Abstract
Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of “service-oriented” systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or “kin-centred care” to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what “person-centredness” began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
Highlights
It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity
We propose a new construct for defining quality of healthcare, where the aim is to meet the needs of the patient as a person, rather than meeting the needs of the healthcare system, which is as complex industry selling a product of disease management[38]
We suggest a focus on the co-creation of better health — a quality system for the people who are working together to co-produce services that contribute to better health (Figure 1)
Summary
The central tenet is kindness, so the dimension of person-centred care is kin-centred as well, involving all those who are related to the person receiving and the person providing care This approach will facilitate the coproduction of quality and safety and achievement of the other domains. The person providing care should experience psychological safety, kindness, dignity and respect with a sense of belonging and meaning This will facilitate the resilience or coping skills required by healthcare professionals to feel physically and mentally safe. The multidimensional model has been piloted recently in different types of care organizations and it helped the involved clinicians and managers to define and specify the organization specific goals for the six technical domains, the umbrella domain of person and kin centred care and how to focus on the four core values. We invite clinical teams to use the model to examine how they can become person centred and publish their experience so that we can coproduce the future
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