Lectures - Patient Centered Care
PCC is a pillar to healthcare quality.
Lecture 1.1 – Introduction to the course
What makes care patient centered or not?
1. Respectful and taking decisions together; shared-decision making
2. More than that: you, as a patient, may already feel patient centeredness when you
enter the health facility > atmosphere, comfortable, friendly staff, they know you
(coordination of care/involvement of family and friends/mental and social needs)
Movement from authority based care (professions are central in decision making) to
evidence based medicine (where care is provided to all patient populations based on the
evidence that is available) now leading to context based medicine (the importance of taking
into account the needs of individual patients and also taking decisions together context
matters!)
Lecture 1.2 – Video 1
The SPF theory
Overall well-being consists of two equal parts: Physical well-being and Social well-being.
Nowadays the healthcare seems to be more focused on the physical well-being (comfort of
patients: not in pain, sleep well etc.). Healthcare is not really focused on the Social well-
being, but studies show us that focusing on both leads to more effective care and better
outcomes. There is a challenge in investing in Social well-being as well and that’s where PCC
comes into play.
PCC
• Movement which became very popular since 2001, when the institute of
medicine (= advisory institute in America) introduced this topic. One of their
objectives for improving healthcare was working towards more PCCD.
• Definition = “Healthcare that establishes a partnership among practitioners,
patients, and their families (when appropriate) to ensure that decisions respect
patients’ wants, needs, and preferences and that patients have the education and
support they need to make decisions and participate in their own care”
,How to organize PCC?
You need a structure, otherwise you don’t know where to start.
How can we organize it within an organization? You have to look at the eight different
dimensions. Investing in these dimensions will result in better outcomes for the organization
and the patients.
Dimension
1. Patient preferences The interaction between the healthcare
professional and the patient. The
professional should treat the patient with
dignity and respect. Not only focusing on
the treatment, but also on improving the
quality of life. Patient should be supported
to set and achieve their own treatment
goals (e.g. personal treatment plans > set
their own goals, choose the focus).
2. Access to care Healthcare should be accessible to all
patients (e.g. financial, making quick
appointments, affordable wait times, e-
consult). Also the building itself has to be
accessible to all (e.g. wheelchair, blind,
foreign language).
3. Emotional support The emotional aspect of the disease (e.g.
fear, anxiety). Take that serious and address
it.
4. Physical comfort Two sided: 1) Address the clinical aspects of
the disease. All about pain management
and support patients with their daily living
needs (e.g. they can sleep well etc.) 2) The
physical comfort within an organization is
, addressed (e.g. waiting rooms, enough
privacy, chemo garden where they give
chemo in a relax and peaceful environment)
5. Family and friends For PCCD it is important to involve relatives
in care. Professionals should pay attention
to questions and needs of the relatives.
Housing for the relatives.
6. Information and education To be in charge as a patient you need to be
informed about all aspects of your care. It
should be provided and adjusted to the
level of the patient (e.g. education level,
background, language).
7. Transition and continuity All healthcare disciplines that can be
involved in the care for one patient. It is
important that relevant patient information
transfer between these professionals and
that the patient who will get transferred,
knows where he is going, why and what
care they will receive from other healthcare
disciplines.
8. Coordination of care All about the team within one discipline or
in one organization that is involved for the
patient. All professionals have to be well
informed and the patient has to tell their
story only once (e.g. regular team meetings,
case manager).
If you want to work PC, you can’t just choose two or three dimensions, but you really need
to improve on all dimensions in order to become more PC. You need a certain level in each
dimension.
There are some potential barriers to deliver good PCC time (a consult has a time limit and
you can’t discuss everything), money (time = money, so money is a problem as well. Often
there is not enough money to invest in e.g. communication training, new information
systems) and patient characteristics (patients with multi morbidity are hydrogenous; not all
have the same education level or want to talk about their feelings. A lot of differences
between patients which makes it very hard for professionals to determine what type of care
a patient needs).
Lecture 1.3 – Video 2
