Service Is Patient-Centered Care

their seminal report “Crossing the Quality Chasm,” the Institute of Medicine (now known as the National Academy of Medicine) listed patient-centered care as one of the six objectives to improve health care in the 21st century. Patient-centered care describes care that is compassionate, empathetic, and responsive to the needs, values, and expressed preferences of an individual patient.

Patient-centered care describes:

1. Care that includes patients and their families as part of the care team’s decision-making
2. Transparent information to support families to make informed decisions
3. Treatment tailored to an individual patient, informed by evidence-based guidelines
4. Importantly, patient-centered care means considering the patient’s needs beyond the medical team’s recognition of their disease or diagnosis

A patient-centered value equation

University of Utah Health’s mission, vision, leadership and improvement are aligned with patient-centered care, as evidenced by the value equation. Improving quality and cost are not enough to create value from the patient’s perspective–service, in the form of the patient voice, is required. University of Utah Health added service to the traditional equation (Q/$) to give the patient an equal voice in determining value. At the University of Utah Health, patient-centered care includes five elements–know me, listen to me, teach me, coordinate for me, and make it easy for me.

As pediatric critical care teams, we take care of kids in the pediatric intensive care unit (PICU) at Primary Children’s Hospital. For us, patient-centered care means having shared expectations with family members.

“For providers and organizations, service acknowledges what’s meaningful and valuable to patients: trust and respect.”

Whether it means patients’ “experience”, “satisfaction” or how “patient-centered” care is, service is flipping what constitutes high-value care to the patient’s perspective. Patient-centered care is how we treat patients and their families. It is the frank conversations with parents about what we don’t know. It is being honest about our errors. It’s sharing what we know about what’s important to them (length of stay, risk of complications, time until a parent can hold their child, etc.) so patients can understand what to expect.

Patient-centered care means having a common mental model of care between all of the members of the care team. For providers and for organizations, it is acknowledging what is meaningful and valuable to patients: trust and respect.

What patient-centeredness is (and is not )

Patient-centeredness is open communication and transparent expectations with families. It is meeting in the middle with patients when evidence argues both sides of a care decision.

It is not doing whatever the patient wants. It is not unnecessary, unsafe, or unethical treatment options. It is not ridiculing providers and care teams online because the TV in the waiting room isn’t working. While the TV, parking, customer service greeters, and bathrooms are important to a patient’s overall experience, these things are often out of the control of clinicians. Even if I can’t control these things as a physician, being patient-centered in my daily work comes with benefits. It’s gratifying to solve a problem together and to help someone in need.

Conclusion

Our opening case study is a tale of two very different experiences. Max spent only two days in the ICU, and the critical care team provided high quality care. The patient came to the ICU sick, got better, and left the ICU without complication–a successful case. But Max’s family looks back on the days in the ICU as the most stressful of their lives–their boy was as sick as he’d ever been. To deliver value for Max’s family–to create an experience of trust, responsiveness, and respect–requires embracing patient-centered care. By reaching beyond great quality and improved costs, providers and organizations will shift high-value care to view of the patient.