In 2001, the Institute of Medicine (now the National Academy of Medicine) first published its list of six measures for quality care: safe, effective, patient-centered, timely, efficient and equitable. Now, 20 years later, the framework continues to provide guidance for physicians, medical practices and health systems as they pursue quality care. It also helps patients understand what to expect from providers.
One aim on the list – patient-centered care (PCC) – seems to garner the most attention and discussion. In fact, as Patient Engagement HIT reported in late August 2021, “Patient-centered care may be the healthcare buzzword of the past decade.” Here, we take a look at what PCC is, what it means for your medical practice (including your relationships with patients) and what to consider when implementing PCC to improve outcomes and reduce medical liability.
What is patient-centered care?
Sara Heath, author of the Patient Engagement HIT piece, puts it plainly: PCC is “healthcare delivery that foremost considers the patient.” But, as Heath goes on to outline in greater detail, PCC isn’t quite that simple: “Clinicians practicing patient-centered care must determine what is important to their patients; collaborate with patients using patient communication like shared decision-making; comfort and support patients through relationship building and empathy; and consider non-clinical, social determinants of health needs when prescribing treatments.”
Definitions from other industry publications and organizations offer additional insights:
- Citing the original Institute of Medicine framework, the Agency for Healthcare Research and Quality defines PCC as “care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions.”
- The New England Journal of Medicine (NEJM) states, “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.”
- Modern Healthcare describes it this way: “PCC initially described an approach to care that allows patients to guide their own clinical decisions. Now its definition has expanded—health systems see it as encompassing not just clinical care, but also patient experience, including how encounters stack up to patients’ expectations from other consumer-facing industries.”
Also of note is that although PCC can be pursued and achieved in all specialties and facilities, the term is often tied to primary care, as with the Patient Centered Medical Home (PCMH) model. In addition to placing the patient’s preferences at the core of care plans, PCMHs also coordinate aspects of that care that take place outside the primary care office, including testing/screening and visits to specialists.
What does patient-centered care mean for your medical practice?
Looking at the definitions of PCC, it’s clear that the concept continues to evolve and expand. What’s also clear is that many of the skills associated with PCC aren’t necessarily taught in medical school and that PCC involves more than just the direct care team. It requires participation by many others in the medical practice – from front desk staff to practice managers – and can even guide office policies (like communication protocols) and business decisions (like operating hours).
When implementing PCC, therefore, practices are likely to encounter regular, perhaps daily, opportunities to take into account patient preferences, cultural traditions and lifestyles to better engage patients with their own care. For example:
- The doctor-patient relationship – Heath uses what she calls a “seminal” Health Affairs blog post to describe how PCC potentially changes the doctor-patient relationship: “Clinicians practicing patient-centered care have to embrace a different set of guiding principles than those who practice the ‘paternalistic’ medicine of the past.” As noted by NEJM this challenges “traditional hierarchies in which providers or clinicians are the lone authority” and shifts “the traditional roles of patients and their families from one of passive ‘order takers’ to active ‘team members.'”
- Communication and conversation – American Family Physician journal lists several features of communication that support PCC, including “eliciting the patient’s agenda with open-ended questions; not interrupting the patient; and engaging in focused active listening.” It says, “Understanding the patient’s perspective of the illness and expressing empathy are key.”
- Patient education – A discussion paper published by the National Academies of Medicine notes the need for practices to boost patients’ health literacy, provide interpretation services and offer education “to increase patients’ knowledge of how to best access care and participate in treatment decisions.”
- Shared decision-making – American Family Physician journal says, “Shared decision making empowers patients by inviting them to consider the pros and cons of different treatment options, including no treatment.”
- Patient care logistics – PCC can be incorporated into many operational decisions, as well, including billing practices, office hours and patient portals, including access to personal health information and clinical notes.
Considerations to improve outcomes and reduce medical liability when implementing patient-centered care
Many universal risk management strategies – including communication, documentation and follow-up – become even more important when practicing PCC. Conversations, for example, must be thoroughly documented in the medical record, and healthcare office policies must be designed to promote patient safety and reduce liability exposure.
ECRI, which has published a list of recommendations specific to PCC, says, “By working synergistically, risk managers, quality improvement professionals, organizational leadership, clinicians and other frontline staff, and patients and families can advance the implementation of person-centered care in their organizations, across the continuum of care.” ECRI suggests a number of action items* for implementing PCC:
- Adopt a consensus definition of person-centered care.
- Identify and evaluate the organization’s policies, procedures, and processes that support and incorporate person-centeredness and designate an individual whose job function formally addresses person-centeredness.
- Engage quality improvement professionals to implement a process for developing person-centered care plans and staff training as appropriate.
- Encourage and train clinicians to engage in shared decision-making.
- Develop processes for integrating shared decision-making interactions into practice and require documentation of the shared decision-making encounter.
- Review best practices for establishing patient-family advisory councils, develop an implementation plan, and designate an executive-level staff member and liaison person to operationalize the patient-family advisory council.
- Involve facility and building management in assessing the environment of care for physical comfort, safety, and access.
*These are selections from a larger list of action items and are quoted directly from ECRI guidance on PCC.
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