Patient-Centered Care: A Step in Transforming the U.S. Health Care System

by Beverley H. Johnson, president and CEO, 
Institute for Family-Centered Care, Bethesda, Maryland


There is clear recognition, coming from all members of our society, that profound, transformational change is needed in the U.S. health care system. Patients and families are dissatisfied; those who work in the system—across all disciplines, but especially physicians in primary care—are dissatisfied. The purchasers of health care are also dissatisfied, and they believe they are not getting quality or value.

Efforts to bring about transformational change are being undertaken at many levels. They include the promising individual programs described in this book as well as national initiatives. Among the latter, no single effort has perhaps had greater impact than that of the Institute of Medicine (IOM). In 1996, the IOM launched a concerted effort focused on assessing and improving the nation’s quality of care. A key element of this effort was the 2001 publication of Crossing the Quality Chasm: A New Health System for the 21st Century. The Quality Chasm report described broad quality issues and proposed six aims: Care should be safe, effective, patient centered, timely, efficient, and equitable.¹

The six aims set forth in the Quality Chasm report soon became a benchmark against which to measure the quality of health care. When studies of the use of these benchmarks have been done, the U.S. system is often found wanting. For example, a recent study from the Commonwealth Fund, which assessed the U.S. health system against that of five other developed nations (New Zealand, Australia, United Kingdom, Germany, and Canada) on the IOM’s six aims, reported that the U.S. system ranked highest in cost; next to last in quality; and last in access, patient safety, efficiency, and equity.²

Viewed in this context, Putting the “Care” in Health Care: Improving the Patient Experience, is both timely and important. It is grounded in the IOM’s premise that the patient experience must be the driver for quality improvement and for the redesign of the health care system. This book offers a broad definition of care, embracing concepts of respect, connection, communication, collaboration, engagement, and empowerment. It stresses that it is not enough for individual clinicians to practice in ways consistent with these concepts—the system itself must encourage, facilitate, and reward this type of practice. The incentives must be aligned correctly—both payment incentives and institutional priorities. As one physician interviewed for this book observes, “It is hard to focus on compassion if your institution focuses on the bottom line.” There is growing awareness that partnering with patients and families to redesign care experiences and improve communication and collaboration leads not only to increased satisfaction among patients and providers but also to improved financial performance.³

Through abundant use of case examples related by physicians, as well as through exploring perspectives of other health professionals, patients, and family members, Putting the “Care” in Health Care: Improving the Patient Experience captures stakeholders’ disappointment with the current health care system as well as their hopes for the future. It describes several innovations that have promise for positive change and returning caring to health care.

One of these promising changes is family-centered rounds, pioneered at Cincinnati Children’s Hospital Medical Center (CCHMC), where the planning and teaching of clinical care is an interdisciplinary process and where patients and families are supported in being full participants in the process. Conducting rounds with patients and families, rather than talking about them in the hospital corridor, enhances satisfactory relationships and improves quality, safety, and efficiency.^4–7 Family-centered rounds change the way residents learn and will shape their future practice. Faculty at CCHMC have found that this collaborative way of conducting rounds is a much better way to teach. To develop a caring, compassionate workforce, the educational programs in all the health professions must explicitly teach and model communication and collaboration skills, not just the science of health care.

Putting the “Care” in Health Care: Improving the Patient Experience also includes a description of the potential for the medical home, a framework for the redesign of primary care. The medical home supports a partnership among patients, families, their physicians, and other members of an interdisciplinary team for the delivery of primary care and the coordination of care across settings with others in the community and over time. Patients and families partner with physicians and care coordinators in community-based practices in quality improvement and redesign. With this collaboration, the future experience of primary care should be satisfying and rewarding for patients, families, and practitioners.

A third innovative organization profiled in this book is the CORE Center, which serves a large population of women, children, and adolescents in Cook County, Illinois, who are living with HIV/AIDS. From the beginning, patients and families, many of whom are living in poverty or other challenging situations, were involved in planning the design of the CORE Center and the processes of care. Center staff and physicians engage patients in their own care planning and support their involvement as peer educators and in peer support. Facilitating patients’ discovery of their own capacity to manage chronic conditions and to be partners in system redesign has not historically been a part of physician training and education in many health care settings.

In recent years, Joint Commission Resources has published several books that stress the importance of informed patients and families who are partners in care and decision making, as well as the need for systems and structures to engage patients and families in quality-improvement and safety initiatives. Two of the most recent of these publications are Patients as Partners: How to Involve Patients and Families in Their own Care and Patient as Partners: Toolkit for Implementing National Patient Safety Goal 13.Putting the “Care” in Health Care: Improving the Patient Experience builds on and has synergy with these publications. The powerful learning in this book comes from the stories, helping the reader understand the experience of care from the perspectives of patients, families, and physicians, and emphasizing possibilities for change and improvement. Through stories, this book highlights a path to this future.

Using collaborative processes such as those described in this book—processes that involve patients and families, physicians, and other health care professionals—to redesign the patient experience and the systems that support it, we can achieve the IOM’s six aims and help ensure the delivery of compassionate care for all patients in all health care settings across our nation.

References
1. Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press, 2001.
2. Davis K.D., et al.: Mirror, mirror on the wall: An international update on the comparative performance of American health care. Fund Report 59, May 16, 2007. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678 (accessed Dec. 17, 2008).
3. Johnson B., et al.: Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices. Institute for Family-Centered Care, 2008. http://www.familycenteredcare.org/pdf/ PartneringwithPatientsandFamilies.pdf (accessed Sep. 5, 2008).
4. Muething S.E., et al.: Family-centered bedside rounds: A new approach to patient care and teaching. Pediatrics 119(4):829–832, 2007.
5. Cincinnati Children’s Hospital Medical Center: Family-centered rounds. http://www.cincinnatichildrens.org/about/ fcc/rounds/default.htm (accessed Dec. 17, 2008).
6. Simmons J.M.: A fundamental shift: Family-centered rounds in an academic medical center. Hospitalist 10(3):45–4, 2006.
7. Uhlig P.N., et al.: System innovation: Concord Hospital. Jt Comm J Qual Improv 28(12):666–672, 2002.