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delivery, and evaluation of health care that is groundedin mutually beneficial partnerships among healthcareproviders, patients, and families',"

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1.1CONCEPTS OF PATIENT-CENTRED CARENumerous proposed definitions of patient-centred careencompass similar core concepts, but there is no globallyaccepted definition." Modern concepts of patient-centred care are based largely on research conductedin 1993 by the Picker Institute in conjunction with theHarvard School of Medicine. The research identifiedeight dimensions of patient-centred care that wereoriginally documented in Through the Patient's Eyes:Understanding and Promoting Patient-Centered Care."The dimensions are:» respect for patients' preferences and values» emotional support» physical comfort» information, communication and education» continuity and transition» coordination of care» the involvement offamily and friends» access to care.

The framework clearly defined the patient's perspectivefor the first time and served as the foundation forthe Picker surveys measuring patient experiences ofhealth care."

The concept of patient-centred care clearly recognisesthe need to include not only the patient in their care,but significant others, including family, friends,carers, spiritual and pastoral advisers, and broadercommunity members.

Patient-centred care also focuses on staff. To succeed, apatient-centred approach should also address the staffexperience, because the staff's ability and inclination tocare effectively for patients is compromised if they donot feel cared for themselves."

Organisation-specific concepts of patient-centredcare have also emerged. Some organisations identifyindividual elements of patient-centred care as part of anoverall patient-centred care framework. An overview ofleading organisations promoting strategies for patient-centred care is presented in Section 2.5.

The World Health Organization (WHO) uses the term'responsiveness' in preference to 'patient-centred care'.Responsiveness describes how a healthcare systemmeets people's expectations regarding respect for peopleand their wishes, communication between healthworkers and patients, and waiting tunes." WHO statesthat recognising responsiveness as an intrinsic goal ofhealth systems reinforces the fact that health systemsare there to serve people.

Several studies reviewing patient-centred care in theUS's (cited in Goodrich and Cornwell") have identifiedthe core elements as:» education and shared knowledge» involvement of family and friends» collaboration and team management» sensitivity to nonmedical and spiritual dimensions

of care» respect for patient needs and preferences» the free flow and accessibility of information.

WHAT IS PATIENT-CENTRED CARE? PAGE 7

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SYSTEM-ORIENTEDRECOMMENDATIONS

Recommendation 7:Education programs should engage patients and familiesas teachers and collaborators, rather than solely as casesto be studied.

Recommendation 1:Policy makers and regulators should include patient-centred care as a dimension of quality in its own right instrategic and other policy documentation.

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Kt::t:OLlunenUauOJ:1 :.!::A core set of nationally endorsed patient surveyquestions should be developed to facilitate collationand comparison of patient care experience data in keyhealthcare settings.

Research funding bodies should acknowledge theimportance of patient-centred care to the healthsystem, and this should be reflected in the distributionof funding.

Recommendatton 3:Patient surveys used to assess patient care experienceneed to include questions specifically addressingrecognised patient-centred care domains and assessmore than patient 'satisfaction'.

Kt:(;U.ltUHt:llUaliun 4:'Improving patient care experience' should be includedas an indicator of quality and reflected in healthcarereporting and funding models.

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To improve transparency, Australian policy makersand regulators should make data regarding patientcare experience in health services publicly availablevia websites.

xecommenuannn 0:Patient-centred care should be a component ofundergraduate and postgraduate education programs forall health professionals.

PAGE 2 PATIENT-CENTRED CARE: IMPROVING QUALITY AND SAFETY THROUGH PARTNERSHIPS WITH PATIENTS AND CONSUMERS

SERVICE-ORIENTEDRECOMMENDATIONSHealth service executives and managers should:

Recommendation 9:Ensure that organisational systems and processes aredesigned to be patient-centred.

Recommendation 10:Ensure their health care organisation develops a sharedpatient-centred mission that senior leaders continuallyarticulate to staff to promote the implementation ofpatient-centred care.

Recommendation 11:Develop and implement policies and procedures forengaging patients, families and carers in their own care.

Recommendation 12:Develop and implement policies and procedures forinvolving patients, families, carers and consumers at aservice level, and in policy and program development,quality improvement, patient safety initiatives andhealthcare design.

Recommendation 13:Provide support for patients, families and carersinvolved in governance to develop the necessary skillsand capacity required for effective partnerships withtheir healthcare organisation.

Recommendation 14:Ensure that the service meets the National Safetyand Quality Health Service 'Partnering withConsumers' Standard.

Recommendation 15:Ensure that systems are in place for the regularcollection and reporting of patient care experience datathrough quantitative patient surveys and qualitative,narrative-based sources.

Recommendation 16:Ensure that organisational approaches to qualityimprovement include feedback about patient careexperience - alongside clinical and operational data-when determining health service action plans.

Recommendation 17:Contribute to the evidence base for patient-centredcare by recording and publishing changes in keyorganisational and patient outcome metrics over time.

Recommendation 18:Provide organisational support to enable staff to partnerwith patients and consumers, and to implement anynecessary changes based on that partnership.

Recommendation 19:Support staff through training and education activitiestailored to building the capacity of all staff to deliverpatient-centred care.

Recommendation 20:Focus on work environment, work culture andsatisfaction of staff as an integral strategy for improvingpatient-centred care. Workforce surveys and reviewof staff recruitment and retention rates shouldbe undertaken at regular intervals to monitor thework environment.

Recommendation 21:Integrate accountability for the care experience ofpatients into staff performance review processes.

Recommendation 22:Foster a culture oflearning within the organisation,equally learning from successes and failures, includingtragic events, to promote patient-centred care.

SUMMARY OF RECOMMENDATIONS PAGE 3