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Time To Learn. Understanding Patient Centered Care
Time To Learn. Understanding Patient Centered Care
patient-centred care
Rinchen Pelzang
Abstract
This article is a literature review of the definition, models and
methods of implementation of patient-centred care (PCC). Modern
healthcare systems are rapidly changing to adopt a more patientcentred approach to care. However, the implementation of PCC
can be hampered by the lack of a clear definition and methods of
measurement. It is increasingly important for healthcare providers
to understand the core elements of PCC. This article examines the
literature to carry out a concept analysis of PCC, including definition,
concepts and theoretical perspectives.
Key Words: Patient-centred care
n Healthcare models
Holistic care
Nurse education
What is PCC?
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professional
Structure
Healthcare professional attributes
Professional competence
Interpersonal skills
Commitment
Personal characteristics
Organizational aspects
Time
The health workers role
Effective staff relationship
Skill mix
Supportive organization system
Power sharing
Potential for innovation and risk-taking
Shared decision-making
Patient attributes
Perception of care
Participation in care
Perspective on illness
Cooperation
Culture
Process
Outcome
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Gordon, 2006)
requirement for structural changes at organizational
and practice level, which can be difficult (Robinson, 1991;
Brown et al, 2006)
the need for more time and human resources to care for
patients (Buerhaus et al, 2005).
the
1) Leadership
The single most important factor contributing to PCC,
whether in the hospital or ambulatory care setting, is the
commitment and engagement of senior leadership at the
level of Chief Executive Officer (CEO) and Board of
Directors (Shaller, 2007). It means that the CEO and Board
of Directors must be sufficiently committed and engaged to
unify and sustain the organization in a common mission. The
organizational transformation required to actually achieve
the sustained delivery of PCC will not happen without the
support and participation of top leadership.
professional
visions and outcomes throughout the organization is critical
to success (Flarey, 1995).
Organizational self-care
Masters of change
Development
Retention/recruitment
Image
Planning
Research
Adaptation
Patient-centred environment
Values
Empowerment
Advocacy
Partners in care
Collaboration
Coordination
Communication
fosters
a connection to nature.
7) Supportive technology
Supportive technology, such as health information
technology (HIT) encourages patients and families directly
in the process of care by facilitating information access and
communication with their caregivers (Shaller, 2007). HIT
facilitates communication between patients and caregivers by
providing access to needed information and decision support
tools. HIT can range from simple email communication
between patients and caregivers, to more sophisticated
patient web portals that enable patients to interact with their
caregivers electronic medical records. Shaller (2007) suggests
that HIT applications in patient care have demonstrated an
enhancement of nursepatient partnerships in care.
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Shortage of staff
Overwork and staff shortages are the main barriers to PCC
observed in the practical setting (Pelzang et al, 2010). Dunn
(2003) points out that lack of time, motivation and wisdom
act as barriers to PCC. Owing to time and staff constraints,
health professionals often do not sit with their patients,
and when they do, often listen hurriedly to their concerns
(Buerhaus et al, 2005). A shortage of health staff leads to rituals
and routines of practice which impede the development of
PCC in hospitals (Kelly, 2007). Even in healthcare practices
where PCC is valued, the demands of caring for many
patients at a time can undermine professionals ability to
provide physical and emotional support, and respect for their
patients preferences (Institute of Medicine (US) Committee
on Quality of Health Care in America, 2001).
Cost-effectiveness of PCC
Economic constraints on health care is a recent driver of
PCC, and one aim of implementing PCC is to provide better
clinical outcomes and lower the cost per case (Stone, 2008).
The evidence on the cost-effectiveness of PCC is not
substantial and conclusive, however, it does indicate that
PCC provides better clinical outcomes and health cost
management (Bezold, 2005; Stone, 2008). Recent studies of
the cost effectiveness of a PCC integrated care pathway by
Olsson et al (2009) and Reid et al (2009) showed improved
patient outcomes and cost-effectiveness, with a 40% reduction
in the total cost of treatment. However, the harsh reality of
budgetary pressures in terms of educating and recruiting large
number of health professionals is reported to be a major issue
in implementing PCC in healthcare systems (Coulter, 2002b).
professional
Conclusion
PCC is understood to be a healthcare system which considers
patients as a whole person with biological, psychological and
social needs. Respect, compassion, concern, shared decisionmaking and communication are seen as basic elements for
PCC. PCC is said to improve the quality of patient care,
reduce the cost of care, and increase satisfaction among nurses,
physicians and patients by strengthening professional practice
and maintaining the values of the patient and healthcare
providers.
It is evident that effective PCC requires health professionals
to have good knowledge of clinical practice, as well as skills in
data gathering, clinical reporting/documentation, procedures,
communication, and relationship development with patients
their families, and other professionals. However, inadequate
emphasis on PCC in education, a lack of coordination and
collaboration among health professionals, a shortage of staff,
and the dominance of a biomedical model of health care act
as barriers to the delivery of PCC. This implies that the
implementation of PCC requires a planned and coordinated
approach, with sufficient staff, efficient teamwork, and adequate
BJN
education of healthcare providers.
Conflict of interest: None
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Key points
n Patient-centred care (PCC) places the patient at the centre of healthcare system
n PCC considers patient as a whole person with physical, psychological and social needs
n Provision of a supportive environment that promotes recovery is recognized as a critical role of the healthcare profession,
and health professionals need to have the skills to provide supportive, holistic care
n Implementation of PCC requires adequate and appropriate education on PCC, with a planned and coordinated approach
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