The concept of patient-centered care has gained increasing prominence in recent years as a key aim of the U.S. health care system. Yet despite growing recognition of the importance of patient-centered care, as well as evidence of its effectiveness in contributing to other system goals such as efficiency and effectiveness, the nation’s health care system falls short of achieving it. Data from national and international studies indicate that patients often rate hospitals and medical care providers highly, but report significant problems in gaining access to critical information, understanding treatment options, getting explanations regarding medications, and receiving responsive, compassionate service from their caregivers.
This paper was commissioned by The Picker Institute to explore what it will take to achieve more rapid and widespread implementation of patient-centered care in both inpatient and ambulatory health care settings. The findings and recommendations of this paper are based largely on a series of interviews with opinion leaders selected for their experience and expertise in either designing or implementing strategies for achieving excellence in patient-centered care.
Key Attributes of Patient-Centered Care
A high degree of consensus exists regarding the key attributes of patient-centered care. In a systematic review of nine models and frameworks for defining patient-centered care, the following six core elements were identified most frequently:
- Education and shared knowledge
- Involvement of family and friends
- Collaboration and team management
- Sensitivity to nonmedical and spiritual dimensions of care
- Respect for patient needs and preferences
- Free flow and accessibility of information
Factors Contributing to Patient-Centered Care
The interviews and literature reviewed for this project identified seven key factors that contribute to achieving patient-centered care at the organizational level:
- Leadership, at the level of the CEO and board of directors, sufficiently committed and engaged to unify and sustain the organization in a common mission.
- A strategic vision clearly and constantly communicated to every member of the organization.
- Involvement of patients and families at multiple levels, not only in the care process but as full participants in key committees throughout the organization.
- Care for the caregivers through a supportive work environment that engages employees in all aspects of process design and treats them with the same dignity and respect that they are expected to show patients and families.
- Systematic measurement and feedback to continuously monitor the impact of specific interventions and change strategies.
- Quality of the built environment that provides a supportive and nurturing physical space and design for patients, families, and employees alike.
- Supportive technology that engages patients and families directly in the process of care by facilitating information access and communication with their caregivers.
These factors can be found at work in a small but growing number of hospitals and medical groups across the country. Among the examples identified through the project interviews, a few were mentioned repeatedly as outstanding illustrations of organizations that have focused on these factors to achieve measurable excellence in performance. Two specific cases highlighted in this paper are the MCG Health System in Augusta, Georgia, and Bronson Methodist Hospital in Kalamazoo, Michigan. These two organizations demonstrate how most or all of the factors identified can be addressed in an integrated, comprehensive way to achieve high levels of patient-centered care, as measured through independently collected patient survey data as well as through other important health care outcomes and organization objectives.
Strategies for Leveraging Change
Key strategies identified as necessary to overcome barriers and to help leverage widespread implementation of patient-centered care can be divided into the following two groups.
- Organization Level. Strategies designed primarily to strengthen the capacity to achieve patient-centered care at the organization level include:
- Leadership development and training
- Internal rewards and incentives
- Training in quality improvement
- Practical tools derived from an expanded evidence base
- System Level. Strategies aimed at changing external incentives in the health care system as a whole, to positively influence and reward organizations striving to achieve high levels of patient-centered care, include:
- Public education and patient engagement
- Public reporting of standardized patient-centered measures
- Accreditation and certification requirements
The findings from this project indicate that, while there are many promising examples of organizations achieving excellence in patient-centered care, these innovators are not yet the norm. The challenge lies in elevating the norm through strategies at both the organization and system level that leverage the experience of these innovators to motivate large-scale implementation of patient-centered care.