Introduction
The concept of the patient-centered approach is fairly recent and unique. Undoubtedly, this approach grows out of the client-oriented policy. The only distinction is that the client and the final consumer are the patients, and the service is medical.
Certainly, it is impossible to equate a client-centered approach with a patient-centered one; however, their formation principles are identical. In forming a service and bringing it to the market, it is necessary to comprehend that the key will be the congruence of the purchasing power and the proposed service model. It is necessary to build a flexible system of interaction with clients and change the conditions of service provision on time in case the needs and desires of the end consumer change.
Basic principles include creating a comfortable emotional and psychological environment and being complicit in finding solutions for the client, along with the desire to constantly improve. The patient-centered approach’s specifics include creating an innovative strategy for planning, delivering, evaluating, and monitoring care based on client-centeredness. The patient-centered approach should be based on partnership and mutually beneficial principles of cooperation represented by administrative, physician, nursing, and support staff.
Principles of the Patient-Centered Approach
Before proceeding directly to the implementation of the approach, it is necessary to analyze the principles on which it is based. The slightest changes can be the most beneficial if the fundamentals of the approach are carefully followed. In 1993, Picker Institute & Harvard Medical School conducted an extensive sociological study, which formed the grounds of the global concept of patient-centered care (Eklund et al., 2019). During the study, the researchers concluded that eight key guides were underlying the approach.
The first principle of patient-centeredness is respect for consumer values, needs, and preferences. Considering the regulation of respect for the patient, this aspect is reflected in ensuring citizens’ rights in providing health care (Kokorelias et al., 2019). Moreover, the patient’s interests are prioritized, and special attention is given to the patient’s opinion.
The second principle is the therapeutic and diagnostic process’s integrity, logic, and continuity. One must understand that patients are a weak link in this aspect. Disease, which reduces a patient’s quality of life, paints the psycho-emotional background of mood in negative colors (Kokorelias et al., 2019). The patient, seeing the consistency of the medical staff, inspires hope for a speedy recovery.
The third principle is that the patient should be informed about all the details of the therapeutic and diagnostic process and the medical and social rehabilitation course (Eklund et al., 2019). This regulation is quite broad and encompasses numerous aspects. For example, patients should have access to information about their disease, clinical condition, treatment options, and prevention methods if they wish. Equally important is a comfortable environment, which is the meaning of the fourth principle. It consists of creating comfortable conditions for the patient’s stay while providing medical care at all stages of therapy (Cengiz & Yoder, 2020). It is reinforced by the need to provide emotional support for the patient.
In implementing this guide, the healthcare provider must consider factors such as the patient’s concerns about their condition and the outcome of the illness (Eklund et al., 2019). It should be taken into account that patients may be anxious about the possible consequences of their illness. It could include, for example, disability, financial insolvency, loss of employment, or family problems.
The sixth principle is creating conditions for communicating with the patient’s immediate environment. The patient’s comfort level should be evaluated. If possible, comprehensive support and communication with relatives, colleagues, and friends should be provided. At the same time, the therapeutic process should not be interrupted, and the seventh principle refers specifically to supporting its continuity (Kokorelias et al., 2019). Moreover, it is crucial to consider expectations as they change over time. To ensure this principle, it is crucial to provide detailed information about medications, restrictions, and diets in a way that is accessible to the patient.
The eighth principle is basic and forms all previous ones. It consists of properly providing medical care for the potential patient (Cengiz & Yoder, 2020). It is the physical accessibility to the medical organization, the availability of public transport, the possibility of an unimpeded appointment with a doctor, the possibility to choose a doctor, and the treatment method (Kokorelias et al., 2019). All principles are equally important, and the success of implementing the patient-centered approach directly depends on the compliance of the medical staff. At the same time, the approach involves several steps that are no less vital than the principles.
Implementation of the Patient-Centered Approach
One of the first steps in implementing the patient-centered approach is knowing patients’ opinions on the quality and accessibility of the healthcare services they receive. The most straightforward way is to ask patients after receiving the requested services. Firstly, changing the interaction model in the exchange structure with the patient as the final and key consumer of medical services is necessary (Kokorelias et al., 2019).
It is crucial to ask questions that relate to possible areas of improvement rather than negative experiences that may have happened. It should be understood that tracking patient sentiment and expectations falls not on the shoulders of the medical staff but on the supporting staff in this area. Medical staff provide the organization with the main flow of values and patient-centeredness in their attitude, which lies in the field of ethics and deontology of medical activity, as well as the degree of empathy.
One can talk about a three-level system of patient-centered health care. At the micro level, the key model is the nurse-patient relationship; at the middle level – the medical organization – the patient; at the macro level – the health care system – the patient (Kokorelias et al., 2019). At the same time, in a balanced healthcare system, the basis of this structure is the micro-level model. It is the primary indivisible element for the formation of the other models, which are also interdependent.
In an unbalanced healthcare system, one of the models may dominate against the background of degradation of other models. For example, a decentralized private sector of medical organizations is formed with hypertrophy of the first model, which prevails in crises (Kokorelias et al., 2019). With the increasing role of the state and centralization of the health care system, bureaucratization, and formalization of the treatment and diagnostic process, the nurse-patient model degrades. At the same time, competitive relations are destroyed with the increase of the state’s share in the formation of the national healthcare system, in the absence of effective management and control instruments.
Patient Compliance and Loyalty
A key underlying principle of the patient-centered approach is to increase patient compliance and loyalty. In this aspect, it is worth distinguishing these two concepts, although linguistically, they are synonymous (Cengiz & Yoder, 2020). Separating these ideas in shaping a patient-centered approach is necessary because of the different functional significance of these definitions.
Commitment to following the prescribed treatment and the physician’s requirements for compliance with the therapeutic and protective regimen reflects a personal attitude in the nurse-patient system. However, this factor is determined by the patient’s level of trust in the nurse’s competence and professional training. According to I.E. Leppik, the adherence category includes several components: a behavioral component, a focus on the result, and the degree of ability to carry out appointments (Kokorelias et al., 2019). In practice, the level of adherence is usually measured by the correctness or incorrectness of medication prescriptions.
Except for the direct adherence assessments, there are indirect methods for measuring adherence. These include the number of pills used, questionnaires, and checking patient records (Forsythe et al., 2019). As for patient loyalty, it is more appropriate to consider it in the medical organization-patient model. This indicator reflects the degree of patient trust in a particular medical organization and the whole medical care system. For example, trust in the private or state healthcare system or the system of paid medicine can be mentioned (Eklund et al., 2019).
Next to medical organizations, an insurance company can be included in the circle of subjects of the motivational model of medical organization-patients. However, this aspect only plays a role in the private sector. As for the public health sector, according to the survey, trust in a doctor (42.4%) is much lower than trust in a medical organization (76.9%) (Eklund et al., 2019). The low level of accessibility of the state system of medical care overshadows this picture. Thus, the level of commitment and loyalty is still low, but the patient-centered approach is a direct way to raise it.
The Role of Competent Nurses
The QSEN competencies apply to individual care and areas where nurses must consider system improvement. Daily care should not become routine or automatic; care should always be individualized. Nurses who are competent in patient-centered care can significantly impact the medical system. For example, they can improve the quality of care.
Nurses with in-depth knowledge and skills in patient-centered care can help improve the quality of care (Forsythe et al., 2019). They can provide an individualized approach to care, considering each patient’s unique needs. It can lead to more suitable treatment outcomes, fewer complications, and improved patient satisfaction.
Competent, patient-centered nurses play an important role in ensuring patient safety. They can follow safety protocols, ensure proper asepsis and antisepsis, closely monitor the patient’s condition, and prevent possible complications. It helps reduce medical errors and improve safety in the medical system. Moreover, patient-centered nurses can become important members of the healthcare team. They can actively collaborate with physicians, pharmacists, physical therapists, and other healthcare team members to provide coordinated and holistic care. It contributes to more efficient use of resources and improved overall health outcomes.
Patient choice, opinion, and service satisfaction have become key points in the healthcare system. This empowerment allows patients to better choose where, when, and from whom they receive health care. When patients deal with health problems, they are at their most vulnerable, and their expectations for pain-free, responsive care increase (Forsythe et al., 2019). Thus, the real measure of good treatment is often the patient’s experience.
For that experience to be positive, healthcare organizations must develop a culture that puts people at the center of the care process, including human resource management (Eklund et al., 2019). A patient-centered approach helps mitigate negative outcomes, especially when staff shortages affect care outcomes. Using the approach will help healthcare providers improve their overall performance. Patient-centered care should provide greater cost benefits in the long run by minimizing duplication and reducing waste through better coordination.
Implementing the approach, however, has a direct positive impact on healthcare workers. It can reduce fatigue and burnout, improve staff retention, and increase job satisfaction. Organizations would also benefit from attracting, training, and retaining the people they need to provide the highest quality healthcare services (Cengiz & Yoder, 2020).
Creating a workplace that actively provides adequate production facilities and other work infrastructure ensures physical and psychological well-being. It has reasonable wages and fair hours, leading to higher patient satisfaction and more successful clinical outcomes. Moreover, career advancement programs that reward healthcare workers for their education, skills, and leadership qualities positively impact staff retention rates and patient outcomes (Cengiz & Yoder, 2020). To improve patient outcomes and monitor them effectively, medical staff must see realistic ways to develop professionally and have the ability to give and receive feedback from peers and management.
Each competency within the QSEN framework encompasses the aptitudes, knowledge bases, and philosophies nurses should possess concerning the topic. For instance, nurses are prompted to determine obstacles preventing patients from vigorously partaking in their care plan in patient-centered care. The skill segment involves taking action to release those barriers or supply critical aids to facilitate patient engagement. On the other hand, the attitude factor emphasizes appreciating and honoring the patient’s intentions for involvement in the care process. By addressing these various aspects of patient-centered care, the QSEN initiative seeks to ensure that nursing experts are well-equipped to deliver high-quality, safe, patient-centered care.
Conclusion
When forming patient-centered management in a medical organization, it is essential to be guided in decision-making primarily by the patient’s interests. The primary goal is to increase the patient’s trust in the doctor and the medical organization. Interaction in this system is carried out on mutually beneficial terms and partnership relations, which should be reflected in the population’s medical services planning and implementation. To assess the activities of the medical organization and the health care system as a whole, it is necessary to consider citizens’ opinions about the quality control system of medical services and the effectiveness of management.
The founder of the medical organization should regularly initiate an independent survey of the attached patients, which should be the basis for planning the volume and type of medical services. Implementation of the patient-oriented approach, if properly implemented, leads, above all, to an increase in the turnout of the population and adherence to treatment, which, in turn, will be reflected in the detection of diseases. Moreover, it directly affects the duration of remissions, the reduction of morbidity, and the wider coverage of the population with preventive measures.
References
Cengiz, A., & Yoder, L. H. (2020). Assessing nursing students’ perceptions of the QSEN competencies: A systematic review of the literature with implications for academic programs. Worldviews on Evidence‐Based Nursing, 17(4), 275-282. Web.
Eklund, J. H., Holmström, I. K., Kumlin, T., Kaminsky, E., Skoglund, K., Höglander, J., & Meranius, M. S. (2019). Same same or different? A review of reviews of person-centered and patient-centered care. Patient Education and Counseling, 102(1), 3-11. Web.
Forsythe, L. P., Carman, K. L., Szydlowski, V., Fayish, L., Davidson, L., Hickam, D. H., & Anyanwu, C. U. (2019). Patient engagement in research: early findings from the Patient-Centered Outcomes Research Institute. Health Affairs, 38(3), 359-367. Web.
Kokorelias, K. M., Gignac, M. A., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: a scoping review. BMC Health Services Research, 19, 1-11. Web.