The 8 Principles to Build Your Patient-Centered System
What is person-centered care?
Person-centered care has been a defining factor of healthcare’s shift to value based medicine. Recognizing medical needs cannot be separated from the context of a person’s life, including their life goals and social, economic, cultural, emotional, and spiritual background and beliefs. A core aspect of person-centered care is being sensitive to non-medical factors in the planning, partnership, and delivery of care.
There are 8 principles that make up a person-centered experience.
- Respect for values, preferences and needs: Facilitate a shared-decision-making environment where the patient dictates what they need from their care and the provider offers their expertise to work towards those goals and to guide them in their experience in doing so.
- Coordination and integration of care: Improve the reliability and consistency of care, alleviating uncertainty and ensure timely execution of a mutually-decided care plan.
- Patient education: Are patients aware of their options when it comes to their care? Was it explained to them in a way that they are able to make an informed decision? Educational materials should be created to their health literacy level.
- Physical comfort: Improve patient experience and comfort, including pain management and assistance with daily activity.
- Emotional support and alleviation of fear: Does your organization offer resources that alleviate fear and stress such as spiritual care?
- Involvement of family and friends: Treat family members and friends as well as you would treat the patient. This includes providing accommodations and support for them as well as involving them in care decisions.
- Continuity and transition: Coordinate care plans once a patient is discharged home or moved to another location. Make a warm hand off and follow up to ensure that all parties have what they need to be successful. Patients should be informed of and supported with medications, physical limitations, dietary changes, etc.
- Social care: Improve access to care and success of care by accounting for life circumstances including emotional, financial, social, and spiritual needs as well as social determinants of health.
As seen above there are a number of dimensions to providing person-centered which can be daunting. It is a fact that person-centered care cannot be manifested by simply saying you will be person-centered. There needs to be meaningful intent and conscious recognition that the patients we serve are people and not simply a diagnosis. Luckily, the path to person-centeredness can be taken in small steps and there are more healthcare organizations that do it well to model off of and tools available than ever before. While it’s a goal of many organizations worldwide, the journey is challenging for even the largest, most integrated, and financially secure organizations among changing policies, financial goals, and an ever-complex health care delivery system.
Here’s how they do it.
Number 1 - Care Planning:
Top organizations approach care planning as an interdisciplinary, multi-faceted operation to improve coordination of care, especially for those with complex needs. Moving away from the traditional, patriarchal dictation of care, person-centered care uses patient preferences, motivations and goals as central inputs for goals of care. Kaiser Permanente achieves this by creating a communication tool for providers, social workers, and case managers to summarize the results of shared decision making and outline how care providers will coordinate to meet a patient’s needs. This central document outlines ongoing treatment plans and serves as a guide for consideration of new treatments. For example - Will this new treatment align with patient preferences? Does it ensure coordination with other ongoing care?
Number 2 - Patient Communication:
Evidence shows that patients who are kept well-informed are much more likely to be compliant and adhere to treatment plans, are more satisfied with their care and even perceive their providers as more competent. Effective communication is vital for everyday life and that includes conversations about your care. Many top organizations emphasize understanding and delivering on ideal patient communication as one of the most impactful person-centered actions that anyone can take. In the fast paced world of healthcare, it can be time consuming and difficult but the benefits speak for themselves. Creating an hourly rounding schedule, communication and care boards in patient rooms, bedside shift reports and post-discharge phone calls are all great ways to keep patients informed and build rapport.
Number 3 - Patient Involvement
Patient involvement is another guaranteed way to build strong care team-patient relationships. One common barrier to patient involvement is that patients have varying levels of health literacy. Person-centered organizations should have a robust collection of education material in various mediums to engage patients and inform them about their care. Providers can then build conversations based on the patient’s understanding of the material and develop goals of care based on patient preferences and needs. goShadow’s work with a high volume orthopedic clinic has had amazing success with our patient education pathway which conveys key information to patients at various steps of the care process. By doing so patients were able to make informed choices about whether to have surgery or opt for an alternative treatment such as injections. As a result of this pathway and the periodic use of Patient Reported Outcome Measures (PROMs), this clinic has been able to achieve and sustain top decile patient satisfaction scores in the inpatient and outpatient setting.
Number 4 - Spiritual Care:
Finally, one often overlooked but integral part of delivery of person-centered care is spiritual care. When someone thinks of person-centered care, spiritual care may not be the first thing that comes to mind. However, when it comes to helping patients feel more in control of their fears and anxieties about diagnoses, treatments and care environment, spiritual care is a powerful intervention. One study found that 88% of hospitalized patients considered spiritual and religious beliefs important to them. Of those patients, 67% felt those beliefs were important for coping with illness. Other studies have reinforced the need for spiritual care services, 73-85% of advanced cancer patients detailed having at least 1 spiritual need - overcoming fear, finding hope, finding meaning, seeking closer connection, and seeking forgiveness. Spiritual care services were also demonstrated to help staff manage symptoms of burnout and building resilience. This is not only important for staff mental well-being but staff spiritual and emotional satisfaction are strongly correlated to patient satisfaction as well as family perception of care.
Putting the System Together
Crafting a person-centered care system is a complex endeavor that addresses factors that would impact care whether we acknowledge them or not such as social, financial and personal preferences. For the goal of a humanizing healthcare system, it is up to governing bodies, organizations, providers and patients to take charge of those factors and innovate. Asking how someone is doing and having a meaningful conversation are person-centered actions that most of us do almost unconsciously, even more so in healthcare. Most healthcare professionals enter this field because we want to help people. The journey to take person-centered care begins with taking conscious action in these aspects, closing the communication loop, and meaningfully engaging all stakeholders in the co-design and co-production of more ideal care pathways.
goShadow offers FREE resources that are used by person-centered organizations, such as communication tools and person-centered assessments. Access them on our website.
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August 31, 2022