10 Guiding Principles for Patient-Centered Care
In August, Mountain States Healthcare Alliance, a 13-hospital integrated healthcare delivery system based in Johnson City, Tenn., received the 2012 National Quality Healthcare Award from the National Quality Forum, recognizing the system's achievement of multiple quality-focused goals. Rather than just representing a culmination of efforts, the award is spurring the system to continue providing quality care, according to Dennis Vonderfecht, president and CEO of MSHA.
"No matter how many quality awards we receive, we can never sit back and say we are satisfied with the level of quality we have achieved," he says. "So while we are extremely gratified to be recognized at this level, we will continue to work just as diligently to ensure that we are providing the best care possible to the people of our region."
One of the areas NQF praised MSHA for was its commitment to patient-centered care. MSHA follows 10 patient-centered care guiding principles to ensure the health system puts the patient first in every decision. Tamera Parsons, vice president of quality and patient safety at MSHA, describes the 10 patient-centered care guiding principles.
1. All team members are considered caregivers. Under this principle, everyone in the workforce, from housekeeping staff to the CEO, is part of patients' care experience. Regardless of one's role, each person is expected to put the patient first. To create a patient-centered culture, MSHA has patient-centered care training for new employees. "They learn from day one that all team members are caregivers," Ms. Parsons says. In addition, MSHA recognizes employees through thank you notes and awards for demonstrating patient-centered care principles.
2. Care is based on continuous healing relationships. This principle reinforces a focus on the continuum of care for patients rather than episodes of care. "We're here to not only provide care, but also to provide healing — a more personal level of healthcare," Ms. Parsons says.
3. Care is customized and reflects patient needs, values and choices. The principle of customizing care recognizes that each patient is different and may have different needs and preferences. In addition to customizing the care plan for each patient, MSHA works to make the environment comfortable to individual patients. For example, one patient may want music in the room, where another patient may not. "It allows the patient's individuality to be a component of care," Ms. Parsons says."
4. Knowledge and information are freely shared between and among patients, care partners, physicians and other caregivers. In a patient-centered environment, all members of the care team — including the patient — need to be aware of the patient's status and care plan. "If the patient is going to be the center of care, [he or she] absolutely needs to be informed and part of the decision-making," Ms. Parsons says.
5. Care is provided in a healing environment of comfort, peace and support. Part of a patient-centered culture is the environment. MSHA has several features that create a healing environment for patients, including music, healing gardens, soothing color schemes and pet therapy programs. The hospitals also ensure rooms have pleasing scents, such as lavender or the smell of baked cookies, according to Ms. Parsons.
6. Families and friends of the patient are considered an essential part of the care team. MSHA recognizes that family and friends are essential supports for the patient's healing process. Family and friends support patients not only emotionally, but also physically, as they can help patients understand physicians' instructions. In the health system's Very Important Partner program, patients identify an individual to listen to care information with them. "Patients [may be] in a state of discomfort and pain or fear, and don't always hear information, so it [allows] a trusted family member or friend identified by the patient to participate in the sharing of information and guidance we give before sending patients home or to the next level of care," Ms. Parsons says.
7. Patient safety is a visible priority. Making patient safety a visible priority demonstrates the organization's commitment to patient care. MSHA implements policies and procedures to enforce patient safety best practices. For example, the system had a campaign around employee immunization and hand hygiene. MSHA also has a balanced scorecard called the blue print. The scorecard tracks the system's performance in key areas, such as heart failure, pneumonia and surgical care.
8. Transparency is the rule in the care of the patient. This principle recognizes that true patient-centered care requires transparency between providers and patients and among providers. Providers should be "upfront and honest with information so [patients] can make informed decisions with us," Ms. Parsons says. One way MSHA supports transparency is by posting its quality and safety performance on its website.
9. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. All processes at MSHA, even those that don't involve patients, should be performed from a "patient-value" perspective," Ms. Parsons says. For example, she says the coding and billing process is done from the perspective of the patient; staff has worked to make bills clear and easy to understand for patients.
10. The patient is the source of control for their care. A core tenet of patient-centered care is that the patient controls his or her care. "Making patients the source of control of their care is the result of effective deployment of all other guiding principles," Ms. Parsons says. "To be the source of control, you have to have transparency and share information, create an environment that allows the patient to heal and focus work on the patient.
After discharge, patients can still have a degree of control by participating in a patient advisory group that meets regularly at each MSHA facility to provide input on how the system can improve care and become more patient-centered. The groups are composed of six to 12 patients who provide input on specific care models, such as diabetes programs. Soliciting suggestions from those on the receiving end of healthcare gives patients some control over future healthcare services and helps MSHA continue to put patients first in their decisions.
Embedding principles in everyday work
To emphasize the importance of these principles to all MSHA operations, system leaders explicitly connect policies to one or more of these patient-centered care principles. For example, MSHA's social media policy states, "MSHA seeks to optimize communication and social presence through the official use of social media and also recognizes the importance of supporting team members in shaping industry conversation through their responsible use of social media." The policy then lists "All team members are considered caregivers" and "Patient safety is a visible priority" as applicable patient-centered care principles. By clearly linking policies to these principles, MSHA brings patient-centered care from an abstract philosophy to a concrete practice.
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