Patient-Centered Care: Understanding Its Interpretation and Implementation in Health Care

Headnote

Providing patient-centered care (PCC) has been the focus of recent organizational restructuring and quality improvement efforts in health care. Much has been written about PCC in the past 5 years; however, there are multiple perspectives about the interpretation and implementation of this concept. Descriptions of PCC in the health care literature generally, in some way, refer to meeting patients' needs. Literature describing PCC falls into two categories. The first category interprets PCC as the reorganization of services around patients' needs. The second defines PCC as understanding patient-perceived needs, priorities, and expectations for health care. PCC, however, is still most often implemented from a traditional provider-centered, disease-focused framework that often results in patient care and outcomes that are not congruent with patients' preferences. Shifting to a model of care in which patients define their needs and priorities creates some unique issues in health care. Nursing, with its long-standing commitment to being patient focused, needs to lead the research effort to develop patient-centered models of care that consider and incorporate patients' preferences. Nurses must be mindful, however, of their socialization in the traditional model of care and the resulting underlying attitudes and assumptions they bring to their research and work with patients.

Providing patient-centered care (PCC) has been the focus of many recent organizational restructuring and quality improvement efforts in health care. Much has been written about PCC in the past 5 years; however, there are multiple perspectives about the meaning and implementation of this concept. The purpose of this article is to explore these multiple perspectives, to examine and highlight the complexity and important issues related to the implementation of a patient-centered philosophy in health care, and to identify the implications for nursing.

BACKGROUND AND SIGNIFICANCE

Why has PCC become a central concept in the traditionally disease-focused, provider-centered institution of health care? This relatively recent shift to a patient-centered focus is in response to:

1. a trend, in general, toward increasing attention to customer needs;

2. rapidly escalating expenditures in health care, and,

3. the shift in focus to the improvement of processes and outcomes of care. (Al-Assaf, 1993, Lehr & Strosberg, 1991)

Some of the strategies designed to meet customer demand while controlling costs and maintaining or improving quality include the development of managed...