Patient-centred or people-centred care is the idea that the patient should be at the centre of the health system so that care “is respectful of and responsive to individual patient preferences, needs, and values”. This is not just “fluff”: new studies are showing that patient-centred care is associated with better recovery from discomfort, better emotional health, and fewer diagnostic tests and referrals. Many of our colleagues in research agree; in fact, “the science and practice of people-centered health systems” was the theme of the Third Global Symposium on Health Systems Research that has just concluded in Cape Town, South Africa.
As managers of rapidly growing primary care organisations serving low-income and middle-income communities in India, Kenya, and Burundi, we share a firm commitment to achieve patient-centred care and keeping the patient at the centre of every decision. Yet we recognise that, in reality, we and many others running health-care organisations risk losing sight of this in our day-to-day work. Patient-centred care is not a clear-cut prescription that can be applied to achieve the right outcomes—this aim will require continuous refinement, innovation, and testing.
To aid ourselves in refocusing on the patient, we worked together to develop a list of five key principles and tactics that we have personally found to be critical when working to achieve patient-centred care. We are sharing this list here in the hope that it may be useful to others, and so that others can add their own thoughts and experiences:
- 1. Include patients in the innovation process. If we really listen to patients, they will tell us what to improve and even how to improve. Let patients be your partner on services, quality improvements, treatment plans, and more. A key way to do this is simply by spending time with your patients, asking them questions, and truly listening, whether in focus groups or during informal conversations. We cannot measurably impact patients’ well being unless we see the system from their eyes. We have all been patients ourselves. We are not serving cases or statistics, but people. Together, we have incorporated human-centred design and other methodologies to systematically improve care delivery processes. At the same time, we need to make sure that we don't lose the personal touch, for each person walking into our facilities is unique. In short: know your patient.
- 2. Focus on primary care. A patient is not an AIDS patient one day and a TB patient another day. Their health cannot be siloed and neither can they. Primary care treats the patient as a person, as a whole, in the context of their family and their environment. The global health community is slowly returning to the idea of primary care as a family doctor, but we need to speed this recognition up, or we will perpetuate a system that treats only disease, too late, and too expensively. Let’s treat people with a focus on their health at the first point of contact to reduce the burden on the whole system.
- 3. Accelerate the innovation process. When developing new innovations and processes, many organisations tend to get caught up in long research and planning periods, pilots, and official evaluations to determine feasibility. Unfortunately, this can slow down innovation and keep patients in the wrong care for longer. How many patients will keep receiving poor, inadequate, out of date, or wrong medical advice during slow proof of concepts and slow evaluations? The cost of this is too high. Therefore, we should speed up the innovation process through rapid testing methods such as Plan-Do-Study-Act to develop effective, sustainable, patient-centred solutions. Don’t get stuck in endless planning. Keep moving forward!
- 4. Include soft skills in your medical training. Soft skills, or the ability to effectively communicate and interact with a patient in a way that makes them feel comfortable, are often ignored or de-prioritised in medical training and education. This is creating a generation of doctors who may know how to correctly diagnose a patient, but are not necessarily able to make the patient feel ownership in their own care. As a result, patients risk missing important follow-ups, misunderstanding treatment, and feeling a combination of fear, confusion, and frustration with their health experience. The importance of this training therefore cannot be emphasised enough. What’s more, we must include nurses, paramedics, clinic managers and other non-clinical staff in these soft skill trainings. Their interactions with patients also constitute part of the patientnexperience, and they should be keeping the patient at the centre of their decision-making, too.
- 5. Collaborate with like-minded innovators. None of us are alone in our efforts to provide patient-centred care and there is no need to tackle this in isolation. Spend time with a supportive group of people where you can talk openly about what you’ve tried, what works, and what doesn’t work. In our meetings in the Primary Care Learning Collaborative, we openly shared our failures and frustrations with each other, and always came back with many new ideas and energy to put them into action. A group of people is always smarter than the smartest person in the group.
Patient-centred innovation is worth the investment, both in time and money. So be encouraged; stay motivated. Don’t lose sight of the mission to keep the patient at the centre. Serve the patient well, because she is your mother and he is your brother. They are us, and we all want affordable, quality health care.
So our question now to our colleagues—programme managers, health innovators, entrepreneurs—is which principles do you use in your work to achieve patient-centred care? Which tools and concepts help you put the patient first?
This post was co-written by representatives of five organisational members of the Center for Health Market Innovations (CHMI)’s Primary Care Learning Collaborative, a peer-learning vehicle that facilitates knowledge-sharing among participating organisations on topics directly addressing the challenges of quality, sustainability, and scale. The organisations employ chain and franchise models to deliver primary health care in Kenya, Burundi, and India. Specific members and authors include:
- Stefanie Weiland & Monica Slinkard LifeNet International, Burundi
- Stephanie Koczela & Rob Korom Penda Health, Kenya
- Devashish Saini & Naveen Vashist Ross Clinics, India
- Melissa Menke & Vincent Mutugi Access Afya, Kenya
- Sundeep Kapila & Garima Kapila Swasth India, India
This post originally appeared on the Lancet Global Health blog on 7/10/2014
Photo: ©Penda health 2013
