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Caring for the Underserved: Providers Do Whatever It Takes

As part of the Institute’s recent Patient-Centered Outcomes Research Institute (PCORI) project, I was asked to participate in four site visits to interview providers about managing chronic disease in vulnerable populations.

I was excited about the opportunity, and spent many days preparing interview questions and gathering background information on the four sites, which included San Francisco General Hospital (SFGH), Santa Clara Valley Medical Center, Hennepin Health, and Denver Health. However, despite all my preparations to learn as much as I could about the hospitals, I could never have prepared for the overwhelming admiration, humility, and inspiration I experienced after speaking with our providers.

‘It’s the Right Thing to Do’

While walking through each campus and getting better acquainted with our interviewees, I saw clear passion for systemwide innovation. Providers were not afraid to take risks, pool resources, and make change happen so patients and clinicians could have better outcomes and experiences.

I was especially struck by providers’ levels of commitment to do whatever it takes to care for their patients  – it was awe-inspiring. It was abundantly clear that everyone is working together, contributing in every way possible, and striving towards excellence for their patients.

In meeting with 60 providers across the four sites, I heard many stories that attested to the depth of essential hospitals’ commitment to serving our nation’s most vulnerable patients. Here are a few notable moments:

  • One nurse commented, “We have this philosophy of ‘getting the job done,’ so we define what the job is and then we get it done. So what that means is that we frequently step out of our roles…We have nurses cleaning rooms and medical assistants that help with registration. We’re just going to get it done because it’s for our patients.”
  • A clinical care coordinator described how on multiple occasions, he personally negotiated with his patients’ insurers to authorize services that were not covered, such as orthotics treatments for a woman whose lymphedema left her walking the streets of Minneapolis barefoot.
  • A physician mentioned that some of his patients experience legal issues. On one occasion, he felt it was necessary to support his patient, so he attended their human services and child protective services meetings and even talked with the family. And when his patient was arrested, he went to court with him.
  • One nurse discussed the lengths she would go to help patients navigate the health care system, including phone calls, home visits, joining patients at medical appointments, and meeting patients in their communities. When we expressed astonishment that she found the time to do so much for her patients, she shrugged it off and said that if she wasn’t doing so much she’d just be “wasting her time.”

Going into these interviews, we framed many questions around understanding providers’ successes and challenges with typical hospital performance measures, such as ED utilization and HCAHPS scores. We were surprised that these issues were not at the forefront of our discussions. Instead, what repeatedly emerged was providers’ dedication to making a difference in the lives of each patient. Although essential hospitals may be challenging places to work, the silver lining is the heart of providers who go to great lengths for their patients, in their words, because “it’s the right thing to do.”



About the Author

Janelle Schrag is a senior program analyst with America's Essential Hospitals.

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