Patient-Centered Care Diana Gonzalez Merisa Akuszewski Azusa Pacific University

Objectives Definition Eight Dimensions Essentials of Patient-Centered Care Communication Teamwork Service Quality Patient-Centered Care Outcomes Facilitators & Barriers

Defining Patient-Centered Care “Patient centered care is care based on a partnership between the patient, their families, and the health care provider that is focused on the patient’s values, preferences, and needs” Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45.

Defining Patient-Centered Care Care is individualized and customized Cultural competency Patient advocacy Patients and families, not clinicians, have control over health care decisions. Patient Autonomy Hughes, R. (2011). Overview and summary: Patient-centered care: Challenges and rewards. The Online Journal of Issues in Nursing,16 (2). McCance, T., McCormack, B., Dewing, J. (2011). An exploration of person-centredness in practice. The Online Journal of Issues in Nursing, 16 (2) Manuscript 1.

Overview of Patient-Centered Dimensions The Eight Dimensions of Patient-Centered Care grew out of years of research by the Picker Institute and Harvard Medical School, thousands of interviews, and the experiences of caregivers and patients. From that research, we now understand what matters most to patients. Overview of Patient-Centered Dimensions Respect for patients' values, preferences and expressed needs Patients indicate a need to be recognized and treated as individuals by hospital staff. They are concerned with their illnesses and conditions and want to be kept informed. An atmosphere respectful of the individual patient should focus on quality of life. Involve the patient in medical decisions. Provide the patient with dignity, and respect a patient's autonomy. Coordination and integration of care Patients report feeling vulnerable and powerless in the face of illness. Proper coordination of care can ease those feelings. Patients identified three areas in which care coordination can reduce feelings of vulnerability: Coordination of clinical care; Coordination of ancillary and support services; and Coordination of front-line patient care. Information and education Patients express a fear information is being withheld from them and staff is not being completely honest about their condition and prognosis. Based on patient interviews, healthcare organizations can focus on three communication items to reduce these fears: Information on clinical status, progress and prognosis; Information on processes of care; and Information to facilitate autonomy, self care and health promotion. Physical comfort The level of physical comfort patients report has a tremendous impact on their experience. Three areas were reported as particularly important to patients: Pain management; Assistance with activities and daily living needs; and Hospital surroundings and environment. Emotional support and alleviation of fear and anxiety Fear and anxiety associated with illness can be as debilitating as the physical effects. Caregivers should pay particular attention to: Anxiety over physical status, treatment and prognosis; Anxiety over the impact of the illness on themselves and family; and Anxiety over the financial impact of illness. Involvement of family and friends Patients continually address the role of family and friends in the patient experience, and often express concern about the impact illness has on family and friends. Family dimensions of patient-centered care were identified as follows: Providing accommodations for family and friends; Involving family and close friends in decision making; Supporting family members as caregivers; and Recognizing the needs of family and friends. Continuity and transition Patients often express considerable anxiety about their ability to care for themselves after discharge. Meeting patient needs in this area requires staff to: Provide understandable, detailed information regarding medications, physical limitations, dietary needs, etc.; Coordinate and plan ongoing treatment and services after discharge; and Provide information regarding access to clinical, social, physical and financial support on a continuing basis. Access to care Patients need to know they can access care when it is needed. Focusing mainly on ambulatory care, the following areas were of importance to the patient: Access to the location of hospitals, clinics and physician offices; Availability of transportation; Ease of scheduling appointments; Availability of appointments when needed; Accessibility to specialists or specialty services when a referral is made; and Clear instructions provided on when and how to get referrals. http://www.nationalresearch.com/products-and-solutions/patient-and-family-experience/eight-dimensions-of-patient-centered-care/

Communication Therapeutic Communication Barriers to Communication Nursing Students Barriers to Communication Interprofessional Collaboration SBAR Huddles Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45.

Teamwork Partnership between patient and caregivers Shared-decision making Multidisciplinary collaboration needed to provide personalized care Ignatavicius, D. & Worman, L. (2013). Medical-Surgical Nursing: Patient-Centered Collaborative Care. (7th ed.). St. Louis, Mo: Saunders Elsevier.

Service Quality Dimensions Gaps in Service Patient Satisfaction Patient Expectation vs. Nurse Perception Gap Nurse and nursing administrator perceptions vs. Patient centered care standards gap Patient Satisfaction Surveys, HCAP’s Dabney, B., & Huey-Ming, T. (2013). Service Quality and Patient-Centered Care. MEDSURG Nursing, 22(6), 359-364. (a) respect for patients’ values, preferences, and expectations; (b) coordination and integration of care; (c) information, communication, and education; (d) physical comfort; (e) emotional support and alleviation of fear and anxiety; (f) involvement of family and friends; and (g) transition and continuity. Gaps in Service This gap is measured by how well the health care delivery design matches the health care provider’s perceptions of the patient’s expectations or needs

Patient-Centered Care Leads to... Better outcomes Safer environment Fewer medical and medication errors Fewer patient falls Lower cost Decreased length of stay Increased patient satisfaction (Bertakis & Azari, 2011; Grumbach & Grundy, 2010; Oshima Lee & Emanuel, 2013)

Facilitators & Barriers to Patient- Centered Care Key Organizational-Level Facilitators: Strong, committed senior leadership Communication of strategic vision Engagement of patients and families Sustained focus on employee satisfaction Regular measurement and feedback reporting Adequate resourcing for care delivery redesign Building staff capacity to support delivering patient-centered care Accountability and incentives Culture that is strongly supportive of change and learning Barriers: Attitudes of healthcare professionals Time needed to implement changes seven out of eight organizations repeatedly identified strong CEO and governance support for achieving patient-centered care as a critical facilitator. Of potential import, the CEOs, deriving either from a business or clinical background, had an average tenure of 7 years in the eight institutions evaluated, with three having 10+ years. (Luxford, Safran, & Delbanco, 2011)

References Bertakis, K. & Azari, R. (2011). Patient-centered care is associated with decreased health care utilization. Journal of American Board of Family Medicine, 34(3), 229-239. doi: 10.3122/jabfm.2011.03.100170 Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45. Retrieved from: http://web.b.ebscohost.com/ehost/detail?vid=6&sid=86ab2aa1-ef3d-45e6-9022- 89a0ff2d6533%40sessionmgr111&hid=120&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2012546038 Dabney, B., & Huey-Ming, T. (2013). Service Quality and Patient-Centered Care. MEDSURG Nursing, 22(6), 359-364. http://web.b.ebscohost.com/ehost/detail?vid=6&sid=86ab2aa1-ef3d-45e6-9022- 89a0ff2d6533%40sessionmgr111&hid=120&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2012416250 Grumbach, K. & Grundy, P. (2010). Outcomes of implementing patient centered medical home interventions: A review of the evidence from prospective evaluation studies in the United States. Patient Centered Primary Care Collaborative, 1-16. Retrieved from: http://forwww.pcpcc.net/files/evidence_outcomes_in_pcmh_2010.pdf Hughes, R. (2011). Overview and summary: Patient-centered care: Challenges and rewards. The Online Journal of Issues in Nursing,16 (2). Ignatavicius, D. & Worman, L. (2013). Medical-Surgical Nursing: Patient-Centered Collaborative Care. (7th ed.). St. Louis, Mo: Saunders Elsevier. Luxford, K., Safran, D. & Delbanco, T. (2011). Promoting patient-centered care: A qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. International Journal for Quality in Health Care, 23(5), 510-515. Retrieved from: http://intqhc.oxfordjournals.org/content/23/5/510.full.pdf+html McCance, T., McCormack, B., Dewing, J. (2011). An exploration of person-centredness in practice. The Online Journal of Issues in Nursing, 16 (2) Manuscript 1. Oshima Lee, E. & Emanuel, E. (2013). Shared decision making to improve care and reduce costs. New England Journal of Medicine, 368 (1), 6-8. doi:10.1056/NEJMp1209500 Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp1209500