Care-Continuum-Consistent Shared Mental Models

In order for our population to thrive, healthcare entities must align themselves across the entire continuum of care–including all providers and stakeholders.  All clinicians and specialties must be able to communicate effectively– and we hope EHRs will help us make that happen.  We must also quickly identify when to adopt evidence-based practice guidelines based on rigorous  science so that we can rapidly adapt our clinical guidelines. When demonstration projects and creative ideas appear to be functioning effectively to improve population health, we must find ways to quickly understand how to use the ideas in our own practice arena.

Shared mental models (SMM) are a shorthand or common language for communication, blueprint overview, and a memory device that helps us as clinicians keep the patient/family and their immediate preferred priorities and longer term goals in mind in the midst of constant turmoil and change.  One such SMM is the patient’s 4Ps: Purpose, Picture, Plan, and Part.  We can use these 4 points to consider:  How will this initiative or idea affect this patient and his purpose for seeking care, picture of how he is now versus his picture of success, the plan, and the part everyone (including the patient/family) plays in helping him achieve that goal?  Using a shorthand SMM such as the 4 Ps helps keep our hand0ff and transition information clear and succinct and most importantly–patient centered and relationship and results based.

From primary care clinics and the medical home,  to acute care, to the SNF, to hospice, to home care–The 4 Ps is useful for everyone as a shorthand and structure to “knowing” our patients.   This kind of mental device is essential for care continuum consistency.

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