Henry* was in the hospital yet again. A now-seasoned diabetes patient, Henry still struggled to maintain healthy blood-glucose levels. As his healthcare providers tried to understand what was going on, their first thought was that Henry simply wasn’t complying with their instructions. But Sarah, a new nurse in the hospital’s emergency department, took a different approach. She asked Henry directly whether there was something keeping him from maintaining healthy blood-glucose levels.
There was. Henry explained that because of sight loss—a symptom he suffered because of his diabetes—he couldn’t read his glucometer. He simply couldn’t take care of his blood sugar levels.
Sara’s simple question is an example of practicing patient-centered healthcare. As Sara focused on Henry as a person—not just as a disease to be treated—she was able to get to the heart of the problem and solve it. She and a colleague went on to find a glucometer that read results out loud, allowing Henry to take control of his health.
What is patient-centered healthcare, really? Why should your practice become more patient centered? And how do you do it? By making changes that strengthen the patient-clinician relationship, promote communication about things that matter, and facilitate patients’ involvement in their own care, you’ll create a patient-centered practice with the happiest patients around.
What Is Patient-Centered Care?
We know what you must be thinking: Isn’t all medical care centered on patients? By definition, yes, it is. “But from time to time other considerations seem to get in the way,” writes Paul D. Cleary, Yale School of Public Health. “Hospital routines may be rigid, or doctors may want to do things in ways that make sense for their needs.” In other words, despite our best intentions, sometimes patients fall from priority number one.
When we give patient-centered care, our thoughts and actions are guided by the belief that our patients are “equal partners in planning, developing and monitoring care to make sure it meets their needs.” Sounds a little daunting, especially to healthcare professionals, who may feel that patients don’t necessarily know what’s in their own best interests.
So how do you reconcile your patients’ best interests with their preferences? We’ll talk a little more about that later, but for now, we’ll say that your practice’s guidelines and state laws will help you make decisions as you follow the principles of patient-centered care. Identified by the Picker Institute and Harvard Medical School, these eight principles will start you on the right track.
- Respect for patients’ values, preferences and expressed needs
Recognize that patients want to be involved in decision-making and want you to respect their cultural values and autonomy.
- Coordination and integration of care
Patients feel more comfortable when they know that all their caregivers are on the same page regarding their care.
- Information and education
Patients want to be informed about clinical status, progress, and prognosis; processes of care; and autonomy, self-care, and health promotion.
- Physical comfort
From pain management to the environment of the hospital to assistance with daily living, physical comfort has a huge impact on patient experience.
- Emotional support and alleviation of fear and anxiety
Emotional struggles can be just as damaging as physical ailments.
- Involvement of family and friends
Support family and friends and recognize their needs.
- Continuity and transition
Similar to principle number 2, this principle requires communication with the patient and with future caregivers.
- Access to care
Give clear instructions on when and how to get referrals and make it easy for patients to schedule appointments.
- Respect for patients’ values, preferences and expressed needs
Why Patient-Centered Care?
Patient-centered care improves the experience for not only the patient but the healthcare worker as well. For patients, patient-centered care improves the service quality, helps patients get care in a timely manner, and helps them be proactive in taking care of themselves.
For healthcare workers, this proactivity reduces pressure and emotional exhaustion—which can be such a relief to overwhelmed workers. A review of seven studies on the topic found that patient-centered care may even improve job satisfaction and increase professionals’ sense of accomplishment.
Challenges and Solutions with Patient-Centered Care
Delivering patient-centered care is hard, and it requires more than a few behavioral changes here and there; it requires a change in underlying attitude. In an effort to be more patient friendly, some hospitals have modeled their atmosphere after that of a hotel, with greeters, modern decor, and gadgets. Other hospitals have updated their scheduling and health record technologies. While elements like these may enhance patient enjoyment, and may even be necessary, “they should not be conflated with achieving patient-centered care.”
When you contemplate a change that you hope will make care more patient-centered, ask yourself these questions:
- Does the change strengthen the patient-clinician relationship?
- Does the change promote communication about things that matter?
- Does the change help patients know more about their health and facilitate their involvement in their own care?
If you can’t answer yes to each of these questions, then you might reconsider the proposed change.
One simple change that does work for all these questions is inviting patients to ask questions. This goes beyond asking the perfunctory, “Any questions?” at the end of an appointment, to which many patients will answer “No.” Even if they do have questions, they know their doctors are busy.
Instead, healthcare professionals should open up a dialog like this: “I want to make sure that I’ve helped you understand everything you need to understand about your illness. Patients usually have questions because it can be complicated. Could you tell me what you understand, and then I can help clarify?” Not only will this approach help patients feel cared for, but it will give them actual information that could improve their self-care.
There are still important questions regarding patient-centered care that need further research: For example, “How can we know whether interventions intended to improve patient-centered care have achieved their goals?” and “How can we meaningfully reward practitioners and health systems that achieve patient-centered care?”
Despite all the research that still needs to be done, you can begin creating a patient-centered practice by strengthening the patient-clinician relationship, promoting communication about things that matter, and facilitating patients’ involvement in their own care. As you work together with your colleagues, you’ll give the best care you’ve ever given, and your patients will be happier than ever.
*Names have been changed.