We are in the age of the customer. Individuals are increasingly in control of and vocal about the products and services they consume. Organizations in most sectors are increasingly using information about what their customers want and need in order to drive strategy and measure their success.
Healthcare is no different, and there is a growing recognition that healthcare organizations need to shift to patient-centered approaches and understand how to deliver positive patient experiences. For example the Productivity Commission's report, `Shifting the Dial - 5 year productivity review', recommended that “all Australian governments [should] re-configure the health care systems around the principles of patient-centered care”.1
Outside of these policy drivers however, the case for change is clear; there is robust evidence that a patient-centred approach to the design, delivery and evaluation of healthcare services will improve patient outcomes, the quality of care and reduce costs. The question is of course, if there is compelling evidence to transform our health services to provide better patient experiences, what should be done to get there?
Through learnings from the literature, extensive conversations with other Australian and international healthcare organizations, and our own experience, we have identified seven practices which can be put into place in order to support patient-centred care:
Leadership commitment may be the single most important contributing factor to the delivery of patient-centered care.2 Sustained commitment over time is critical in moving organizations away from a provider orientation and towards one which is truly focused on patients. In Australia, our current health system is built on foundations that are often decades if not centuries old: roles, behaviours and practices centered on the needs of those giving, rather than receiving care. As such, making the shift to patient centeredness is a paradigm shift for most healthcare organisations - it demands an unambiguous and durable commitment from the organizations' most senior leaders to change.
Commitment over time however, can yield significant benefits. For example following a financial crisis in early 2000s, Virginia Mason, a health services provider in the United States, undertook a lean transformation of their hospital services. Using the Toyota Management System as a starting point, the organization developed the `Virginia Mason Production System' (VMPS). Through sustained commitment of their leaders, Virginia Mason has reaped extensive benefits, not only in terms of maintaining their financial viability but also in relation to their ability to provide outstanding patient experiences. For example, by reducing inefficiencies in practice, waiting areas have been completely removed in some clinics, as the need for them has been made redundant as patients simply do not have to wait.3
If an organization is patient-centered, this must be reflected in its vision and mission. These public statements are key in establishing shared expectations of care - shared across not only those in leadership and frontline care delivery roles, but also between the health care organization and its patients. For example, the University of Pittsburgh Medical Centre's mission includes a commitment to…. put our patients, health plan members, employees, and community at the center of everything we do and create a model that ensures that every patient gets the right care, in the right way, at the right time, every time….4
Involving patients in establishing a vision is important and organizations must work to ensure that patients understand what this means. Strategies such as establishing a charter of health care rights may be one potential mechanism to achieve this.5
For organizations that are genuinely patient-centred, these statements are more than just symbolic. They form an integral part of a simple, and compelling narrative that is able to be used staff and management on a day to day basis.
In organizations with a patient centred culture there is a shared perception of the importance and value of the patient experience. Staff across all levels of the organization and from all disciplines and professional backgrounds hold a high level of awareness of and demonstrate a commitment to the behaviors, values and assumptions that place the patient at the center of care.
To support the development of a patient centered culture, there are a range of culture-change strategies which could be used. At the Cleveland Clinic in the United States for example, a whole of organization transformation was undertaken through the introduction of a number of strategies, including one focused on embedding a culture of `serving leadership'. Initially introduced through workshops commencing at the leadership level and subsequently cascaded down through the entire organization, the culture of serving leadership has since become embedded, with all of the clinic's managers (in excess of 3000 personnel) receiving serving leadership training.6
We have discovered that one of the major challenges in Australian health care organizations is that the responsibility for patient experience typically sits with a particular individual or role - often a quality manager, or patient liaison officer. For organizations who demonstrate maturity in their patient-centered practice, accountability looks quite different - with patient experience being everyone's responsibility. These accountabilities are articulated in organizational policy and staff from all levels of seniority, disciplines and professional backgrounds have their individual responsibilities as they impact the experience of the patient specified in their position description. For example the serving leader competencies associated with the Cleveland Clinic's initiative described above are built into the clinic's performance management system.7 In other provider organizations, individual clinicians are responsible for and measured upon indicators of experience that patients have identified as important to them.
Historically, collecting patient reported measures at scale and in a timely manner has not occurred in the majority of Australian health care organizations. Earlier this year OECD Health Ministers released a statement urging investment in “measures that will help us assess whether our health systems deliver what matters most to people.”8 Organizations will benefit from automated systems which ask every patient for feedback and make data available in real time. The true value in measurement of course lies in using it to design and implement processes to improve patient experience and patient-centered delivery.9 Organizations which develop a `reporting culture' learn to embrace this level of transparency and information as a key driver for ongoing service improvement.
Including patients in the design and redesign of health care services is fundamental to enhancing the patient experience. Without patients' input, we are left to assume that we understand what patients want and need and risk simply perpetuating current practices. The inclusion of patients should be considered the standard way of doing business and occur at multiple levels of the organization, including the point of care delivery, at the clinical microsystem level and at the organizational leadership level.10 For example, The Hospital for Sick Children in Toronto (SickKids) involves patients and their families at three levels: in direct care, where patients are each asked how they would like to be involved in decision making about their own care, organizational design initiatives, and at the policy making level.11
Patients' involvement need not be complex. There are a range of mechanisms that can be utilized to involve patients in all parts of their health care, such as working groups, designing facilities, and serving on advisory committees.12 For example at Beth Israel Deaconess Medical Centre, patients are brought into decision-making processes related to quality and safe care through patient and family councils, acting as advisors on staff committees, and project-based feedback opportunities.13 More locally, at the Royal Children's Hospital in Melbourne, consumers are involved in senior staff appointments. The fundamental tenet is to have a defined strategy for codesign in your organization, then sticking to it.14
Digital technologies are an important enabler for patient centered care. Health IT can be harnessed to support the sharing of information, the provision of patient education and the promotion of health literacy.
Solutions which facilitate the accurate and timely sharing of information about the patient's care between care givers continues to be of utmost importance in enabling patient centeredness; this is particularly the case when patients can access (and even contribute) to this information source and digital health solutions are the clear mechanism through which do make this happen. Health IT also provides great power to address problems that patients routinely highlight as having an impact on their experience, such as waiting times. For example, at the Children's Hospital in Melbourne, scheduling and queue management systems are in place which allow for patients to self-check in via an app when within a one kilometer radius. They are then sent a text message 10 minutes prior to their own appointment; thus allowing patients to wait in areas of the hospital which suit them, rather than spending extensive time in the waiting room.15 The important caution here is that while technology can help solve problems that impact on patients' experience - it is not a panacea to end all ills.
We believe there are several characteristics of a patient-centered orgnaization. It has:
So where is a health care organisation to start on its journey towards a more patient-centered approach? Considering the maturity of each organization in relation to each of these enablers may be one way to initiate action, as every organization will present with areas of strength as well as opportunities for improvement. Without doubt however, winning the hearts and minds of leadership is critical not only to initiate action, but also to sustain the necessary focus over time.
1 Shifting the Dial - 5 year productivity review. Productivity Commission. 2017
2 Shaller, D. (2007). Patient centered care: what does it take? Report for the Picker Institute and the Commonwealth Fund. NY: The Commonwealth Fund.
3 Information gathered during a site visit undertaken by KPMG team. November, 2017.
4 University of Pittsburgh Medical Centre. Mission, Vision and Values -UPMC accessed November 2017
5 Jorm, C., Dunbar, N., Sudano, L, and Travaglia, J. (2009). Should patient safety be more patient centred? Australian Health Review. 33(3): 390-9.
6 Patrnchack, J. (2013). Building an engaged workforce at Cleveland Clinic. Journal of Healthcare Leadership, 5: 9 -20.
7 Patrnchack, J. (2013). Building an engaged workforce at Cleveland Clinic. Journal of Healthcare Leadership, 5: 9 -20.
8 OECD Health Ministerial Meeting. The next generation of health reforms. Ministerial statement 17 January 2017.
9 Shaller, D. (2007). Patient centered care: what does it take? Report for the Picker Institute and the Commonwealth Fund. NY: The Commonwealth Fund.
10 Shaller, D. (2007). Patient centered care: what does it take? Report for the Picker Institute and the Commonwealth Fund. NY: The Commonwealth Fund.
11 Information gathered during a site visit undertaken by KPMG team. November, 2017.
12 Carman, K.L., Dardess, P., Maurer, M., et al (2013). Patient and Family Engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs. 32 (2):223-231
13 Patient and Family Engagement at BIDMC accessed November 2017.
14 Information gathered during a site visit undertaken by KPMG team. July 2017
15 Information gathered during a site visit undertaken by KPMG team. July, 2017.