healthtransformation
.foundation
Joaquim Cardoso MSc
February 22, 2024
This article was published by NEJM Catalyst on January 1, 2017
What is the message?
The central message of the article is the importance and benefits of patient-centered care in the healthcare system.
Patient-centered care emphasizes tailoring healthcare decisions and quality measures to individual patients’ needs and desired outcomes, with active collaboration between patients, families, and providers.
What are the key points?
Elements of Patient-Centered Care: This includes alignment of healthcare systems with patient-centered goals, collaborative and accessible care, focus on physical and emotional well-being, respect for patient preferences and values, involvement of patients and families in decision-making, encouragement of family presence in care settings, and timely information sharing.
Benefits of Patient-Centered Care: The primary goal is to improve individual health outcomes, leading to improved patient and family satisfaction, enhanced provider reputation, better morale and productivity among healthcare professionals, improved resource allocation, and reduced expenses.
Examples of Patient-Centered Care: Examples include patient-centered care in doctor’s offices, hospitals, and personalized medicine. In these models, care is personalized, involving patients and families in decision-making, and providing support beyond immediate medical needs.
Cultural Shift to Patient-Centered Care: Patient-centered care requires a shift in healthcare practices and systems, involving all stakeholders in the process and changing traditional hierarchies. Patients and families are seen as active team members, with their feedback driving continuous improvement in healthcare delivery.
The article
Explore the definition, benefits, and examples of patient-centered care. How does patient-centered care translate to new delivery models?
In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.
Elements of Patient-Centered Care
Patient- and family-centered care encourages the active collaboration and shared decision-making (1 ) between patients, families, and providers to design and manage a customized (2) and comprehensive care plan.
1 http://www.nejm.org/doi/full/10.1056/NEJMp1109283
2 https://catalyst.nejm.org/healthcare-built-order-customized-care/
Most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered:
- The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals.
- Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place.
- Care focuses on physical comfort as well as emotional well-being.
- Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected.
- Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level.
- The presence of family members in the care setting is encouraged and facilitated.
- Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.
7 Elements of Patient-Centered Care.
Benefits of Patient-Centered Care
The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve.
Not only do patients benefit, but providers and health care systems benefit as well, through:
- Improved satisfaction scores among patients and their families.
- Enhanced reputation of providers among health care consumers.
- Better morale and productivity among clinicians and ancillary staff.
- Improved resource allocation.
- Reduced expenses and increased financial margins throughout the continuum of care.
Patient-Centered Care Examples
Patient-focused care is realized in a number of ways, across a variety health care settings, from family care and specialty providers, to acute, emergency, and long-term care providers. Here are a few examples.
- Patient-centered care in the doctor’s office. Under patient- centered care, care focuses more on the patient’s problem than on his or her diagnosis. Patients have trusted, personal relationships (3) with their doctors in patient-focused care models. Empathy, two-way communication (4) , and eye-to-eye contact (5) are crucial, as is the ability of the doctor to see beyond a patient’s immediate symptoms or pain (6) . This broader look at the needs of the whole patient requires providers to offer services or referral to services such as peer support programs (7), social workers, financial counselors, mental and emotional health providers, transportation and daily living assistance, and in some communities, language and literacy education. While human interaction takes a primary role in patient-centered care, physician practices may also employ a variety of technology-based tools (8) to help patients take
ownership (9) of their health care outside of the doctor’s office. Tools range from 24/7 online portals that let patients schedule appointments, get information about their condition and care instructions (10) , review lab results and doctor’s notes (11) , and pay bills at their convenience, to wearable technology and apps that let patients track their “important numbers” such as weight, blood pressure, glucose levels, and cholesterol.
3 https://catalyst.nejm.org/videos/measure-patient-trust/
4 https://catalyst.nejm.org/engaging-patients-adding-value-talking/
5 https://catalyst.nejm.org/electronic-health-record-tale-two-visits/
6 https://catalyst.nejm.org/chronic-pain-care-falls-short/ 7 https://catalyst.nejm.org/videos/power-social-connectedness-peer-support-programs/
8 https://catalyst.nejm.org/digital-health-technology-access/
9 https://catalyst.nejm.org/patient-researchers-physician-consultants-confront-chronic-disease/
10 https://catalyst.nejm.org/patient-centered-checklists-next-frontier/
11 https://catalyst.nejm.org/opennotes-knowing-change-health-care/
- Patient-centered care in the hospital. Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates (12) . A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly
postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.
12 https://catalyst.nejm.org/ease-operating-room-mobile-communication-app/
- Personalized medicine. The concept of patient-centered care extends to the treatments and therapies (13) clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed (14) in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.
13 https://catalyst.nejm.org/adopt-precision-medicine-personalized-health/
14 https://catalyst.nejm.org/p4-medicine-democratization-health/
Cultural Shift to Patient-Centered Care
As with other forms of value-based health care 15 , patient-centered care requires a shift 16 in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture.
15 https://catalyst.nejm.org/what-is-value-based-healthcare/
16 https://catalyst.nejm.org/problems-patient-engagement-design/
Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated (17) that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils 18 , and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided.
17 http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/ 18 https://catalyst.nejm.org/pfac-quality-memorial-sloan-kettering/
As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.
