What Does Patient-Centered Care Truly Mean?

Defining patient-centered care

Defining patient-centered care may seem like an obvious effort: it is healthcare delivery that foremost considers the patient.

But it’s that very pursuit of considering the patient first that presents a challenge. After centuries of more paternalistic medicine that puts the power in the provider’s hands, patient-centered care asks clinicians to place patients at the nexus of care decisions.

“In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements,” according to a 2017 NEJM Catalyst article. “Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.”

Clinicians practicing patient-centered care have to embrace a different set of guiding principles than those who practice more the paternalistic medicine of the past, James Rickert, MD, an orthopedic surgery specialist wrote in a seminal 2012 Health Affairs blog post.

“Physicians practicing patient-centered care improve their patients' clinical outcomes and satisfaction rates by improving the quality of the doctor-patient relationship, while at the same time decreasing the utilization of diagnostic testing, prescriptions, hospitalizations, and referrals,” Rickert wrote. “Patient-centered practitioners focus on improving different aspects of the patient-physician interaction by employing measurable skills and behaviors. This type of care can be employed by physicians in any specialty, and it is effective across disease types.”

Clinicians practicing patient-centered care must:

• Determine what is important to their patients
• Collaborate with patients using patient communication like shared decision-making
• Comfort and support patients through relationship building and empathy
• Consider non-clinical, social determinants of health needs when prescribing treatments

But it is not only clinicians who can practice patient-centered care; patient-centricity can also be baked into the administrative process in a medical practice. Patient-centered care can include more convenient scheduling options, like non-tradition or weekend office hours and online appointment scheduling.

Patient-centered billing, which both clearly explains what a patient owes and provides an easy way to make payments, is also central to this effort.

Making the shift to patient-centered care is not easy, as it requires medical practices to rethink their relationships to patients and patients’ relationships to themselves as healthcare consumers.

But in considering the challenges to patient-centered care, organizations and clinicians can also consider the opportunities for promoting more patient-centered care in practice.

Challenges to patient-centered care

As noted above, patient-centricity is difficult to achieve, in large part because it runs counter to the decades of conventional wisdom promoting a more paternalistic patient-provider relationship. Power hierarchies that place clinicians at the top and patients lower can get in the way of truly patient-centered care that considers patient goals and needs.

Providers can work with patients to overcome power hierarchies by making a concerted effort to elicit patient input. This is best done during shared decision-making, when a clinician can inform patients about various treatment options, their expected outcomes, and then ask that patient her input about the ultimate care decision.

Appointment agenda-setting and wellness goal setting also present opportunities for collecting patient input and overcoming power hierarchies, experts say. These strategies also inherently promote patient-centered care, as they give clinicians the knowledge they need to craft a care plan that meets patient goals and needs.

But patient-centered care includes more than partnering with the patient; healthcare organizations can bake patient-centricity into administrative tasks to ensure a positive patient experience.

After all, it’s often that administrative burden that hampers patient satisfaction. Patient satisfaction pain points often include billing procedures, healthcare affordability, patient access, and hospital or clinic wayfinding and even parking.

Opportunities, best practices for patient-centered care

But with that understanding of the biggest patient-centered care hurdles comes ample opportunity. Healthcare organizations can design a set of strategies to support better patient partnership and to improve the overall healthcare experience.

According to a resource from the Commonwealth Fund, organizations can drive patient-centered care by emphasizing seven key attributes:

• Leadership and C-suite engagement
• Communication of clear strategic mission
• Patient and family advisory and involvement when launching initiatives
• Supportive work environment for clinicians and caregivers
• Systemic measurement and feedback loops
• High quality hospital environments
• Health IT that supports strategic patient-centered missions

Leaning on those principles can help lead organizations to the solutions that will best deliver patient-centered care.

In some cases, that shift to patient-centricity will require administrative or organizational change. Hospitals and clinics might enable new appointment scheduling systems, offer online bill payments, make it easier to message medical providers, support clearer hospital wayfinding, and streamline or even automate the call center to provide more consumer-centric care.

Providers looking to deliver patient-centered care during their interpersonal patient interactions should lean on a number of patient communication strategies. Things like shared decision-making, patient education that accounts for limited patient health literacy, screening and consideration for social determinants of health, and empathic communication will be integral to this mission.

According to the American Academy of Family Physicians (AAFP), key phrases and best practices for patient-centered communication include:

• “Which of these is the most concerning to you?”
• “Because we have limited time, which of these problems would you like to discuss today?”
• “That makes sense.”
• “Could you summarize what we have discussed so far?”
• “Tell me more about what was worrying you.”
• “What difficulties are you facing because of your illness?”
• “I can understand how that might upset you.”
• “It must be a lot of stress to deal with…”

Many of these best practice get at the heart of both the moral and the business cases for patient-centered care. For the former, that includes the empathic communication strategies that center patient needs and input. And for the latter, that includes the operational changes that make it easier, more welcoming, and more pleasant for patients to engage with their healthcare provider offices.

But in addition to those goals, healthcare organizations must contend with another key professional shift: the move to value-based care and how patient-centricity can drive that.

Patient-centered care and value-based care

Value-based care is the principle that healthcare organizations will be paid for the value of services rendered rather than the volume. In order to determine that value, healthcare organizations must attest to a number of clinical quality measures, not least of which include those related to patient experience.

And in order to perform well in patient experience clinical quality measures, healthcare organizations need to consider patient-centricity.

Patient-centered care in alternative payment models

The reasons patient-centered care is important in alternative payment models are twofold. Foremost, patient-centered care and especially shared decision-making can in some cases reduce the use of redundant testing or high-acuity care. Secondly, patient-centered care can generate a better patient experience, improving clinical quality measures and yielding success in an APM, according to the National Academies of Medicine.

Particularly, success with these programs hinges on patient health literacy and cultural competency.

The CMS Meaningful Measures Initiative and Quality Payment Program both present opportunities for organizations to adopt patient-centricity to achieve good results. A number of national quality accreditation programs, like those out of the National Quality Forum (NQF), the Institute of Healthcare Improvement (IHI), and the Patient-Centered Outcomes Research Institute all call for patient-centered care principles.

Patient-centered care in health IT programs

Patient-centered care in health IT programs largely refers to patient right of access to their health data. The federal government has pushed that principle for close to a decade, starting first with the Medicare and Medicaid EHR Incentive Programs (meaningful use), which required participants to offering at least on unique patient access to health data. This marked the insurgence of the patient portal.

Since then, programs like Promoting Interoperability, MIPS, and most recently the ONC information blocking rule have further pushed patient data access. Particularly, the ONC information blocking rule called on hospitals and clinicians to grant all patients digital access to their health data, including clinical notes.

That in itself is important for patient-centered care. Patients have a right to see their medical information, and that access also enables a level of patient education that helps the patient participate in her own care.

With open clinical notes came another patient experience initiative: making sure patients aren’t upset by what they see. Healthcare professionals should always write accurate clinical notes and never alter the content to appease a patient; however, there is some language clinicians can avoid while still writing an accurate clinical note.

Patient satisfaction with clinical notes can dip when clinicians use words like “incorrect,” “obese,” “wrong,” “anxious,” “depressed,” “inaccurate,” or “elderly,” according to research published in the Journal of General Internal Medicine.

Leonor Fernandez, MD, a physician with Beth Israel Deaconess Medical Center in Boston, an assistant professor of medicine at Harvard Medical School, and an author of the JGIM study said she uses the Golden Rule when writing her clinical notes, considering what she would want to her and what she would feel comfortable saying to a patient’s face.

“I try and mirror the concept of what would it feel like if I was reading this out loud to the patient,” Fernandez explained. “If I might wince and really substantially change the terms, because otherwise I feel they might be offended, then I shouldn't write that. We do this all the time when we talk to a patient in the room. We hopefully pick our words so that they're a little more meaningful, so that they're a little more affirming of the patient's strengths and what they're trying to do, or their fears.”

As healthcare continues to adjust to these reporting requirements while also shifting toward consumerism in healthcare, it will be essential to embrace patient-centered care. In doing so, the industry can move the needle on patient experience and personalized therapies and outcomes.