Patient-Centered Care: A Healthcare Reform Imperative and a Hospital Design Opportunity

Abstract

Patient-centered care (PCC) has been cited by the Institute of Medicine, the Agency for Healthcare Research and Quality, Planetree, the Picker Institute, the Institute for Patient- and Family- Centered Care, the National Cancer Institute, and the American Nurse Association as an essential element in the delivery of quality healthcare (Agency for Healthcare Research and Quality, 2002; American Nurses' Association, 2001; Epstein & Street, 2007; Frampton, Gilpin, & Charmel, 2003; Institute for Patient- and Family-Centered Care, 2011; Institute of Medicine, 2001; National Research Corporation [NRC Picker], 2011). Although it is a recognized priority, PCC is largely an undefined or over-simplified concept in most healthcare professions and also in the health- care design discipline. PCC is more than providers' individualized approach to care.PCC involves a systemic organizational change from top to bottom (American Association of Critical- Care Nurses [AACN], 2011) and requires a focused vision, mission, value, and cultural influence for each healthcare provider and the organization as a whole. According to the AACN (2011), there are five ways that hospitals can improve the patient experience:1) be clear about the mission for patientcentered and quality care in all departments of the hospital; 2) establish leadership and support for the patient experience as the top priority; 3) align the organizational culture with the importance of making the individual patient experience as positive as possible; 4) engage everyone in the organization; and 5) maintain a relentless commitment to improving the patient experience. (p. 12)These five elements can serve as guiding principles for healthcare design team members who aspire to create a PCC environment.A synthesis of definitions found in the literature suggests that PCC is characterized by care that is (1) respectful of the whole person-physical and emotional needs, life experiences, values and beliefs, and cultural influences; (2) sensitive to the social context and support of family and friends; (3) delivered in a caring, compassionate, and therapeutic relationship based on mutual trust and respect; (4) integrated and coordinated across a continuum of disciplines, specialties, and services; and (5) transparent, with information and education that will empower patients to be engaged in their own care decisions and the management of their own health. Healthcare providers will need a specific set of competencies to deliver such culturally and socially sensitive, relationship-based care to patients, and organizational leaders will need to be absolutely committed to the cultural values that are the framework for PCC.The new healthcare reform laws link reimbursement for services with a number of patient and provider outcome indicators, including patient, nurse, and physician satisfaction levels. Hospitals that have implemented PCC initiatives and healthcare leaders who have worked to enculturate PCC among healthcare providers have experienced increased patient satisfaction levels; decreased costs; shortened lengths of stay (Piette, Weinberger, & McPhee, 2000; Sharp Health- Care, 2011); reduced numbers of diagnostic tests, referrals, and readmissions (Bertakis & Azari, 2011; Stewart et al., 2000); fewer medication errors, and increased nurse job satisfaction (Rathert & May, 2007). Physicians have also reported improved satisfaction levels when working in organizations (both inpatient and outpatient settings) that embrace a PCC concept (Krupat, Bell, Kravitz, Thom, & Azari, 2001). With such outcomes, it is difficult to refute the positive benefits of PCC for both patients and healthcare providers.Ideal Patient ExperienceGreat design balances the needs of patients, families, and healthcare providers, but at times, the needs of these groups create competing priorities. Patient and family privacy needs compete with the provider's need for a direct line of sight of the patient from a hallway documentation alcove. …