Patient-centred care: improving quality and safety by focusing care

Public health Well-being Medicine Australia

Patient-centred care is health care that is respectful of, and responsive to, the preferences, needs and values of patients and consumers. The widely accepted dimensions of patient-centred care are respect, emotional support, physical comfort, information and communication, continuity and transition, care coordination, involvement of family and carers, and access to care. Surveys measuring patients’ experience of health care are typically based on these domains.

Research demonstrates that patient-centred care improves patient care experience and creates public value for services. When healthcare administrators, providers, patients and families work in partnership, the quality and safety of health care rise, costs decrease, and provider satisfaction increases and patient care experience improves. Patient-centred care can also positively affect business metrics such as finances, quality, safety, satisfaction and market share.

Patient-centred care is recognised as a dimension of high-quality health care in its own right and is identified in the seminal Institute of Medicine report, Crossing the Quality Chasm, as one of the six quality aims for improving care. In recent years, strategies used in the US and UK to improve overall healthcare quality, such as public reporting and financial incentives, have emerged as policy-level drivers for improving patient-centred care.

In Australia, a patient-centred approach is supported by the Australian Charter of Healthcare Rights, the National Safety and Quality Framework, other national service standards, reports of state-based inquiries, and a range of jurisdictional and private sector initiatives.

Recent national health reform arrangements (such as the Performance and Accountability Framework of the 2010 National Health and Hospitals Network Agreement) provide further incentives to improve patient-centred care by linking it to performance and funding. Another driver for improving patient-centred care is the establishment of a National Performance Authority to report transparently on a range of performance indicators, including ‘patient satisfaction’ for every Local Hospital Network, public hospital, private hospital and primary healthcare organisation.

Against this background, Australian healthcare organisations are becoming increasingly interested in patient-centred care. Most organisations can readily put patient charters and informed consent policies in place, but many find it hard to actively change the way care is delivered, and struggle to involve patients and learn from their experience. Key strategies from leading patient-centred care organisations include demonstrating committed senior leadership; regular monitoring and reporting of patient feedback data; engaging patients, families and carers as partners; resourcing improvements in care delivery and environment; building staff capacity and a supportive work environment; establishing performance accountability; and supporting a learning organisation culture.

Internationally, healthcare services use a range of strategies to promote patient-centred care, including staff development, leadership, collecting and reporting patient feedback, redesigning and co-designing service delivery, implementing patient rights charters, and engaging patients and carers as partners in improving care. A range of international organisations provide frameworks and tools to help organisations implement these strategies, such as the US-based Institute for Patient- and Family-Centered Care, and Planetree.

Based on these strategies and frameworks (and taking into account Australia’s healthcare system, with its mix of public and private sectors), practical policy and service-level recommendations to foster patient-centred care are outlined in this discussion paper.

Authors: Dr Karen Luxford, Dr Donella Piper, Dr Nicola Dunbar and Ms Naomi Poole

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