D. Shaller, Patient-Centered Care: What Does It Take?, The Commonwealth Fund, October 2007
The concept of patient-centered care has gained increasing prominence in recent years as a key aim of the U.S. health care system. Yet despite growing recognition of the importance of patient-centered care, as well as evidence of its effectiveness in contributing to other system goals such as efficiency and effectiveness, the nation's health care system falls short of achieving it. Data from national and international studies indicate that patients often rate hospitals and medical care providers highly, but report significant problems in gaining access to critical information, understanding treatment options, getting explanations regarding medications, and receiving responsive, compassionate service from their caregivers.
This paper was commissioned by The Picker Institute to explore what it will take to achieve more rapid and widespread implementation of patient-centered care in both inpatient and ambulatory health care settings. The findings and recommendations of this paper are based largely on a series of interviews with opinion leaders selected for their experience and expertise in either designing or implementing strategies for achieving excellence in patient-centered care.
A high degree of consensus exists regarding the key attributes of patient-centered care. In a systematic review of nine models and frameworks for defining patient-centered care, the following six core elements were identified most frequently:
The interviews and literature reviewed for this project identified seven key factors that contribute to achieving patient-centered care at the organizational level:
These factors can be found at work in a small but growing number of hospitals and medical groups across the country. Among the examples identified through the project interviews, a few were mentioned repeatedly as outstanding illustrations of organizations that have focused on these factors to achieve measurable excellence in performance. Two specific cases highlighted in this paper are the MCG Health System in Augusta, Georgia, and Bronson Methodist Hospital in Kalamazoo, Michigan. These two organizations demonstrate how most or all of the factors identified can be addressed in an integrated, comprehensive way to achieve high levels of patient-centered care, as measured through independently collected patient survey data as well as through other important health care outcomes and organization objectives.
Key strategies identified as necessary to overcome barriers and to help leverage widespread implementation of patient-centered care can be divided into the following two groups.
The findings from this project indicate that, while there are many promising examples of organizations achieving excellence in patient-centered care, these innovators are not yet the norm. The challenge lies in elevating the norm through strategies at both the organization and system level that leverage the experience of these innovators to motivate large-scale implementation of patient-centered care.