PATIENT-CENTERED CARE IMPROVEMENT GUIDE
“There is nothing more powerful than an idea whose time has come.” Victor Hugo
PATIENT-CENTERED CARE: AN IDEA WHOSE TIME HAS COME
rganizing the delivery of health care around the needs of the patient may seem like a simple and obvious approach. In a system as complex as health care, however, little is simple. In fact, thirty years ago when the idea of “patient-centered care” first emerged as a return to the holistic roots of health care, it was swiftly dismissed by all but the most philosophically progressive providers as trivial, superficial, or unrealistic. Its defining characteristics of partnering with patients and families, of welcoming―even encouraging―their involvement, and of personalizing care to preserve patients’ normal routines as much as possible, were widely seen as a threat to the conventions of health care where providers are the experts, family are visitors, and patients are body parts to be fixed. Indeed, for decades, the provision of consumer-focused health care information, opportunities for loved ones’ involvement in patient care, a healing physical environment, food, spirituality, and so forth have largely been considered expendable when compared to the critical and far more pressing demands of quality and patient safety―not to mention maintaining a healthy operating margin. How times have changed. This once radical concept has undeniably been pushed into the mainstream, in part by the Picker Institute’s introduction of its scientific approach to identifying and understanding patients’ varied needs and by the expansion of the Planetree membership network, comprised of health care organizations across North America and abroad all implementing a patient-centered approach to care. The Institute of Medicine’s 2001 seminal report Crossing the Quality of Chasm identified patient-centeredness as an essential foundation for quality and patient safety―versus the conventional perspective of a patient-centered approach being a peripheral aim―effectively ushering in a reorientation of the health care delivery system: one in which the way care is delivered is considered equally as important as the care itself. With the introduction of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient experience of care survey, there now exists a standardized tool to evaluate the way care is provided from the patient perspective. The program’s development has reinforced that, from the vantage point of patients, the health care experience encompasses much more than clinical capabilities, pharmaceuticals and technology. Whereas other nationally standardized and publicly reported outcomes, like CMS’s core measures, evaluate hospitals on aspects of clinical quality that mean little to patients themselves and/or reflect outcomes that patients take for granted as minimum standards of care, HCAHPS examines those aspects of the health care experience that mean the most to patients, including communication with nurses and physicians, cleanliness and noise levels, pain control, and quality of discharge instructions and medication information. With individual hospitals’ scores publicly available for the curiosity, scrutiny and comparability of health care consumers, HCAHPS has hastened the need for hospitals to examine the way care is delivered from the perspective of their patients. And with the advent of value-based purchasing, HCAHPS will likely become a basis for reimbursement, effectively advancing patient-centered care from the “right thing to do” to a business imperative.
© 2008 by Planetree (www.planetree.org) and Picker Institute (www.pickerinstitute.org). All rights reserved.
PATIENT-CENTERED CARE IMPROVEMENT GUIDE
DEFINING PATIENT-CENTERED CARE The result is that, today, patient-centered care is in the consciousness of most every health care leader. Organizational mission statements reference...
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