How is patient‐centred care understood by the clinical, managerial and lay stakeholders responsible for promoting this agenda?

Abstract

Aims and objectives This study explores how the term patient-centred care is understood, particularly by those who are involved in translating the concept from a theoretical idea into a practical application. It examines the ways in which intermediate level stakeholders such as health service managers, educationalists, professional leaders and officers of patient bodies understand and promote patient-centred care among health professionals actually delivering patient care.Design Qualitative interview study.Setting and participants Interviewees were drawn from groups and organizations from four categories: health agencies and regulatory bodies, Royal Colleges and other professional bodies, educational institutions, patient and user groups and consumer organizations.Main variables studied The meanings and understandings of patient-centred care, commitment to implementing patient-centred care and barriers and opportunities to implementation.Results and conclusions Patient-centred care covers a range of activities from patient involvement in individual care to public involvement in health policy decisions. Current Department of Health policy has made patient-centred care a priority, but has not clarified exactly what it means. Thus, health professionals, educationalists, managers and patient representatives have all developed different meanings of patient-centred care to reflect their own particular backgrounds and roles. The individual aspects of patient-centred care have been neglected in policy terms and important research findings have not been incorporated into policies to change the attitudes and behaviours of health professionals. Developing a shared understanding of patientcentred care which encompasses all its components is an important role for the new Commission for Patient and Public Involvement.

The Place of Patient-Centred Care in Medical Professional Culture: A Qualitative Study

“…We know that, when asked directly, clinicians tend to espouse patient-centeredness and believe that they themselves engage in patient-centred care, within the bounds of various professional constraints and organisational, personal and patient-derived limitations such as lack of resources and leadership, lack of skill and time, and difficulties in communicating with certain groups of patients (Tufano, Ralston et al 2008). There is, however, some empirical evidence that health professionals defining patient-centred care actually adopt a model in which professional priorities determine patients' needs (Gillespie, Florin et al 2004) and that adopting a patient-centred ideology can threaten clinicians' sense of status in relation to patients and colleagues (O'Flynn and Britten 2006). While this research is helpful, it is limited because doctors' espoused stance towards patient-centred care, whether positive or negative, might not accord with their actual (personal and cultural) values.…”

A Description of Nurse Practitioners’ Self-Report Implementation of Patient-Centered Care

“…The overall purpose of this study was to describe nurse practitioners' self-reported implementation of PCC. Although PCC is considered an essential element of high quality care and several studies and reviews of literature have been conducted to clarify what exactly comprises PCC [7][8][9][10][11][12][13][14][15], there is no agreement on its conceptualization [16]. Differences in the definition of what constitutes PCC lead to variability in its operationalization.…”

Doctors on Status and Respect: A Qualitative Study

“…This apparent resistance has been understood as stemming from "old-fashioned," paternalistic, clinical values (Gillespie, Florin, and Gillam 2004); from concerns about the resources required to, for example, spend more time talking to patients (Tufano, Ralston, and Martin 2008); from the perception that adopting a patientcentred ideology can threaten clinicians' sense of status in relation to patients and colleagues (O'Flynn and Britten 2006); and even from "cynical disengagement" on the part of students and doctors (Coulehan and Williams 2003;White et al 2009). We would argue that doctors' apparent resistance to patient-centred care, and other similar humanistic medical movements, might stem in part from a the perception that such movements are already consistent with current medical values and practice and that their formalisation into social movements, with the associated bureaucratic criticisms and demands, are yet another sign of managerial disrespect.…”