Rationale and approaches to person-centred care

Research demonstrates that person-centred care improves patient experience and creates public value for services. When health professionals, managers, patients, families and carers work in partnership, the quality and safety of health care rises, costs decrease, provider satisfaction increases and patient care experience improves. Person-centred care can also positively affect business metrics such as finances, quality, safety and satisfaction.

Patient outcomes

There is an increasing body of research about the association between patient experience and perceptions of care, and overall measures of quality and safety.

• Clinical benefits found to be associated with better patient experience and person-centred care include decreased readmission rates, decreased rates of healthcare-acquired infections, improved delivery of preventive care services, reduced length of stay, improved adherence to treatment regimens and improved functional status.
•  Studies of associations between the experience of patients and patient safety indicators across a large number of hospitals in the US found positive associations between patient experience and overall technical quality and safety.
• For patients who have had an acute myocardial infarction (AMI), several studies have shown an association between person-centred care and clinical outcomes, including mortality. One study found that better person-centred care during admission for AMI was associated with a decreased risk of death one year after discharge.
• One study found that factors such as better communication with doctors, a clean and quiet hospital environment and the responsiveness of medical staff were significantly associated with a decreased likelihood of pressure ulcers and post-operative infections.
• Participation of hospital patients in their own care, such as asking questions or participating in decision making, has been found to reduce the risk of experiencing an adverse event.

Business outcomes

Evidence about the impact of person-centred care on the business and operation of health services is also emerging.

• One study compared data for inpatient units at two similar hospitals in the US over five years. One hospital introduced an extensive program of person-centred practices, and the other continued their usual practices. The person-centred inpatient unit consistently demonstrated a shorter average length of stay, a statistically significant lower cost per case, a shift in emphasis from the use of higher-cost staff to lower-cost staff, and higher-than-average overall patient satisfaction scores.
• In a study of the introduction of person-centred management practices for patients with multiple conditions compared with usual care, a significant decrease in costs was found for the person-centred group compared with the usual care group, without any shortening of life.
• In the US, there have also been reports of hospitals experiencing considerable reductions in malpractice claims following the implementation of person-centred care practices, despite an increase in patient care activity.
• Increasing patient satisfaction through person-centred approaches also increases employee satisfaction. This, in turn, improves employee retention rates and the ability to continue practising person-centred care.

Australian healthcare organisations are becoming increasingly interested in person-centred care. Many health services have already taken steps to embed person-centred care principles into practice and provide care that addresses the needs and desires of the consumer, as well as their immediate treatment requirements.

Internationally, governments and healthcare services have used a wide variety of strategies to promote person-centred care. Various international organisations have also helped to develop and implement these strategies, including Planetree, the Picker Institute and the Institute for Patient-and Family-Centered Care.

At different levels

There is a role for person-centred care at each level of the healthcare system:

• The individual level refers to an individual’s experience of their care. At this level, care should be provided in a manner that is respectful, assures the ongoing and candid sharing of useful information, and supports and encourages the participation of patients and families.
• The service level refers to the service, department or program level of care. At this level, consumers and family advisers should participate in the overall design of the service, department or program. This could be as full members of quality improvement and redesign teams, and participating in planning, implementing and evaluating change.
• The organisational level refers to the organisation as a whole. The organisational level overlaps with the service level in that the organisation is made up of various services, departments and programs. At this level, consumers, families and carers should participate as full members of key organisational committees for subjects such as patient safety, facility design, quality improvement, consumer and family education, ethics and research.
• The environment or system level refers to the regulatory level of the health system. Here, the perspectives of consumers, families, carers and consumers can inform local, state, federal and international agency policy and program development. These agencies, along with accrediting and licensing bodies, are in a position to set expectations and develop reimbursement incentives to encourage and support the engagement of consumers and families in healthcare decision making at all levels.

Organisation recommendations

Key strategies for building person-centred care into the systems of healthcare organisations include regular monitoring and reporting of consumer feedback data; engaging consumers, families and carers as partners; demonstrating committed senior leadership; building staff capacity and a supportive work environment; establishing performance accountability; and supporting a learning organisation culture.

In its review of person-centred care, the Commission recommended that health service executives and managers should:

• ensure that organisational systems and processes are designed to be person-centred
• ensure their healthcare organisation develops a shared person-centred mission that senior leaders continually articulate to staff to promote the implementation of person-centred care
• develop and implement policies and procedures for engaging consumers, families and carers in their own care
• develop and implement policies and procedures for involving consumers, families and carers at the service level, and in policy and program development, quality improvement, patient safety initiatives and healthcare design
• provide support for consumers, families and carers involved in governance to develop the necessary skills and capacity required for effective partnerships with their healthcare organisation
• ensure that the service meets the National Safety and Quality Health Service Partnering with Consumers Standard
• ensure that systems are in place for the regular collection and reporting of patient experience data through quantitative patient surveys and qualitative, narrative-based sources
• ensure that organisational approaches to quality improvement include feedback about patient experience – alongside clinical and operational data – when determining health service action plans
• contribute to the evidence base for person-centred care by recording and publishing changes in key organisational and patient outcome metrics over time
• provide organisational support to enable staff to partner with consumers, and to implement any necessary changes based on that partnership
• support staff through training and education activities tailored to building the capacity of all staff to deliver person-centred care
• focus on work environment, work culture and satisfaction of staff as an integral strategy for improving person-centred care; workforce surveys and review of staff recruitment and retention rates should be undertaken at regular intervals to monitor the work environment
• integrate accountability for patient experience into staff performance review processes
• foster a culture of learning within the organisation, equally learning from successes and failures including tragic events, to promote person-centred care.

External links

Australian Institute for Patient and Family Centred Care

Training and consultancy to support the delivery of patient- and family-centred care

Centre for Health Communication and Participation

Evidence, guidelines and resources for consumer engagement in hospitals, from La Trobe University

Institute for Healthcare Improvement

Online training and tools, and international conferences on high-quality health care

Planetree

A range of tools and resources supporting the delivery of person-centred care from this international agency

Institute for Patient- and Family-Centered Care

US resources and educational programs about patient- and family-centred care

Picker Institute

UK research, tools and insights into high-quality person-centred care