How can a patient-centred approach help to achieve high quality healthcare?
It has been shown that a patient-centred approach can imporve the way healthcare is delivered
Achieving high quality healthcare is an ambition of governments and health organisations around the world. There are many different opinions on what ‘high quality’ means, how it should be measured, and how it can be achieved 1. As a general rule, ‘high quality’ is taken to mean healthcare that follows the latest recommendations of specialist medical societies and experts who have considered all the latest evidence. However, most people now agree that high quality healthcare must also be based on the needs, preferences and values of each individual patient – in other words, it must be ‘patient centred’2. In addition to receiving the most appropriate treatment, patient-centred care can help to achieve many other things that are considered signs of high quality care, such as feeling listened to, not having to wait too long for treatment and being able to access care easily and conveniently1,2
What is ‘high quality’ patient-centred care and how do we measure it?
Measuring the quality of healthcare is important, as it allows healthcare professionals to understand what they are already doing well and what may still need to be improved3. However, as patient-centred care focuses on individual needs that vary from one person to another, it is not always clear what to measure4. A list of patient-centred quality standards – in terms of goals for healthcare organisations – has been published by the government in the United Kingdom5. These include: ensuring healthcare professionals are trained in communication skills; reducing the number of different doctors and nurses involved during a single period of patient care (e.g.a hospital stay); and ensuring staff introduce themselves and explain their role to the patient before starting to provide care5.
Healthcare organisations are increasingly recognising the value of patient insights and experiences to help them re-design processes and systems in a more patient-centred way
Studies looking at the quality of patient-centred care focus either on the personal experiences of the patient (e.g. whether they feel their personal priorities were taken into account by healthcare teams), or on whether their health improves as a result of the care4,6. Video recordings have shown that patients’ memories of a discussion with their doctor don’t always reflect how the discussion actually went, which makes it difficult to use patient surveys to measure care quality. Measuring health improvement might therefore be the best way of assessing the value of different types of patient-centred care7. For example, a five-year study comparing two hospitals showed that patient-centred care resulted in shorter stays in hospital and a lower overall cost of care. In another study, patient-centred care was associated with better relief from symptoms and fewer medical tests7,9.
How can patients share responsibility for high-quality care?
Patients and their family members often have a lot of valuable insights, both about their own health condition and the way care has been delivered to them in and out of hospital10. These insights mean that patients can play active and important roles in measuring and improving the quality of healthcare at different organisational levels. The University of Montreal in Canada recently set up a new department to involve patients in designing better healthcare services10. The department includes teams of patients and doctors who help design training for medical students, research new ways of delivering patient centred care, and assess the quality of healthcare services in their local area10. Patients who took part in this project have said that it helped them to feel like they were making a difference, as well as improving their own communication and team-working skills10.
Patients and their family members can also draw on specific experiences to suggest simple, practical ideas to improve the way healthcare is delivered. For example, the daughter of a woman with serious memory problems caused by dementia suggested using a logbook to record when her mother had been washed, fed and given her medication each day, to improve communication between family members and different health workers. In another case, a cancer patient noticed that doctors and nurses didn’t always introduce themselves personally, which she found off-putting. She set up a national campaign called “Hello, my name is…”, which encouraged doctors and nurses to interact in a more ‘human’ way and less like anonymous professionals11.
In the past few decades, our understanding of high quality healthcare has changed, becoming a broader definition of care encompassing what takes place at home and in the local community12. Healthcare organisations are increasingly recognising the value of patient insights and experiences to help them re-design processes and systems in a more patient-centred way.
1. Committee on Quality of Health Care in America. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
2. Raleigh VS, Foot C. Getting the Measure of Quality: Opportunities and challenges. The Kings Fund, 2010. Available from: https://www.kingsfund.org.uk/sites/files/kf/Getting-the-measure-of-quality-Veena-Raleigh-Catherine-Foot-The-Kings-Fund-January-2010.pdf [Accessed 27 April 2017]
3. Werner RM, Asch DA. Clinical concerns about clinical performance measurement. Annals of Family Medicine. 2007;5:159–63.
4. Health Foundation, 2014. Helping measure person-centred care. Available from: http://www.health.org.uk/sites/health/files/HelpingMeasurePersonCentredCare.pdf (Accessed 27 April 2017)
5. National Institute for Health and Care Excellence (NICE). Patient experience in adult NHS services. February 2012. Available from: https://www.nice.org.uk/guidance/cg138 [Accessed 27 April 2017]
6. Epstein RM, Street RL. The Values and Value of Patient-Centered Care. Annals of Family Medicine. 2011;9(2):100-3
7. Frampton S, Guastello S, Brady C et al. Picker Institute, October 2008. Patient-centred care Improvement Guide. Available from http://patient-centeredcare.org/ [Accessed 27 April 2017]
8. Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009;47(8);826-834.
9. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000;49(9):796-804.
10. Pomey MP, Hihat H; Khalifa M, et al. Patient partnership in quality improvement of healthcare services:Patients’ inputs and challenges faced. Patient Experience Journal. 2015; 2(1):6.
11. “Hello, my name is…” Campaign. Available from: www.hellomynameis.org.uk [Accessed 27 April 2017]
12. Royal College of General Practitioners, November 2014. An Inquiry into Patient Centred Care in the 21st Century. Implications for General Practice and Primary Care. Available from: http://www.rcgp.org.uk/policy/rcgp-policy-areas/inquiry-into-patient-centred-care-in-the-21st-century.aspx [Accessed 27 April 2017]