The evolution of patient-centered care.
Subject: Health care reform (Evaluation)
Medical law (Evaluation)
Patients (Care and treatment)
Patients (Laws, regulations and rules)
Author: Cliff, Barbara
Pub Date: 03/01/2012
Publication: Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2012 American College of Healthcare Executives ISSN: 1096-9012
Issue: Date: March-April, 2012 Source Volume: 57 Source Issue: 2
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Product: Product Code: 9105280 Health Regulation NAICS Code: 92615 Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 285087583
Full Text: Patient-centered care has become a central goal for the US healthcare system under the Affordable Care Act. But haven't patients always been central to the business of hospitals? What is so different about the present reality of patient-centered care?

"Patient-centered care" is used to describe numerous related paradigms but has no universally accepted definition. According to the Institute for Healthcare Improvement (2011), "Care that is truly patient-centered considers patients' cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient and their loved ones an integral part of the care team who collaborate with healthcare professionals in making clinical decisions ... When care is patient-centered ... unneeded and unwanted services can be reduced." A healthcare system that is truly patient-centered may provide higher quality healthcare with greater efficiency while improving the patient experience.


References to patient-centered care date to the 1950s (Balik et al. 2011) but tree provision of patient-centered care has not been a priority for healthcare institutions--and for understandable reasons. Patient safety, quality of care, and a healthy operating margin have often been more immediate concerns than patient-centered care, which comprises "softer," nonclinical components such as involving family and friends in care, considering the spiritual aspects in care, designing a physical environment that is healing, and providing nutritious and nurturing food (Frampton et al. 2008). This view no longer stands. In 2001, the Institute of Medicine released its seminal report, Crossing the Quality Chasm: A New Health System for the 21st Century, which identified six aims of improvement for the US healthcare system by asserting that care must be "safe, effective, patient-centered, timely, efficient, and equitable."

Patient-centered cafe's move into the mainstream after decades on the fringe is largely the result of the convergence of several evolving social and economic realities:

1. The aging of baby boomers and the associated rise in consumer expectations around the healthcare experience

2. Unprecedented access to health information, fueled by the Internet

3. The demand for greater transparency in reporting of outcomes, and new governmental incentives to report those results for widespread dissemination to the public

4. Increased demand for timely and convenient access to costly medical technologies and pharmaceuticals that continue to drive healthcare costs--including out-of-pocket costs for patients and employer contributions--increasingly skyward (Frampton and Charmel 2009)

Awareness is growing that to achieve the best outcomes, patients and families must be more actively engaged in decisions about their healthcare and must have enhanced access to information and support (Johnson et al. 2008). Patient-centered care shifts the focus from the diagnosis to the patient, a shift that can result in significant improvements in clinical outcomes, patient satisfaction, and cost reduction.


Planetree is an internationally recognized leader in patient-centered care and has made great strides in advancing the concept. "The Planetree model of ore is a patient-centered, holistic approach to healthcare, promoting mental, emotional, spiritual, social, and physical healing. It empowers patients and families through the exchange of information and encourages healing partnerships with caregivers. It seeks to maximize positive healthcare outcomes by integrating optimal medical therapies and incorporating art and nature into the healing environment" (Planetree 2011).

Windber Medical Center, a 54-bed hospital in western Pennsylvania, is a Designated Planetree Patient-Centered Hospital. We are the only Planetree hospital in Pennsylvania and one of only thirteen hospitals in the country to have achieved Planetree Designation status, which can be viewed as the gold standard of patient-centered care. Our actions are guided by the core components of the Planetree philosophy, so patient-centered care is not something we do, but rather something we are. The very culture of our acute care hospital embraces the concept that the patient is central to his or her own care and the family is a component of that unit of care.


Developing a patient-centered culture takes time. It requires a shift in healthcare delivery in which the focus at all times is on doing what's best for patients and their family members. It recognizes the individual needs of the patient; empowers patients and their families to become active partners in their care; and delivers care in a healing environment that supports patients' physical, emotional, and spiritual needs (Jarousse 2011a). Hospitals & Health Networks has identified seven key organizational attributes for developing a patient-centered culture, as shown in Exhibit 1.

As healthcare reform continues to drive hospitals to achieve better outcomes with fewer resources at a lower cost, patient-centered care will continue to take on greater importance. Evidence shows that patient-centered care improves outcomes by reducing length of stay, readmissions, and emergency department visits and enhances patient compliance with plans of care. Patient satisfaction is, in turn, improved. And, in a patient-centered environment, employees are more satisfied with their work and are more willing to stay in their jobs (Jarousse 2011b). As it's a central goal for the US healthcare system under healthcare reform, the time to start shifting to a more patient-centered model of care is now!


Balik, B., J. Conway, L. Zipperer, and J. Watson. 2011. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement.

Frampton, S., and P. Charmel (eds.). 2009. Putting Patients First: Best Practices in Patient-Centered Care, 2nd ed. San Francisco: Jossey-Bass.

Frampton, S., S. Guastello, C. Brady, M. Hale, S. Horowitz, S. Bennett Smith, and S. Stone. 2008. Patient-Centered Care Improvement Guide. Derby, CT: Planetree.

Institute for Healthcare Improvement. 2011. "Patient-Centered Care on Medical/Surgical Units." IHI Knowledge Center. Accessed December 11. CenteredCare.aspx.

Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.

Jarousse, L. 2011a. "Defining, Measuring and Sustaining a Patient-Centered Culture." H&HN Gatefold November.

Jarousse, L. 2011b. "Putting Patients First." Trustee November/December.

Johnson, B., M. Abraham, J. Conway, L. Simmons, S. Edgman-Levitan, P. Sodomka, J. Schlucter, and D. Ford. 2008. Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices. Bethesda, MD: Institute for Family-Centered Care, in collaboration with the Institute for Healthcare Improvement.

Planetree. 2011. "About Us." Accessed December 11.

For more information about the concepts in this column, please contact Dr. Cliff at

Barbara Cliff, RN, PhD, FACHE, President/CEO, Windber Medical Center

Key Attributes for Developing a Patient-Centered Culture

1. Leadership Commitment: Senior leaders and the board must set a
clear vision and demonstrate commitment to patient- and
family-centered care.

2. Workforce: The hospital and its staff, including the medical
staff, must commit to meeting the unique needs of the patients they

3. Healing Environment: The hospital must provide a nurturing
environment that supports the health and well-being of patients and
their families.

4. Data Usage: Hospitals must collect, analyze and act upon data
that identifies what's important to patients and families during
their stay and use that data to make meaningful change within the

5. Supportive Work Environment: The work environment should
facilitate employee engagement, provide employees tools they need
to do their jobs and treat them with dimity and respect.

6. Communication: Effective communication is essential to the
establishment of a patient-centered culture. Leadership must
continually communicate the organization's commitment to
patient-centered care and clinicians must establish open
communication with patients and their families to involve them
fully in their care and ensure their needs are met.

7. Patient, Family and Community Involvement: Hospitals must be
responsive to the changing needs and values of patients, families
and the community.

Reprinted from Hospitals & Health Networks, by permission, November
2011. Copyright 2011, by Health Forum, Inc.
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.