“Patient-centered care” is a core principle in health care, and the concept continues to move from innovation to expectation and in some cases, even regulation. But what exactly does it mean to provide patient-centered care, and how does one achieve this, at either the individual or institutional level? This chapter explores the term patient-centered, and current thinking about how to strengthen the partnership between patients and providers in the delivery of care. Throughout, emphasis is given to those innovations most relevant to the hospitalized patient.
DEFINING PATIENT-CENTERED CARE
While the term patient centered now appears commonly in both medical literature and lay media, one may encounter a variety of definitions for this phrase. Perhaps the most “official” definition is the one proposed by the Institute of Medicine (IOM) in the landmark 2001 document Crossing the Quality Chasm. It describes patient-centered care 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 IOM goes on to describe patient-centered care as one of the six key “aims for improvement” for quality of care. As such it is presented as an intrinsic value, fundamental and irrefutable, as opposed to a system property with a known association with better outcomes. The concept has been advanced in the form of slogans such as “Nothing about me without me,” “Every patient is the only patient,” “You’re a person before you’re a patient,” and “Human First.” At its core, patient-centered care can be described as treating each patient with the respect and dignity that every human being inherently deserves.
Overlapping terms appear in the both the lay and medical literature, including patient partnering and family-centered care. In this chapter, the term “patient-centered” will be used to encompass the general concept of making care delivery more responsive to the needs and wishes of the individual patient and his or her family. Family can be defined broadly as all the individuals whom the patient wants involved in his or her care regardless of whether they are related biologically, legally, or otherwise. From this definition, it follows that if a patient has any family, patient-centered care must include them.
The construct presumes that care delivery under current models is not adequately patient-centered. The IOM “Chasm” report conceptualizes the health care delivery system as in evolution, from a clinician-centric, poorly coordinated and non–evidence-based model to a patient-centric, integrated system that consistently applies scientifically supported interventions. In “clinician-centric” models, the patient plays a passive role in decision making regarding choice, timing, and settings of care delivery; these are the exclusive domain of the providers, and those same providers decide what information reaches the patient. Stories abound in the lay and medical literature of patients feeling at the mercy of the medical system, unable to exert control over their own care. However, it is hard ...