self-care will likely be an extensively debated topic. There are ways powerful healthcare entities could lend their unique expertise.
Government: program structure/funding. Government precedent for underwriting patient guidance (initially for oncology patients) was established by the federal -backed healthcare “Navigator” role in the early 1990s. This approach can be revived for patient educators.
Patient advocacy: addressing literacy. Patient advocacy groups can help achieve a higher level of population-wide health literacy by promoting best practices for patient education, identifying the highest priority topics in each therapeutic area, and through patient outreach.
Healthcare brands: patient insight. Through research, brands and their patient engagement partners can become intimate with their patients’ disease and treatment journey. They can pinpoint what education and skill-building patients most need at each stage, and their learning preferences.
Medical education institutions: training HCPs. Medical and nursing schools can double down on teaching the imperative of self-care in the clinician’s workstream and how to accomplish it. Currently teaching patients self-care is not prioritized in curriculums.
Medtech: accessible learning. Medical technology companies could develop technology options in multiple settings (including the home) that enable patients and their caregivers to learn self-care regardless of tech savvy.
Neuroscience: immersion and interactivity. Brain science has shown us that learning strategies that incorporate interactivity and involve multiple senses help people remember information. Virtual reality does both. VR is currently used by children’s hospitals to help parents and child patients visualize and understand their disease. It can serve as an immersive learning tool and as a therapeutic distraction for children and adults facing frightening procedures, and can mitigate multiple anxiety disorders that undermine learning.
Pharmacist networks. Emergency measures during the height of COVID granted new power to pharmacists who are on the front line with patients every day and often have their trust. Their knowledge of drug safety and vaccination science can be lent to help educate patients.
Behavioral science: affective learning. Affective learning objectives focus on the learner’s interests, emotions, perceptions, tones, aspirations, and learner acceptance or rejection of educational content. Without affective learning, patient knowledge doesn’t transfer into behaviors. Behavioral scientists can incorporate necessary affective components in patient education.
Health systems and ACOs: integration techniques. Health systems excel in streamlining clinician work processes and scaling policies. They could be instrumental in creating a blueprint for in-work-stream patient education, leveraging how nurse navigators and hospitalists were instituted. In addition, ACOs are increasingly motivated to deliver preventive care services. Understanding the mechanisms used by high-performing ACOs may help the system increase the use of efficient patient education.
Nursing education industry: Virtual learning. In 2022, virtual simulation and online learning became commonplace in nurse education as classrooms rolled out virtual programs developed during the pandemic. This industry can lend best practices in virtual patient education.
Who will teach America self-care?
Policy makers, influencers, educators, patient insights experts, and healthcare brands can all take steps to bolster patient self-care. What will you contribute to the crusade?
- Schibell, N. (November 11, 2022). “Predictions 2023: Retail health, decentralized trials, and wellness are on the front lines”. Forrester Research, Inc.
- Safavi, K. “How AI and self care can make up for practitioner scarcity“. Hospital & Healthcare Management.