By Neil Sheth, MD, Chief of Orthopedics, Pennsylvania Hospital

In the business world of commercial products and services, there is an entire paradigm, dogma and philosophy on “putting the customer first.” Put simply, this is based on placing the customer at the center of one’s mission and designing around his/her wants, needs and desires. From Design Thinking, to Customer Journey Maps, to Focus Groups, companies that sell products and services utilize a sophisticated body of established science and techniques to try to get inside the mind of their customer to design what they want. Not what we think they want, but what they truly want. The best companies in the world are heralded for their dedication to the “customer-centric” solutions and experience that they deliver.

Clinical integrity is about bringing this same ethos into the world of healthcare and medicine. Putting the patient’s needs, wants and desires at the center of our mission and developing a much more integrative and complementary view of how we can address the totality of a patient’s needs. We know that healing and wellbeing arise from biopsychosocial processes and that humans possess an innate healing agency that is more powerful than any healing agent. In our increasing hyperspecialization in medicine, we have lost touch with this broader perspective on healing agency and must work to expand our “patient-centric” ethos to continually introduce better and better care.

As a surgeon, a patient-centric approach implies that I need to go beyond the scalpel. From experience design at every patient touchpoint, to the words, language and tools I utilize to inform and educate the patient, are evidence-based, integrative and complementary to promote better outcomes.

Experience Design (Patient Experience “PX”):

Any illness or physical trauma co-opts stress, anxiety, emotional and psychological distress. It’s incumbent on clinicians to explore each avenue of a patient’s journey, to identify ways in which we can enhance the experience to reduce a patient’s anxiety and duress. In the world of products, they call this User Experience (UX) design, in patient care we call it PX.

Some questions we can ask ourselves as it relates to PX:

• Clinical paperwork: Have we simplified the paperwork, made it understandable, and have we leveraged technology where appropriate to enhance the onboarding and journey through to off-boarding?
• Financial options: Have we explored all potential paths to give the patient financial options and reduce the burden of medical costs?
• Color, sounds, room temperature: Does the physical design of the waiting room, treatment rooms and OR room leverage known techniques in patient environment design that promote a sense of calm and well-being?
• Language and patient interaction: Are all of the clinicians trained in empathy and utilizing language that connects emotionally with the patient to make them feel heard and cared for?

Integrative Complementary Therapies:

We now know from a well-established body of research and published science that complementary therapies such as nutrition, acupuncture and meditation are very effective. I don’t need to become an expert in these domains, however at minimum, my duty as a clinician is to be aware of the science in these domains and be able to recommend options to my patients.

These are treatment modalities and clinical tools that we should we aware of:

• Nutrition: In orthopaedics, there are now hundreds of randomized trials that demonstrate that targeted nutritional therapies can enhance outcomes. And furthermore, patients are asking for it – research data shows that 91% want a recommendation from their care provider. We should be presenting our patients with safe and effective options so they aren’t walking down the aisles selecting from unstudied solutions.
• Massage: From reducing pain, to improving blood flow and reducing healing time, massage after surgery has many proven benefits. There are specialists in surgical massage that we can collate and present to the patient.
• Meditation: Meditation is now a very well-studied domain. We can provide literature to our patients on the basics of meditation.
• Acupuncture: Studies have shown that acupuncture can relieve anxiety and stress during the preoperative stage. It can reduce the usage of narcotics and maintains the respiratory stability and homeostasis during surgery. It can also exert a protective effect on vital organs, and during the postoperative stages, enhance the recovery while effectively alleviating the postoperative pain.
• Nature immersion: A growing body of research points to the beneficial effects that exposure to the natural world has on health, reducing stress and promoting healing. Do we notify patients of this and encourage them to get some time in nature as a part of their surgical readiness?

Clinical integrity is about going above and beyond for the patient. Viewing it as a clinical duty to do what’s right and exhausting all modalities in enhancing patient care. This is a critically needed ethos that will improve care, enhance outcomes, and reduce overall healthcare costs.