When Stay-at-Home Orders Make Patients Hesitant, Human-Centered Care is the Best Option

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By Melissa Powell

We’ve become so inundated with messages surrounding the pandemic that it’s difficult for patients to know how much risk to take on compared to the risks of contracting COVID-19.

Some are hesitant to visit their preventative care providers, while others are even scared to visit the emergency room. Believe it or not, emergency care admittance rates have dropped 50 percent in the US since the beginning of the COVID-19 pandemic.

Patients are more anxious than ever, and that anxiety has been felt in skilled nursing facilities as well. According to data compiled by the National Investment Center for Seniors Housing and Care (NIC), skilled nursing facilities in the U.S. saw occupancy rates slip to 78.9 percent in April, as compared to 84.7 percent in February, before the outbreak took hold. The rate stood at 84.4 percent in April 2019.

NIC senior principal Bill Kauffman said it was unlike anything his organization had seen “in recent memory,” and added that the industry is adjusting “to a new normal.”

Without a clear timeline for the pandemic’s end in sight, what kind of adjustment are we talking about here? What will help to soothe patients and encourage them to access safe, preventative care once again?

The answer centers around a design philosophy called human-centered care.

What is Human-Centered Care?

Human-centered care refers to the method of changing how people interact with technology to ultimately improve patients’ lives. Originated in the ’80s, human-centered design arose to help software companies boost product adoption rates among consumers.

These concepts hail from user experience (UX) design, which is already a framework broadly employed by the tech startup world. The companies that dominate our daily lives — namely, Apple, Uber, Facebook, and Google — have mastered the art of addressing people’s needs.

Yet human-centered design doesn’t have to limit itself to social media or cab services. It can and should touch upon the most sensitive areas of our lives.

While you may think that healthcare is already “human-centered,” just consider how much friction technology creates between the practitioner and the patient: Simple administrative tasks, billing, insurance, and data management prioritize a healthcare facility’s bottom line over providing care.

Recently, a study conducted by Mayo Clinic gave an “F” rating to the usability of electronic health records (EHR). On average, physicians spend twice as much time interfacing with EHR than they do communicating with patients.

Human-centered care is about focusing on the patient and reimagining traditional technologies that act as an impediment to care. The patient’s needs, contexts, and perspectives are put first.

Traditionally, the healthcare world has taken a paternalistic approach towards patients. Consumers want to make informed decisions based on transparency, convenience, and relative costs — and these options often aren’t often granted in healthcare.

How Can Human-Centered Care Improve Health Care?

Consider the example of BID (Better Immunization Data), a new program launched by the Zambian government to better leverage limited health resources. BID tested out four different systems on actual users, eventually settling on the best solution that also took into account the opinions of providers, patients, and families.

Replacing paper records, the BID system introduced a fully technologized solution to the arduous task of data collection. When a patient receives an immunization, the provider simply has to scan a barcode on the patient’s health card, which automatically updates their records.

The system tracks immunization records and notifies care providers when patients need new immunizations. An estimate of the needed stock is produced automatically, allowing providers to better plan for future care.

The new system decreases the amount of time that providers need to spend managing data and instead allows them to focus wholly on the patient.

What Does This Mean for COVID-19?

Human-centered care is perhaps the best approach to address challenges like those presented by the pandemic, since the model focuses on an iterative, qualitative method to meet human needs. 

Before the pandemic, James Reason, professor emeritus of psychology at the University of Manchester, England, summarized the thinking behind such care as follows: All systems have flaws, and it is best to address them through a top-down approach — i.e., management needs to actively engage patients to understand and anticipate their needs. 

Such an approach is obviously that much more critical now. At one California facility, management did its due diligence by reaching out to residents, one of whom said that “the cons of getting COVID outweigh my normal health concerns.”

Officials conducted over two dozen interviews, and discovered that three themes prevailed:

1. Healthcare facilities are seen as hotbeds for infectious disease.
2. Patients were largely unaware of risk-mitigation efforts currently in place. 
3. The patients most in need of care were the most socially isolated.

Researchers found, conversely, that health care interactions could be improved by creating a physical divide between patients, and indeed skilled nursing facilities have taken such measures during the pandemic, while remaining mindful of the deleterious effects isolation can have on seniors.

But the bottom line is that residents need to be informed about the current measures in place as well as the risks, that there is much to be said about a human-centered approach. Transparency can go a long way toward assuaging resident fears. Information needs to be disseminated not just in person, but also by online sources, mail, and phone.

The tech piece is, again, particularly compelling. Such means as bedside tablets can be an invaluable tool in communicating with residents, just as they are invaluable to the resident in communicating with loved ones during a pandemic. Also available are handheld devices like those made by Vis a Vis Health, allowing providers to communicate with residents following discharge.

It’s all part of the “new normal” now facing the entire industry. Patients’ needs must be addressed, and patient-provider interactions need to be maintained, if not improved. Human-centered design goes a long way toward addressing those concerns.

Melissa Powell is COO of The Allure Group, a network of six New York City-based skilled nursing facilities.