It is no secret that the American population is aging and that chronic disease and preventable conditions abound. At the same time, more holistic and personalized approaches to healthcare have captured the imagination of professionals, academics, and policymakers, as evidenced in part by health reform rhetoric on “medical homes” and “centers of excellence.” Moreover, there is ongoing pressure to bring healthcare delivery into line with models attuned to consumer satisfaction and emotional and moral meaning-making. While it might be intriguing to some, then, the salient question is not whether patient-centered care is on the map but what it means for everyday health administration and whether and how one can move an agenda that shifts primary attention from paperwork and profit to people. This paper attends to these questions, seeking to help health administration neophytes and seasoned professionals understand why patients should direct their work and appreciate a variety of ways to harness interest in their care and customer service. Several innovations are suggested, which might be of practical interest to busy executives striving to craft an organization in which care for consumers becomes and remains everyone’s concern. In the pages that follow, we unpack this brief definition of patient-centered care, argue that it signifies a shift outside of both the diagnostic and administrative spheres, clarify its affordability, and articulate a vision of the manager’s responsibility in a healthcare system characterized by patient-centered care.
Understanding Patient-Centered Care
Defining Patient-Centered Care
As a model of care, patient-centered care is oriented around ensuring that healthcare is based on patient preferences, values, and needs. It takes into account the individual socio-cultural, religious, and other factors that shape what care is meaningful and relevant to different people in their specific situations. Patient-centered care aims to provide healthcare that sees those who use and deliver it as whole people with individual personalities and histories. As a result, it affords all involved their dignity and rights to respectful care.
Respect for an individual is at the center. The care is coordinated in nature and applies a multi-sectoral approach. The patient is considered an expert in the care process. There may be a special focus on the social determinants of health status and its effects and the provision of comprehensive care. Care should be made easily and broadly accessible.
Health as an outcome has been stressed as a positive aspect of patient-centered care delivery, since it has the potential to decrease morbidity and improve lifespan. There is evidence indicating that an increase in patient satisfaction due to better patient-centered care delivery also has the potential to improve the care experience. Further studies are needed to explore these issues in order to better understand the intended and unintended consequences of patient-centered care delivery improvements on specific health outcomes. Lastly, applying patient-centered care will make the healthcare delivery system more responsive to its patients’ and their families’ needs and preferences. Soliciting patients’ perspectives on patient-centeredness can provide important information regarding this aspect of care delivery. More on this later in the paper.
Key Principles
At the heart of patient-centered care practice is a doctor-patient relationship built on a continuous flow of communication in which patients are deeply listened to and the information exchange between patients and health care providers is open, honest, and accurate. Respect for persons—respecting patients’ autonomy and encouraging shared decision-making; empathy—understanding patients’ needs and concerns, revealing close attention to patient experience and their affective feelings, and showing understanding of how these are related to their physical situations; consider the patient as a whole—taking account of patients’ physical, emotional, social, cultural, and spiritual well-being along with attention to the manifestations of disease. Applying such principles correctly involves considering context, social framework, and interactions, and it is dedicated to changing the culture and mindset at the local, business, system, society, and international levels. Delivering patient-centered care consists of putting these principles in place through an organizational culture that values service to the patient and takes a systems approach. At the core of shaping this culture is the leadership of health administrators, who assume such roles in strategic planning, shaping organizational culture, planning health care and education programs, providing facilities, doing research, providing regulatory framework and policy, financing services, and/or delivering direct patient care.
Benefits and Importance
Patient-centered care results in higher patient satisfaction and improved health outcomes. Satisfied patients are less likely to sue for malpractice than those who are dissatisfied with their care. Individual and environmental care supports can greatly benefit the experience and care of patients. Patients who feel that they are being spiritually and emotionally supported by their care team often view their overall experience more favorably than patients who do not. For many, an indicator of a positive experience is one where the patient feels cared for, not only medically but also emotionally and spiritually. Furthermore, higher levels of perceived care and caring have also been associated with specific improved health outcomes. Encouraging the provision of patient-centered care is a recent trend directed at reducing healthcare costs. As care becomes more patient-centered, the number of diagnostic tests and treatment procedures ordered should be reduced. Reducing these unwarranted tests and procedures will not only reduce costs for hospitals, providers, and insurance companies, but for some patients, it will also reduce their financial burden. Moreover, the fewer the medical complications, the shorter the length of stay in the hospital, which may also result in general cost savings.
Key to many patient-centered care models is the creation of a healing environment. Creating an environment that is welcoming and calming will not only have direct effects on a patient’s well-being and health, but it will also provide a setting for patients to relax and regain their bearings. In addition, many leading institutions are also redesigning or constructing their facilities based on patient-centered care practices that include the creation of spaces where both the patient and caregiver can comfortably interact, in the form of private patient rooms, family areas, and consultation spaces. This not only helps in the care process but also aids in developing a collaborative culture among healthcare team members. Patient-centered care demands patients take a more active role in both their care and in organizational decision-making. This need for patients and their families to be more informed and involved in their care directly intersects with taking charge of one’s own health. Encouraging patients to be involved and better understand their own care will likely increase their personal investment in controlling or taking control of their health-related concerns. This relationship between patient-centered care and self-management marks the first of strong ties between promoting individual action and socio-relational and organizational-structural changes.
The Role of Health Administrators
Health administrators and health service managers are responsible for the establishment and maintenance of vision and mission, policy formation and implementation, financing and resource allocation, development of efficient service models, compliance with regulatory standards, and continuous improvement, among other day-to-day tasks inherent to leading and managing healthcare organizations. As such, health administrators and health service managers hold a key role in promoting the implementation and sustainability of patient-centered care by being the main agents of change in healthcare organizations. In fact, health administrators must serve as advocates for practical patient-centric practices within their respective organizations in order to ensure that day-to-day procedures and care align with both standards and the unique needs of their local patients and families. Beyond the founding of mission and vision statements, administrators and managers also bear the responsibility of strategic planning, directing the design of efficient, effective, safe, and timely care models in accordance with both anticipated organizational goals and the unique needs of the communities where they operate. Building commitment, better communication, and improved patient engagement rely on the promotion of a culture of collaboration. Execution of tasks according to leaders’ directions is ensured by promoting staff commitment, encouraging open communication, and working to develop shared goals. Because culture trickles down from the top, the promotion of change building from the C-suite is important. Identifying and addressing enablers and obstacles is crucial for the formation and sustainability of a patient-centered care culture and subsequent improvements in patient experience, outcomes, and population health. In fact, health workers must first think of culture as a dynamic quality, one that is constantly evolving and transforming, as they and their patients’ needs shift. The combination of population growth, changing disease patterns, long-term shifts in aging, and an increased reliance on primary care and preventive services in recent years has contributed to a culture that continues to evolve and transform. In order to provide high-quality individualized care, administrators and mid-level managers must have the capacity to continually reassess and improve their service models, ensuring care delivery to their evolving patient populations.
Responsibilities and Functions
Designed as part of a patient-centered care framework: responsibilities and functions
At the center of the patient-centered care framework are the organizational leaders. The health administrators are mainly responsible for initiating and leading the strategic process of care improvement. They are also responsible for ensuring the administrative and financial health of the organization. One of the valuable functions of health administrators who have a patient-centered care philosophy is ongoing data management and evaluation for continuous performance and care quality improvements. This involves tracking patient satisfaction trends and understanding the role played in the short term with the organization’s initiatives and long-term care improvement. Patient feedback should be systematically and routinely integrated into the organization’s overall effectiveness and continuous improvement processes.
Today’s health services are fragmented across physicians, hospitals, and other health care services. It is the role of the health administrator to create partnerships and coalitions, including managed care, to ensure that the delivery of care is coordinated and of the highest quality. At the same time, they have a group of patients and other problems to address. They advocate for funding that is available to better meet their patients’ needs. Health administrators use data meticulously, evaluating that the care offered is the best in the community. Maintenance is in compliance with all health care regulations, both local and federal.
Challenges Faced
Patient-centered care is a popular framework for guiding the approach of health care organizations and providers. However, it is primarily from the perspective of patients themselves that co-production, shared decision-making, and care coordinator models have been evaluated and established to elicit patient satisfaction. Health administrators face myriad challenges in implementing these values into the systems of care that are responsible for these delivery models. As long as health care is delivered within multidisciplinary teams, communication across teams cannot always be a personal exchange but often relies on protocols and practice guidelines. Although primary care teams (and, increasingly, other care teams such as those for children with special health care needs) have long acknowledged the importance of incorporating the values and preferences of families into care planning, there are some patients who are content to accept the care plan as decided and are satisfied if desired outcomes are achieved under the plan.
In developed countries, providing the resources to offer new, innovative, and individualized health care options as part of the package deal has become increasingly difficult. The high rates of childhood chronic health conditions result in the care for one group of people who have distinctive clinical needs for genetic counseling, vaccinations, surgery, and subspecialty care, along with the general health and behavioral health services that all children need. This degree of complexity—where the care differs by condition and the position of the patient within a developmental, educational, and social and health disparities context—makes managing these children more labor-intensive and costly than one size fits all care. A similar resistance is evident from health care organizations in many pediatric networks. The most pushback and least enrollment in one pediatric pre-paid group practice came from clinics with young, fluctuating patient populations that required care with subspecialists, such as neonatal and neuro-tumor patients. Thus, gaining momentum for new ways of being and measuring patient and family-centered with multidisciplinary, orchestrated care will need to overcome these supply-side barriers in addition to addressing practice change in individual clinical settings. A standard, guideline-dominated response action to prioritize care flows and resources will likely not address this growing patient complexity and diversity. In addition, as the population served in a practice grows, the clinic profile and needs of the families served change, and teams must flex their practice profiles to align with their populations’ needs. The cohort of clients must each receive the clinic’s distinctive developmental disabilities and transition care offerings given the changing age distributions of this group over time. This requires regular modification and extension of the practice templates. Thus, for many of these multidisciplinary teams, the player and the team must change in unison. This poses a serious challenge when administratively trying to adapt a team template to patient-defined models of care. At any given time, is there going to be a best practice? How do you know if it is working on an ongoing basis? In a data-driven, evidence-seeking, comparative effectiveness world, what are the metrics to measure all that has been described: safety, communication sensitivity, care coordination, providing care that meets family or patient goals and values, providing cost-effective care? Some routine tools have been used in family-centered care, but a comprehensive meaningful utilization and outcomes tool has not been established and put into routine use. The Affordable Care Act offers a new incentive—support and penalty for hospitals, but not clinicians at this time, to measure patient goals and care effectiveness.
Innovations in Patient-Centered Care
Technology Solutions
Collaborative Care Models
In conclusion, health administrators can, and we argue, increasingly will play a central role in placing patient priorities into organizational systems. Indeed, the preponderance of evidence indicates that patients are already seeking care from organizations that are associated in the public mind with the delivery of patient-centered care. The alignment of patient desires and organizational services will, we believe, increasingly draw executives towards the application of collaborative care models and towards the development of technologies that further this end.
There are, of course, obstacles in the path to greater adoption of patient-centered care. Illustrations of these obstacles have appeared throughout this essay, and they are riddled with difficulty. It is not easy to find common purpose between the diverse and divergent interests of the many stakeholders in the modern health care system. Nevertheless, our view is that focusing on patient-centered outcomes is central. Moreover, decisions about which forms of service delivery to prioritize and therefore fund are, ultimately, moral decisions that cannot be defined solely by efficiency concepts of cost and utility. There is thus a necessary space for further research into different forms of service delivery and the examination of innovative ways to measure these. Ongoing dialogues that include patients, providers of care, and policymakers are needed to sustain momentum towards the configurational values of patient-centered care. As it stands, it would be an exceptional and potentially brave executive who admits that their organization is not patient-centered. It will be research on the ways to operationalize patient-centered values into health care delivery that will represent the next step.
