It’s long been an axiom in the business world that “the customer comes first.” In other words, what employees and managers want and do, and how the corporate structure is organized, cannot become the driving force in creating business value. It is, in fact, the other way around. Employees, managers, and corporate structure exist only to efficiently give the customer what they want and need (more precisely, perhaps, what they’re willing to pay for).
Healthcare, while answering to a very high standard of ethics and morality, is much the same. The patient, as customer (with patient health outcomes as the pinnacle of value provided by healthcare), must come first.
That, in essence, is “patient-centered care.” It’s a significant part of the evidence-based practice (EBP) process, which strives to make use of science and resources in pursuit of the best possible measurable patient outcomes.
What is the Definition of Patient-Centered Care?
The Institute of Medicine or IOM (renamed the National Academy of Medicine in 2015) defines patient-centered as: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”
At first glance, it’s tempting to argue that patients do not know what is in their best interest, and that only trained professional healthcare providers know the correct options for treatment and practices of care. If we allowed patients to dictate everything doctors and nurses do, their health would be compromised and the business of healthcare would fail.
But patient-centered care does not mean patients tell doctors and nurses how to treat them medically. The Annals of Family Medicine notes, “A doctor who acquiesces to a patient’s request for unnecessary antibiotics may have a happy patient, yet inappropriate prescribing could hardly be called patient-centered care.”
Rather, the art and practice of patient-centered medicine treat patients (including their family and friends) with the utmost respect for their belief systems, preferences, and ability to be fully informed, while evaluating and treating them based on the best applicable science for their particular symptoms and illness.
The Annals of Family Medicine says, “Patient-centered care is a quality of personal, professional, and organizational relationships” that are not “superficial and unconvincing.”
When a hospital or clinic renovates their public space with greeters and greenery, with soothing colors, lighting and music, those things are not patient-centered care, even if they temporarily make patients and their visitors feel less intimidated and more comforted.
True patient-centered care invites genuine conversations between patients and their caregivers at every opportunity. “The proximal outcomes — the patient feeling known, respected, involved, engaged, and knowledgeable — are desirable in and of themselves and may mitigate a patient’s distress associated with illness and uncertainty,” according to the Annals of Family Medicine.
The State of Patient-Centered Care
Nearly 20 years ago, the Institute of Medicine produced a scathing report on the state of healthcare, reporting that it “harms patients too frequently and routinely fails to deliver its potential benefits.”
The report began a renaissance that continues today, exhibited by the widespread (but nowhere near universal) adoption of EBP, with its required shift toward patient-centered, measurable outcomes.
It’s not easy turning a ship as massive as national healthcare, and the ship in the U.S. is still turning. Too often, bureaucracies prevail, with protocols that require too much testing despite diminishing returns (often for legal reasons), and care providers who are rushed to see too many patients in the name of improving short-term financial bottom lines. Many times, there are overlapping systems of insurance and treatment protocols so contorted that few who go through them emerge feeling respected and valued, much less healed.
Modern healthcare in the U.S. is excellent at treating trauma and routine short-term illness. But, as reported by the World Health Organization, “The burden of chronic diseases is rapidly increasing worldwide.” The IOM also reports that “more than 40 percent of people with chronic conditions have more than one such condition,” which exacerbates the need to coordinate care across teams, organizations and insurance entities.
This growing need to treat complicated and intertwined chronic conditions means practitioners at all levels — nurses in particular — must continually be educated to ever-higher levels, especially regarding patient and team communications and protocols.
Nurses strongly influence patients’ perception of their quality of care because they interact with patients more than any other healthcare practitioners (in most cases). Consequently, nurses take a front-line role in helping patients understand treatment options and how they can best assist in recovery.
From a practical perspective, The Online Journal of Issues in Nursing reports that “patient ratings of nursing care have the most direct impact on [patient] ratings of overall quality of care and services.” These ratings are the measurable evidence that drives institutions to make changes to improve patient care.
Nurses and managers of nursing staff who are most able to motivate others to embrace the philosophy and protocols of patient-centered care will be very valuable to healthcare employers now and well into the future.
Learn more about La Salle’s online RN to BSN program.