Timothy Hoff

Does your healthcare provider know you?

Northeastern University sociologist Timothy Hoff has found that the healthcare system is much more transactional and impersonal.
February 26th, 2014

The U.S. health­care system today is increas­ingly embracing tech­nolo­gies and inno­va­tions that value speed, effi­ciency, and cost reduc­tion. North­eastern Uni­ver­sity soci­ol­o­gist Tim­othy Hoff says it’s being assumed that this trend is leading to a more patient-​​centric system.

But it’s not: according to Hoff, we’re cre­ating a health­care system that is much more trans­ac­tional and imper­sonal, rather than one focused on max­i­mizing rela­tion­ship quality and values such as trust.

“You could argue the system feels more dis­con­nected and per­son­ally alien­ating than ever before,” says Hoff, an associate pro­fessor of man­age­ment and orga­ni­za­tional devel­op­ment, health­care sys­tems, and health policy, with joint appoint­ments in the D’Amore-McKim School of Busi­ness and the School of Public Policy and Urban Affairs.

Hoff’s research focuses pri­marily on the human con­nec­tion in healthcare—that is, the rela­tion­ships and social bonds patients and health­care pro­fes­sionals build together. He is part of the North­eastern Uni­ver­sity Center for Health Policy and Health­care Research, which fos­ters inter­dis­ci­pli­nary research and edu­ca­tion per­taining to health policy and healthcare delivery.

From vir­tual care tech­nolo­gies to mobile health apps, health­care today looks much dif­ferent than it did 10 or even five years ago. And Hoff says these inno­va­tions aren’t the problem—it’s that our health­care sys­tems, both in the U.S. and else­where around the globe, are relying too heavily on them, and not as much on building a strong provider-​​patient relation­ship. He says this flies in the face of what he’s learned from talking to patients and health­care pro­fes­sionals, both of whom value that rela­tion­ship and become dis­sat­is­fied when it falls short.

“Tech­nology such as elec­tronic health records and mobile health apps can fur­ther the depths of an already solid provider-​​patient bond, but it can’t replace it,” he says. “On its own, it deem­pha­sizes the value of human con­tact and relationship-​​building, both of which pro­duce lots of ben­e­fi­cial things for patient care.”

Hoff recently pub­lished a research article in Mil­bank Quar­terly, the world’s leading health policy journal, for which he inter­viewed health­care pro­fes­sionals deliv­ering patient-​​centered med­ical home care to older adults and ana­lyzed how these expe­ri­ences shaped the staff’s thinking, learning, and future actions in imple­menting such care. He found that there isn’t a one-​​size-​​fits-​​all approach to making med­ical home imple­men­ta­tion work and sug­gested that assess­ments of and rewards for this type of care should include more recog­ni­tion of the value of its social and rela­tional com­po­nents. The med­ical home model, he said, is a key inno­va­tion of U.S. health reform.

This work leads into Hoff’s forth­coming study focused on exam­ining the changing nature of the patient-​​physician relation­ship through a social psy­cho­log­ical lens. For 18 months, he expects to inter­view cur­rent and retired doc­tors, nurses, phar­ma­cists, and edu­ca­tors about their patient-​​care expe­ri­ences, with ques­tions focusing pri­marily on aspects of the patient-​​provider relationship.

He likens the study to an arche­o­log­ical dig, hoping to cap­ture a base­line of data about what the provider-​​patient relation­ship used to be like, what it looks like now, and how it is evolving. The find­ings, he says, could inform both healthcare policy and management.

This all comes as the U.S. rolls out the Obama administration’s Afford­able Care Act. Hoff says Amer­i­cans’ greater access to health­care is a major step for­ward for the country, but he wor­ries that despite this law’s best inten­tions, it will provide greater access to a system that in his view increas­ingly sees patients as wid­gets and is under-​​resourced to provide good long-​​term, rela­tional care.

How can the health­care system get back on the right track? In Hoff’s opinion, “It’s about first com­mit­ting to a set of goals focused on what we want the patient-​​provider rela­tion­ship to be. Once we do that, the tech­nolo­gies and inno­va­tions get built to serve those goals. But we haven’t clar­i­fied these goals yet. For example, the phrase ‘patient-​​centric care’ gets thrown around a lot, because it’s assumed we all know what it means. But no one knows what it means. It’s become a mar­keting pitch insurers, hos­pi­tals, and prac­tices use to get business.”

Oth­er­wise, he warns, impor­tant parts of the system such as pri­mary care will con­tinue evolving into a highly unrewarding expe­ri­ence for everyone involved. “We’ll have a health­care system in which elec­tronic health records will be able to show that you’ve had the same doctor for 15 years,” he says, “but you’ll prob­ably never see that doctor and when you do, he or she will have no idea who you are.”

Hoff’s work focuses largely on pri­mary care, though he sees sim­ilar trends occur­ring in the arena of spe­cialty care. However, he points to two areas where we can learn some­thing valu­able: end-​​of-​​life care, in which patients and care­takers often develop deeper rela­tion­ships and trust within short periods of time, and pedi­atric care, which he says can set a foun­da­tion to build con­ti­nuity of care for a person’s entire life.

Hoff also notes that patients are often iden­ti­fied as “con­sumers” in dis­cus­sions of health­care eco­nomics, pointing for example to New York Times colum­nist Paul Krugman’s 2011 op-​​ed taking issue with this label. For his part, Hoff is focused less on the term itself and more on what it implies—that industry has a larger say than health­care pro­fes­sionals in how to improve health­care in America.

“I don’t dis­agree at all with calling patients ‘con­sumers,’ as long as we under­stand that they’re not the same as people shop­ping for smart­phones,” he says.

- By Greg St. Martin


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