Patient-centred care for healthcare providers

The widely accepted dimensions of patient-centred care are:

• respect
• emotional support
• physical comfort
• information and communication
• continuity and transition
• care coordination
• involvement of family and carers
• access to care.

These dimensions form the backbone of numerous quality improvement programmes and surveys measuring patients’ experience of health care.

(Image source: Picker Institute, Europe)

There is now clear research demonstrating that patient-centred care improves patient care experience and creates public value for services. (1)

"When healthcare administrators, providers, patients and families work in partnership, the quality and safety of health care rise, costs decrease, and provider satisfaction increases and patient care experience improves. Patient-centred care can also positively affect business metrics such as finances, quality, safety, satisfaction and market share." (1)

World Health Organisation, May 2015

Patient-centred care has been increasingly recognised as a critical dimension of high-quality health care since the landmark Institute of Medicine report, Crossing the Quality Chasm (2) included it as one of the six quality aims for improving care. These aims are built around the core need for health care to be:

• Safe: avoiding injuries to patients from the care that is intended to help them.
• Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
• Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
• Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy. 
• Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

In many countries,  a patient-centred approach is now supported by national policies and Consumer Rights Charters. Within New Zealand, professional authorities such as the NZ Medical Council (NZMC) and the The Code of Health and Disability Consumers’ Rights uphold the importance of patient-centred care and a useful chapter in Cole's Guide to Good Medical Practice (NZMC) discusses the relationship between patient-centred care and cultural competence. (3) 

The Health Quality and Safety Commission has a programme of work focused on Partners in Care(external link) and the new NZ Health Strategy(external link) has a related concept of people-powered as a core theme. 

Internationally, in May 2016 at the Sixty-ninth World Health Assembly (WHA) Member States adopted, with overwhelming support, resolution WHA 69.24 “Strengthening integrated people-centred health services”(external link) that supports the “Framework on integrated people-centred health services”. (4)

Delivering person centred care in long-term conditions

Transforming support for people with long term conditions makes sense from every angle: improving wellbeing, developing a more positive sense of control, achieving better health outcomes, and potentially lower healthcare costs. It now seems possible to envisage this as the norm but substantial barriers and challenges exist. We need clinical and patient leadership to help navigate these challenges, along with system drivers and incentives, and practical support to encourage these new ways of working. People with lower activation levels, poor health literacy, and difficult social circumstances need specific and tailored support but have the most to gain.11 We believe that the success of any clinician, team, or organisation should be defined by their efforts to tackle these disadvantages and to ensure a person’s goals and priorities are always at the centre of his or her care. 

Read more about the article here.(external link)

Videos about patient centred care, ranging from discussions about the future of patient-centred care (at TEDx University of Minnesota), to a study showing that person-centred and community-centred approaches for health and wellbeing are pivotal to improving health and wellbeing outcomes.

Patient-centred care – the future

Dave Moen talks about the future of patient-centred care (at TEDx University of Minnesota).

(TEDx Talks, 2012)

David Moen, M.D., is an emergency department physician and led the development of Fairview Health Network—an integrated, multi-specialty provider network built on the belief that providers are in the best position to transform care. (speaks at TEDxUMN University of Minnesota in August 2012, 21.56 mins)

Practical learning tips to put people and communities at the heart of health and wellbeing

"The Realising the Value programme conducted analysis of the evidence for person-centred and community-centred approaches for health and wellbeing, working with five frontline sites across England, and published tools, recommendations and economic modelling to show how they can be successfully implemented. It concluded that that person and community-centred approaches are pivotal to improving health and wellbeing outcomes."

(The Health Foundation, UK)