Monday, July 20, 2009

Patient Centredness

A new essay by Don Berwick on the role of patient centredness as a dimension of quality in healthcare was published yesterday in the journal Health Affairs.

Abstract:“Patient-centeredness” is a dimension of health care quality in its own right, not just because of its connection with other desired aims, like safety and effectiveness. Its proper incorporation into new health care designs will involve some radical, unfamiliar, and disruptive shifts in control and power, out of the hands of those who give care and into the hands of those who receive it. Such a consumerist view of the quality of care, itself, has important differences from the more classical, professionally dominated definitions of “quality.”

Key issues discussed:
In Berwick's essay he argues that imposing a clinician view of what is best for a patient is a form of violence against patients. His proposed definition of “patient-centered care” is this: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.

He goes on to propose that these principles should be applied to include the experience of family and loved ones of their choosing, becoming “patient- and family-centered care.” In this view, a patient- and family-centred health care system would be radically and uncomfortably different from the health systems we experience today.


Characteristics might include:

  • Hospitals would have no restrictions on visitingPatients would determine what they eat and wear in hospital
  • Patients and family members would participate in clinical rounds
  • Patients and families would participate in the design of health care processes and services
  • Medical records would belong to patients
  • Shared decision-making technologies would be used universally
  • Appointment schedules would conform to queuing theory designs rather than clinician convenience
  • Patients physically capable of self-care would have the option to do it

Read the article online

Donald M. Berwick, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist A seasoned clinician and expert fears the loss of his humanity if he should become a patient. Health Affairs, July/August 2009; 28(4): w555-w565.

Russell McGowan

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