How a healthCARING model can eliminate patient non-compliance

160401 hi_logo

UPDATED – July 2016

Over the past few years I have written a number of “patient non-compliance” pieces for Hospital Impact, and apparently the posts have struck a chord with readers.

Today I am sharing brilliant feedback from Ziva Mann, Cambridge Health Alliance’s (CHA) Patient Lead; along with a story that highlights the impact to patients, families, and communities of not improving the system to better address this challenge.


First the feedback

After reading and reflecting on a 2014 Hospital Impact post, “Lessons on Patient-centered care,” Mann shared:

“Our Patient Partners suggested calling the concept ‘health capacity,’ and making it part of an ongoing assessment (i.e., conversation).

They said that we should look at each person and ask:

  • What is your capacity to do the work of your health today?
  • What resources do you have right now, to listen, ask questions, absorb, retain and then act?
  • What burdens do you have–responsibilities, needs, issues–that would take away from your capacity to do the work of your health?

It takes work for a provider or staff member to be present during the appointment. The same is true for patients. And if only we flipped that equation more often, supported staff better, we could all be more comfortable when we find ourselves in the other person’s shoes.”

Such wonderful and important feedback relative to true patient-centered care and the “non-compliant” patient.

Just consider the new paradigm:

  • Where we truly listen to our Patient Partners in the design process of an evolved care model (a healthCARING model)
  • Where we create a relationship-centered care model in which clinicians and staff are whole and healthy
  • Where these whole and healthy clinicians and staff are positioned to share their whole selves with their patients
  • Where patients feel safe to share their whole stories and where their whole stories are truly listened to and honored
  • Where the questions above are asked and patients who now have trust in their care team choose to share their truths
  • Where together clinicians and patients co-create a care pathway that leverages state-of-the-art clinical wisdom, medical research, patient preferences, and the information garnered through the sharing in this safe space and through the authentic and trusting relationship that is created in this new healthCARING model

That’s true innovation, better care and so much more…

  • Improved physician, nurse, and staff satisfaction, retention, engagement
  • Improved patient safety, engagement, experience, care pathway adherence
  • Enhanced and actualized Patient Partners
  • Better outcomes (aligned with patient preferences)
  • Lower costs

Yes, healthCARING.

Yes, a healthCARING model designed by the amazing CHA Patient Partners in a program facilitated by Mann and Sue Natale, ACNO for Ambulatory Services.


Now the story

And here is what happens in our current system of care … a non-healthCARING system.

(Note: This is a true story)

An African-American gentleman in his mid-fifties (Jim) is married and is blessed with four children (two living at home). He is slightly overweight and on medication to help manage his blood pressure. His wife lost her job recently, adding financial stress to the family. Jim soon thereafter was also laid off, thus multiplying the financial stressors. COBRA is offered, but Jim believes he cannot afford its cost.

Feeling it necessary to choose between feeding his family or paying for his medicine, he opts to stop taking his blood pressure medication.

One and a half months later, Jim experiences numbness and tingling in the right side of his face with facial drooping and loss of feeling and sensation on the left side of his body. Jim is rushed to the hospital and diagnosed with a cerebral vascular accident (CVA/stroke).

Jim did not believe there was a pathway within the healthcare system to support him and his healthcare as his socioeconomic condition changed.

Jim did not believe he had a trusting relationship with folks within the healthcare system to share the challenges he was now facing in his efforts to remain “compliant.”

Yes, the urgent care he received to address his stroke was excellent, and yet, Jim is now out of work, aphasic, beginning a long rehabilitation process, feeling a burden to his already stressed family, and costing the healthcare and safety-net system far beyond the cost of blood pressure medication.


This story should never happen.

We can do better.

It is time to transform the broken healthcare system into a healthCARING system for the benefit of all.

Listen to your Patient Partners. And if you do not already have them engaged, make it a priority to develop a Patient Partner program.

Together we can lead and we can serve.

We must.



  1. Sure is a 50/50 problem. Patient has to be as open as the healthcare provider in order for the model to work. Hardest part of this is perhaps the assessment of the provider while the patient may not be compliant to do so because of the affect of his/her illness. Family support is extremely important in negotiating the in and outs of the health care system.Dad J. Peter Dahlborg Dianne M. Dahlborg

    • Thank you for commenting, Dad. The authentic relationship between clinician and patient is essential to co-create the care pathway which best meets the patient’s preferences. Regarding family, we also must be careful here. Many families and supportive and essential for optimal care. Others are not. The authentic relationship and the hearing of the patient’s whole story (including family dynamics) is critically important to the care pathway co-creation as well. Thank you again for sharing. Tom

  2. This is brilliant! It should have been obvious that a healthCARING system as described here is the way to go. We have come a long way from the time when my father first practiced medicine where there was no discussion, the doctor was “god” and the patient was told what to do. But we still have a long way to go.
    Bravo, Ziva and your team and Thomas Dahlborg!

    • Thank you for sharing your feedback, insight, and perspective, Margot. Ziva and her team truly have the right approach.

      There is great opportunity to create a healthCARING model together and people like Ziva and her team are truly leading the way.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s