AJN, American Journal of Nursing:
True patient-centered care requires more than lip service.
Patient-centered care. Family-centered care. Hospital Web sites and ads declaring their patients to be “at the heart of everything we do.” These phrases are everywhere, and they convey something most people entering a hospital want to believe: that the hospital is focused on their individual needs and wants, and will provide care and services to match.
Figure. Maureen Shaw...Image Tools
But at how many hospitals are these words just a marketing ploy? How many facilities care about patient satisfaction only as a rating that affects reimbursement, rather than embracing it as an organizational value?
When I needed hospitalization a few years ago, I was confident that I'd receive excellent care. The hospital I was admitted to was a well-regarded, Magnet-designated community medical center. Its publicity and patient-orientation materials touted its reputation for patient-focused care, its high patient satisfaction ratings, and its various awards for clinical excellence. But my experience fell far short of my expectations. Although I found the entire staff—from nurses to dietary aides to patient transporters and technicians—to be friendly and kind, few ever asked how I was or whether there was anything I needed. Staff members were clearly busy and looked harried, and simple requests often went unfulfilled. At night, the noise levels from staff conversations, telephones, and a lot of noisy equipment prevented real rest. Discharge patient education consisted of a four-page computer printout with little explanation.
Real patient-centered care involves doing more than adding a few patient-friendly amenities like massages, valet parking, and upgraded linens and food service. It means more than changing a few job titles or hiring “guest relations” representatives (yes, complete with team blazers). It requires a complete organizational shift from a model focused on providers to one focused on patients, in which their needs and desires drive how care is organized and delivered. In short, it's about the patients, not us. And that means we need to know what matters to patients.
In this issue of AJN, we're publishing two articles on incorporating the patient's perspective in delivering care. “The Perceptions of Health Care Team Members About Engaging Patients in Care Redesign” describes original research by Canadian investigators who explored how team members at three hospitals felt about including patient representatives on teams participating in a Transforming Care at the Bedside (TCAB) initiative to redesign patient care. Some providers were surprised that patient representatives could offer insight into “things [we] hadn't thought about.” (For more on TCAB, see our supplement: http://journals.lww.com/ajnonline/toc/2009/11001). We also invited patient advocate Jessie Gruman to write a Viewpoint. A five-time cancer survivor herself, Gruman is the founder of the Center for Advancing Health (www.cfah.org), a nonprofit organization working to increase patient engagement in health care. She writes about what patients want from nurses and other caregivers during and after hospitalization, and she does so with grace and clarity.
Just as systems factors can impede efforts to reduce medical errors, organizational factors can prevent nurses from providing patient-centered care. Known barriers include insufficient staffing, lack of support personnel and equipment, and unwieldy documentation processes.
I think another key barrier is the presence of governance models that don't empower nurses at the point of care to make evidence-based changes. True patient-centered care cannot happen in an organization with a traditional top-down hierarchy, in which those at the bedside are treated as interchangeable company “assets” instead of as individual professionals with valuable contributions to make.
As Planetree, an organization founded in 1978 to advocate patient-centered care, has stated, patient-centered care “is a model in which providers partner with patients and families to identify and satisfy the full range of patient needs and preferences…. To succeed, a patient-centered approach must also address the staff experience, as staff's ability and inclination to effectively care for patients is unquestionably compromised if they do not feel cared for themselves.”
I believe that nurses want to give the kind of care patients want—indeed, the kind of care we want for ourselves and our families. We need to ensure that our workplaces allow us to do that.
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