Abstract
Background The degree to which medical care is patient-centered is frequently cited as a key attribute of healthcare quality. However, the precise definitions, skills and behaviors that underlie patient-centered care remain somewhat elusive.
Methods We used a pragmatic literature review, focus groups with patients, and interviews with key delivery system and health plan leaders as well as primary care teams to guide development of an operational definition of patient-centered care. We then sought specific opportunites to partner with the health system leadership and disseminate this work, in order to mobilize our entire organization to find ways to become more patient-centered. As part of the focus groups and interviews, we gathered feedback about a proposed definition of patient-centered care that could be adopted organization wide.
Results The literature review identified key attributes of patient-centered care at the system level, clinical level and interpersonal level. Both focus groups and interviews showed concordance in their views of what patient-centered care was--how it was defined, and how it was manifested by our doctors and our entire organization. We have utilized both evidence from the scientific literature and input from our members and practitioners to identify specific strategies and intervention opportunities for our health system. The field of patient-centered care research is fertile, however a clear taxonomy is needed to describe how patient-centeredness relates to related constructs such as activation, empowerment, doctor-patient communication, trust, and shared decision-making. Promising interventions exist, but few have been replicated.
Conclusions Systems, and individuals within systems have opportunities to further develop and exemplify a patient-centered culture. Identifying specific attributes of delivery system design, communication, clincian training and optimal care transitions are among the areas that are ripe for improvement. Key issues that need to be addressed for successful cultural and system change and the highest priorities for research to support such change will be highlighted.
