Project Director Division of Standards and Survey Methods The Joint Commission USA.
I have been fortunate to serve as the Principal Investigator of a study (Hospitals, Language and Culture: A Snapshot of the Nation) that investigated how hospitals across the US are meeting the diverse cultural and linguistic needs of the patients they serve. A key principle of patient-centred care is, sensitivity and responsiveness to the patients' cultural health beliefs and communication needs. Our study found that hospitals in the US are challenged to meet these needs. Despite the challenges, some hospitals have implemented promising systems and practices to better meet diverse needs. Our most recent research report, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations found that hospitals need to consider several things in order to become more patient-centred:
These 'themes' represent a systematic approach that results in action, tailored to the specific needs of the patient. Through our work, we observed that "one size fits all" approach does not exist and hospitals must be willing to continually assess, monitor and evaluate how they meet the patients' needs. Since demographics and needs change, this is a continuous process. It becomes a difficult concept for hospitals to grasp since they are driven by metrics and patient-centred care is difficult to measure. It is often considered to be 'soft' and of a lesser merit than other safety imperatives.
As I mentioned above, we have identified four main areas or 'themes' that should be present in a hospital in order to provide care that suits best to patient's needs. These are rather broad-based themes, which allow a hospital to focus their approach towards resources and needs. There is a growing appreciation of the need for patient-centred care among providers, hospitals and patients. Healthcare systems that can provide appropriate monitoring and evaluation of patient-centred approach needs to be improved. While many promising practices have been identified for providing patient-centred care, many remain untested for their effectiveness. Better mechanisms to monitor the needs and effectiveness of systems to respond to those needs must be in place, so that there is a greater evidence base of quality and safety. But individual hospitals can look at these systems through their quality improvement initiatives. Integrating patient-centred and culturally competent care principles into quality improvement effort was one amongst the 32 recommendations that were made in our first research report, Exploring Cultural and Linguistic Services in the Nation's Hospitals: A Report of Findings.
I think technology can support patient-centred care, but I don't believe that patient-centred care is entirely dependent upon it. I believe that technology can facilitate systems for information sharing that can improve the way needs are met. But, there must be an organisational commitment to providing culturally competent, patient-centred care. As a part of our research, we interviewed administrators and clinical staff at 60 hospitals in the US. In some cases, responses to our interviews indicated a desire for better technology to address the issues. However, patient-centredness is not simply information management, nor is a specific practice or procedure. It is the provision of the type of care that is able to adapt to changing needs, is sensitive to different beliefs and can accommodate and assist patients as they navigate a complex system. As I reflect on some of the hospitals I visited that were particularly adept at providing culturally competent patient-centred care, I recall that I was impressed not with the technology, but with the human element that was present within the hospital's systems. These were also hospitals that made use of information technology to assist in the collection and use of data; and invested in systems such as remote video interpreting and telephone interpreting systems to compliment human resources to meet the language needs. So, there is a need for technology, but it is secondary to the need for organisational commitment.
Leadership support and organisational commitment is essential. Without this commitment, patient-centred care can not be achieved at an organisational level. Leadership brings attention to the issues allowing discussion and collaboration to occur and bring about proposed solutions. It also provides the necessary financial and human resources to make certain that in the domain of healthcare, quality is achieved.
I think it is important that we define patient-centred care. To define, it should include attention to the myriad of health care needs that individual and populations of patients wish to be fulfilled. These needs may include issues like cultural, educational, physical and environmental constructs that may impact how care is interpreted by the patient. It is also important for hospitals to consider how their processes, systems and environment can influence the way care is provided.
For more information, please visit http://www.jointcommission.org/PatientSafety/HLC/