Earlier this year, my colleague Miles Cottier and I had the unique opportunity to conduct an analysis of women's health trends around the world during the pandemic. We can say that this was an eye-opening experience, not just in terms of what we found, but how it challenged us, as men, to face an uncomfortable truth about our health care system: it is a system largely built by men that fails women on a daily basis. And without elevating women's health concerns systematically, we as a health care system will continue to fail them.
Here, we reflect on some of the things we learned while looking into women's health care that made us think differently about the way we organize women's health delivery.
Women's health isn't always recognized as a medical sub-specialty. Except when it's called maternal health.
Stephanie McClellan, CMO of Tia Clinic, an integrative provider network for women's health, writes, "The current system confines women's health to a body part or a medical specialization, when in reality, "health" as a whole should be the driving force behind women's healthcare at large." It's a distinction that colors the entire spectrum of service line structures and is a major difference between how women and men receive health care.
Consider your organization's website. How often do you refer to women's health, if at all? Then, compare how often you might see the phrases maternal health, reproductive health, or simply obstetrics and gynecology. Certainly, we wouldn't see urology referred to as paternal health, but we feel comfortable using maternal health as short-hand for a full-range of women's medical needs, irrespective of whether they're actually related to pregnancy.
Essentially, what we need to realize is that the days when women's health was code for maternal health are over. We should no longer have the view of women's health delivery as a set of disjointed treatments for various body parts, across diverse, siloed specializations. Instead, we must overlay a dedicated perspective across all of our service lines, from orthopedics to behavioral health, that directly responds to and addresses the particular needs of our female patients.
Only when we take an expansive definition of women's health, one that extends all of our existing service lines and represents a unique service line in itself, will we be able to move away from the limitations of our traditional one-size-fits-all approach.
We need to take a holistic approach to women's health care delivery
A better strategy is to start focusing on care coordination for a woman's life-long patient journey through the system. UPMC did this. Their approach was based on three steps: (1) a cross-system leadership structure, (2) data analysis of female patient trends using their data warehouse, and (3) women's health goals reflective of actual women's habits instead of our perception of them. To offer just one example of its impact, the creation of the Women's Health Service Line contributed to major improvements in the cost and delivery of hysterectomies: a 34% decrease in open surgeries, a 28% reduction in 30-day readmission, and a 20% reduction in in-patient length of stay.
Women's behavioral health services could also greatly benefit from better care coordination and the easiest way to do that is to integrate behavioral health services with physical health services. This is what St. Joes Women's Health Concerns Clinic has done. This clinic is staffed by clinicians, psychiatrists, and social workers that provide assessments, consultations, and treatments for behavioral health issues that emerge at various times throughout a women's physical health care journey, offering these services when patients are at the clinic for non-behavioral health visits. By working hand-in-hand with primary care physicians to refer mothers early in pregnancy to the clinic, rates of postpartum depression are less than half of the rates in surrounding systems.
We need to embed women's voices directly into how we design health care
Seventy-eight percent of women are the primary health care decision-maker for their household. They are, in fact, often the most influential of health care consumers. Yet, they are not treated as such. In fact, one study found that 65% of female patients reported being made to feel more like a number than an individual while accessing health care.
What health systems can do is partner with women, listen to what they have to say, and use their experiences and knowledge to help build a better, more inclusive and targeted health system strategy. One example of what this can look like comes from the UK National Health Service's Maternity Voice Partnerships.
These are regionally-organized groups of women, families, providers, doctors, midwives, and commissioners that seek out and elevate the voices of women in the community—especially those who are underrepresented—and use their experiences to improve maternity care services. This only begins to illustrate the power of incorporating women's voices into strategic planning.
If women are our top health consumers, let's treat them as such
If we do listen to women and use their experiences and preferences, we can build a more equitable, holistic, accessible, and frictionless care experience. The Ripa Center for Women's Health did just that. The center was designed by women, for women, and addresses common barriers preventing women from accessing health care, namely time and competing priorities (e.g., work, family.) The outpatient center provides an integrative women's health experience under one roof, with patients able to schedule same-day primary care appointments and access on-site screening mammograms, bone density scans, and general ultrasounds.
Their flagship service is the 'Half Day for Health' program, a 'one-stop-shop' approach where women can schedule a three-hour, annual appointment that includes a primary care visit, a consult with a gynecologist, and any necessary mammogram or bone density imaging services. This approach is both sensitive to consumer needs and enables effective data sharing and better coordination of services.
Whether it's taking a formal service line approach or even just re-labeling maternal health to a more encompassing and inclusive 'women's health,' we have real solutions, ready and available, to better meet the needs of our female patients. If we are to fulfill the promise of making health care truly work for our patients, we must start acting on them.