New Roles and Rules for Patient-Centered Care

New Roles and Rules for Patient-Centered Care

Michael L. Millenson, BA1,2

1Health Quality Advisors LLC, Highland Park, IL, USA; 2Kellogg School of Management, Northwestern University, Evanston, IL, USA.

J Gen Intern Med 29(7):97980DOI: 10.1007/s11606-014-2788-y Society of General Internal Medicine 2014

P atient-centered care was anointed one of six aimsforUShealthcareina2001InstituteofMedicine report that simultaneously unfurled a long list of its defining traits. The term encompassed qualities of compassion, empathy and responsiveness to the needs, values and expressed preferences of the individual patient while addressing technical care and interpersonal interactions within a healing relationship.1

A dozen years later, a 2013 IOM workshop sounded a strikingly different note. It recommended strategies and policies at multiple levels to advance patients, in partnership with providers, as leaders and drivers of care delivery improvement through the protected use of clinical data, informed, shared decisions and value improvement.2

Despite the leaden language, this shift signals significant progress. Behaviors formerly presented as ideals are being reframed to include measurable benchmarks such as one might see in a financial plan. The analogy is apt, since patient-centeredness is now deemed essential to transforming the $2.7 trillion health care system. As the IOM workshop put it: Prepared, engaged patients are a fundamental precursor to high-quality care, lower costs and better health.

The ongoing change from aspirational goals to operational ones in patient-centeredness can be seen in the meaningful use regulations affecting doctors and hospitals using health information technology obtained with federal grants. Even more significant, the Patient Protection and Affordable Care Act uses patient-centered 43 times and includes nine separate provisions requiring patient-centered quality measures. There are also references to patient satisfaction, patient experience of care, patient engagement and shared decision-making.

This burst of activity and enthusiasm, while welcome, carries its own dangers. Distinct ethical, economic and clinical concepts have been cobbled together under the patient-centeredness banner. These separate ideas are sometimes complementary, but they can also clash. The central importance of a new kind of collaborative relationship between doctor and patient risks being lost in a blizzard of buzzwords.

Certainly, patient-centered care was not the goal originally pursued by patients: what they demanded was shared power. The Boston feminists who authored Our Bodies, Ourselves were angry about doctors denying them information; that their manifesto quickly morphed...