The BMJ Spotlight: Patient Centred Care
This spotlight series of articles on patient centred care explores how doctors and patients can work collaboratively to improve the way healthcare is designed and delivered so that it better meets the needs and priorities of patients.
Empowered patients are driving a social movement and spearheading a shift in roles “as profound as women’s liberation, racial equality, gay rights, and disability rights”.
They are capable and motivated to help themselves and other patients to get better care and work with health professionals to improve services which are not well geared to meet the challenge of demographic change and the rise in number of people living with long term conditions where it is important that people take on a greater role in self managing their health and medical conditions.
The spotlight series is another step in the development of The BMJ’s Patient Partnership strategy and brings together analysis and comment from doctors, patients, carers, and community representatives to help inform, inspire and spur change.
It was supported by DNV GL and edited by Tessa Richards, Angela Coulter, and Paul Wicks. The articles were commissioned and peer reviewed according to the The BMJ's normal processes. Competing interests are available here.
The importance of taking a systems approach to person centred care
Combining systems thinking with the co-creation of person centred care offers a powerful framework for redesigning healthcare.
Time to deliver patient centred care
Patient centred care is central to the mission of healthcare, yet traditonally neither patients nor the public have the power to shape the services they use and pay for, or define their value. As a result, many patients find services difficult to navigate, disempowering, burdensome, and seemingly designed to frustrate.
Roundtable: How can we get better at providing patient centred care?
Participants in our discussion on person centred care in January 2015 agreed that a change in culture and better use of technology could benefit both patients and doctors.
New South Wales mounts “patient based care” challenge
The Clinical Excellence Commission in New South Wales is driving person centred care by stimulating districts to compete to provide it. Karen Luxford and Stephanie Newell describe the integrated approach, its uptake, and encouraging early evidence of change.
Commentary: Swedish initative on person centred care.
US experience with doctors and patients sharing clinical notes
The move to offer patients online access to their clinicians’ notes is accelerating and holds promise of supporting more truly collaborative relationships between patients and clinicians, say Jan Walker, Michael Meltsner, and Tom Delbanco.
"Opening access to notes needs to be accompanied by reform of their content if they are to become a more effective communication tool between clinicians and patients and caregivers;"
"We saw providing online access to medical records, seamless information exchange, the promotion of patient partnership, and peer to peer support as central"
“Our experience has shown that it is not sufficient to provide patients with viewing rights. They need to understand the content of their records too. This has been helped by an explicit consent model”
“Health information, contact details of providers, and interactive services where they can ask questions anonymously that are answered within seven days”
Delivering person centred care in long term conditions
Transforming care for people with long term conditions, including support for self management, requires comprehensive reform of health systems largely geared to provide acute care. Simon Eaton, Sue Roberts, and Bridget Turner explore the barriers to change, arguing that the success of new approaches will depend on whole system change and strong leadership.
"I now feel I can manage my health independently except in a crisis. However, I am still requested to go to the hospital once every six months for an appointment that may not be needed."
“The current focus on person centred care runs the risk of overemphasising independence and stigmatising dependence and interdependence - which are facts of life for many older patients.”
“Shared haemodialysis care does require flexibility in units where traditionally services have been set up to ‘do things to patients.’”
“I want to be recognised as the most important member of the team: the one who know most about living with this disease.”
Patient reported outcome measures in practice
Scores of tools to measure outcomes that matter to patients have been developed over the past 30 years but few are used routinely at the point of care. Eugene C Nelson and colleagues describe examples where they are used in primary and secondary care and argue for their wider uptake to improve quality of care.
Commentary: Measuring what matters: the case for patient generated PROMS
From patient centred to people powered: autonomy on the rise
Following in the path of feminists and civil rights leaders, informed patients are building a progressive social movement to improve medical care. Dave deBronkart says medicine should let patients help improve care, share responsibility, and think for themselves.
Commentary: We need to be better prepared for a technological future
Commentary: Social media provides patients with support, information, and friendship
Patient communities reform healthcare in India
Anita Jain reports on public disillusionment with health service provision and how it has led patient advocates in India to mobilise and push for change.
Patients and staff as codesigners of healthcare services
Glenn Robert and colleagues describe an approach that aims to ensure that healthcare organisations realise the full potential of patients—the biggest resource they have for improving the quality of care.
Decision aids that really promote shared decision making: the pace quickens
Decision aids can help shared decision making, but most have been hard to produce, onerous to update, and are not being used widely. Thomas Agoritsas and colleagues explore why and describe a new electronic model that holds promise of being more useful for clinicians and patients to use together at the point of care.
Seeing things from the patients' view: what will it take?
Changing medical curriculums, listening to and discussing patient stories, and financial incentives that reward health staff for providing more patient centred care may help, but there are no magic bullets, says Nigel Hawkes.
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