Improving the Dialysis Patient Experience: An Interview with Dr. Francesca Tentori

At DaVita, creating an exceptional, caring experience for our dialysis patients is our top priority. For patients living with chronic kidney conditions, receiving consistent, quality care can make a world of difference in their quality of life. We sat down with Dr. Francesca Tentori, the Vice President of DaVita Outcomes Research and Patient Empowerment, to learn more about how DaVita is improving the dialysis patient experience.

What motivated you to head up the Patient Experience initiative?

I truly believe the experience of care is as important as clinical outcomes. This concept became even more clear to me when I became a patient (when delivering my daughters) and a caregiver (for my dad) myself. DaVita’s philosophy is to put patients’ quality of life at the top of the clinical pyramid: their experience of care is a huge component of quality of life for any person with a chronic condition. As a dialysis organization, we have an incredible opportunity in this area. So my passion was a really good fit for this area!

By improving the patient’s dialysis experience, how will this affect patient retention and clinical outcomes?

In general, if we have a positive experience as consumers, we are more likely to go back to a certain store/restaurant/hotel. While dialysis is a life-saving treatment, the same concept applies to individuals who are on dialysis: if their overall experience at their clinic is positive, they are more likely to go to treatments and stay on dialysis for the prescribed time. If their interactions at the clinic are negative, they are less likely to want to go and spend time there.

What is your long-term goal for the Patient Experience initiative?

My goal is to understand how to optimize the experience of patients with kidney disease and implement those practices in every clinic for every patient. I hope  that DaVita will be recognized for their patient experience, and people will choose it as a provider because of this factor. Think of Southwest Airlines or Disney, and how people are attracted to those brands. We want to provide life-sustaining treatment in the safest environment, leveraging the best medical evidence, while creating a place where patients feel comfortable and cared for.  My dream is that patients will feel empowered in actually choosing a dialysis organization based on their experience of care, as opposed to just going to the dialysis center that is closest to them.

What are your thoughts on how patient experience influences morbidity and mortality?

There is strong evidence in many chronic conditions that a positive experience of care results in greater engagement in self-care on the part of affected individuals. For dialysis patients, that engagement can mean greater adherence to dialysis regimen, medication prescriptions, or the many “rules” around their diet and fluid intake. Self-care may have a positive impact on overall health, and result in fewer adverse clinical outcomes. For example, if I am a dialysis patient who has a strong relationship with my clinical team, I will have better understanding of the reasons why I am asked to limit the amount of water I drink, and I am more likely to do so. As a consequence, less fluid will accumulate in my body, dialysis treatments will be able to eliminate it, and I can help prevent instances such as   needing to go to the emergency room in the middle of the night because I am short of breath.

With regards to mortality, we know that dialysis patients’ perceptions of their quality of life can have an impact on predicting death. It is plausible that better experience of care may also have an impact on mortality, although we need to acknowledge that these associations are likely confounded: patients who are closer to death may be more likely to report a worse experience of care because they are sicker. Just as important, data on the experience of these patients is more likely missing, since they are less likely to participate in surveys/answer questions.

What is the top thing you would recommend for clinics do to improve patient experience?

I would recommend practicing the caring behaviors DaVita teammates have identified as most important, under our WE CARE model:

Welcome

Empathize

Connect

Actively listen

Respect

Encourage

What are the top 3 things physicians can do to improve patient experience?

Listen, listen, and listen!

To learn more about Dr. Tentori’s work and how DaVita is transforming the dialysis patient experience, visit DaVita’s Patient Education center.