Thirty years ago the idea of "patient-centered care" first came into sight as a return to the holistic roots of health care. The defining characteristics of partnering with patients and families, of welcoming, and even encouraging their involvement of personalizing care to preserve the patient's normal routines as much as possible was seen as a threat to health care where the providers were the experts.
With the introduction of HCAHPS (Hospital Consumer Assessment of Healthcare Provides and Systems), a patient experience of care survey stresses that more is involved in healthcare than clinical capabilities, pharmaceuticals and technology. HCAHPS evaluate the experiences of health care that mean the most to patients, including communication with nurses and physicians, cleanliness and noise levels, pain control, quality of discharge instructions and medication information. As a result of the HCAHPS patient-centered care has been reintroduced.
Patient-centered care is defined by the Institute of Medicine 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."
Patient-centered care is organized around the patient. It is a model in which providers' partner with patients and families to identify and satisfy the full range of patient needs and preferences. Patient-centered care does not replace excellent medicine; it both complements clinical excellence and contributes to it through an effective partnership and communication.
Patient-centered care revolves around six dimensions: 1) Respect for patients' values, preferences, and expressed needs. 2) Coordination and integration of care through collaboration and teamwork. 3) Accessibility and free flow of information, communication and education. 4) Physical comfort. 5) Sensitivity to non-medical and the spiritual dimensions of care: Emotional support. 6) Involvement of family and friends.
Respect for Patients' values, preferences, and expressed needs: Respect is evident in the sharing of desired information with patients and families, the partnering with patients and families regarding care priorities and planning, tailoring their level of involvement according to their preferences, not those of the care providers, and changing of the plan as health status changes.
Coordination and Integration of Care: As care becomes more complex due to multiple chronic illnesses, an increasing number of care providers, and shorter episodes of care, the need for creating smooth transitions across the continuum of care becomes more vital. The coordination and collaboration of care providers, the patient and families' provides a smooth transition of care.
Information, Communication and Education: Some individuals prefer comprehensive explanations, while other prefers none. Some people learn best visually, while others favor the personal experience. Adjusting the message and delivery according to the patients' preference is a cornerstone to patient-centered care. Patients want to be able to trust what they are being told, and to receive it in a manner that makes sense to them.
Physical Comfort: Ensuring that patients will be comfortable and free from pain is a basic expectation of patient-centered care.
Emotional Support: Patient-centered care deliveries emotional support to patients and families through nursing interventions, and spiritual support. Many times families are who know the patient the best and through their involvement in care uncertainty and anxiety can be reduced.
Involvement of Family and Friends: Patient-centered care requires that visiting hours, and engagement of family and friends in all aspects of the process as defined by the family, are structured to meet the patients' needs.
Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in health care delivery and design. Given that non-consumer stakeholders often don't know what matters most to patients regarding their ability to get and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation.
Editor's note:?Margie Hale is Chief Nursing Officer at Baraga County Memorial Hospital.