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Author List:
Cramer IE (Center for Organization, Leadership and Management Research)
Holmes S (Center for Organization, Leadership and Management Research)
VanDeusen Lukas C (Center or Organization, Leadership and Management Research)
Restuccia J (Boston University School of Management)
Charns MP (Center for Organization, Leadership and Management Research)
Cohen AB (Boston University School of Management)
Shwartz M (Boston University School of Management)
Objectives:
The Institute of Medicine’s Crossing the Quality Chasm report identified patient centeredness as key to dramatically improving patient outcomes and achieving perfect health care. Integral to care for people with chronic illness, patient centeredness is of prime importance in VA. However, we do not know how providers define being patient centered; the term has been used universally without definition. The Robert Wood Johnson Foundation’s funded Evaluation of Pursuing Perfection examined how different organizations define, work towards and succeed at increasing patient centeredness.
Methods:
Data were obtained through five waves of semi-structured face-to-face interviews and one wave of telephone interviews (750 separate interviews, 780 employees, 12 healthcare systems). Employees included representatives from all levels within the organization from senior managers to front line staff who represented multiple professional, technical and support positions. The research team coded interview data into broad themes suggested by the data, literature and team discussions.
Results:
Organizations defined patient centeredness differently and operationalized it differently. Two overlapping dimensions of patient centeredness were identified: system redesign and patient involvement. Methods for implementing these varied. We identified a continuum of conceptual approaches to patient centeredness. At one end of the continuum an organization may specify that the provision of excellent care, as defined by clinicians, is inherently patient centered to the other end where organizations saw patients and families as active participants in quality improvement initiatives and as decision-makers in their own care. How senior leaders directed efforts or lent support to increasing patient centeredness also affected what changes were made and how.
Implications:
The variation among sites indicates a need for further development of models of patient centeredness that can be delineated and disseminated for adoption within all healthcare settings. Education for employees, patients and family members about what to ask for and how to implement a patient centered approach is also needed.
Impacts:
The process and outcomes of care for people with chronic illness are enhanced when a patient centered approach is used. Developing a model for use in VA requires understanding what it means to be patient centered and how to make it happen.
