Are we truly patient centered in the care we deliver?
Cynthia Startup, Director, Regional Clinical Services Planning/Strategic Development Emergency/Trauma
Are we truly patient centered in the care we deliver? NRC Picker gives me reason to question it.
According to Dr. Don Berwick, patient centered care has 3 maxims:
(1) “The needs of the patient come first.”(2) “Nothing about me without me.”(3) “Every patient is the only patient.”
I have been in healthcare since 1983 and I can honestly say that the notion of “patient centered care” seemed to be a no-brainer to me. Of course we provide care with the patient in mind and at the center of our decision-making. Don’t we?
However, as I reflect on my nursing career, it was the experiences where I felt like a patient advocate and when decision making about care was really in partnership with the patient or family, that gave me satisfaction in knowing I was delivering patient centered care. And… the care I provided didn’t always happen that way. Medical models, nursing models, organizational structure, policy, guidelines, and human resource supply and demand issues provided me with many dilemmas in deciding how I provided care.
Patient centered care is no longer a “no-brainer” to me. It comes with a price of giving up some control, of recognizing that even the best health care intentions are not always what are best for the patient. It is being part of decisions that we would not necessarily make for ourselves or loved ones given we were in the same situation. It comes with having to listen, really listen to the stories patients and families tell us about their lives because they are clues as to how they want to be treated and what care they need.
The majority of patient complaints or accolades never come from the patient or family as “the nurse didn’t connect the IV tubing to the pump correctly” or “that was a great technique the physician used for the colonoscopy”. Complaints or accolades come from how a patient or family felt they were listened to, or whether or not a professional relationship was established with their caregiver.
I have absolutely seen progress made in partnering with patients and families but in the interest of striking a conversation, I ask these questions for reflection:
- With the “Vision” of People First, do you provide patient centered care? Where can we insert the patient voice where it isn’t now?
- Stories often guide our behavior because they give meaning to what we do… What story or experience guides your behavior? How does that behavior impact how patients perceive the care they receive in partnership with you?
- Can we replace the word compliance with partnership? How many times have you read in a chart that a patient is non-compliant? What if a conversation with the patient occurred to figure out what value or story may be driving their behavior? The patient is in partnership or not with their care. (My opinion)
- How loud does the patient voice have to be before we listen? In my experience, sometimes they need to scream and then listening stops.
“The currency of leadership is attention”. Patients and families will help us lead if we provide the attention. We can impact the patient experience of health care in a very different way…in a way that matters to them.
Related links: Symposium website
Erica
I find in residential care there are some challenges to providing patient or resident centred care given limits on the budgets. For example, staffing levels rather than resident input sometimes determine care given. To keep all residents and staff safe, we cannot always meet the resident’s individual expectations with our current staffing levels, given the increasing complexity of residents’ care needs. I really like the idea of resident centrered care but we need the staffing to support it or in the end our claims about providing resident centred care are meaningless.
Cynthia Startup
Thanks Mary. I agree it is part of a culture that we, in health care, have actually built. It will take innovation and focused attention to change it. We are on a good path… I also believe that when we start to listen to what matters to patients we can actually realign the resources to build in that “flexability”.
My hope is that this article helps us all to take a small step toward changing the culture one conversation and story at a time.
Cynthia.
Mary Ackenhusen
Cynthia
I really liked your message about patient centered care in the VCH News. My husband was at a healthcare conference a few weeks ago, and the first impression when I asked him about it was ” Everyone talks about patient centered care, but nobody seems to practice it”. It’s hard for sure, because like you said so well, it means we have to give up a bit of control, and we have to take time to listen. Neither is a natural part of our culture.
It also means that as we “standardize” our processes to reduce variation and error, we need to make sure that we don’t lose the ability to flex to respond to individual circumstances.
Thanks for raising the topic!