Patient centeredness is increasingly referenced as a core value in the provision of care and the concept of patient-centered care is moving from innovation to expectation and in some cases, even regulation. But what exactly does it mean to be providing 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.
While the term patient centeredness 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, which describes patient centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”1 The IOM goes on to describe patient centeredness 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” or “Every patient is the only patient.” Overlapping terms appear in both lay literature 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.
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 nonevidence-based model to a patient-centric, integrated system that consistently applies scientifically supported interventions. In early stage clinician-centric models, the patient plays a passive role as decisions regarding choice, timing, and settings of care delivery are the exclusive domain of the providers, and those same providers decide what information reaches the patient. Stories abound in 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 to find a quantitative assessment of the current state of patient centeredness (or lack thereof) in the U.S. health care system. Some insights can be gleaned from national results of the CAHPS inpatient survey distributed by the Centers for Medicare and Medicaid Services (CMS), in which more than a quarter of patients report “never” receiving communication about new medications and their side effects, and more than 15% give the lowest possible score to questions about the responsiveness of hospital staff (composite scores, 2007 data).