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PATIENT-CENTERED CARE AS ORGANIZATIONALCULTURE CHANGE


We would be remiss in producing an Improvement Guide full of specific practices in patient-centered care without making it abundantly clear that an organizational culture of patient-centered care is characterized not by discrete programs, but by the core values and attitudes behind the implementation of such programs. Patient-centered care is about engaging the hearts and minds of those you work with and those you care for. It is about reconnecting staff with their passion for serving others. It is about examining all aspects of the patient experience and considering them from the perspective of patients versus the convenience of providers. Ultimately, it is about a collective commitment to a set of beliefs about the way patients will be cared for, how family will be treated, how leadership will support staff, and how staff will nurture each other and themselves.

In the absence of such an overarching organizational vision, programs and policies, on their own, may effectively address specific objectives, but they will fall short of cultivating an authentically patient-centered organization. In a patient-centered culture, the core value of prioritizing the perspectives of patients and families may be manifested with, for instance, the development of a Patient and Family Advisory Council, with routine patient rounding to understand their perceptions of their care, or with regular focus groups. Without the conviction of the core values behind these practices―without a genuine recognition of the need to be responsive to the voice of health care consumers―such practices will be in vain. On the other hand, in an organization where a culture of patient-centeredness has taken root, these formal approaches are naturally complemented by the countless informal ways that staff―committed on a deep level to meeting the needs of those they care for―interact with patients, families, and even each other at the bedside, in the lobby, in the cafeteria, etc.

This difference between discrete patient-centered practices and comprehensive culture change is corroborated in conversations with leaders at a number of patient-centered hospitals that have performed well on the HCAHPS survey. These leaders confirm that, in their view, their survey success cannot be attributed to any precise or tangible actions or programs. Asked to identify the specific drivers for their HCAHPS success, many of them took a more nebulous approach, describing instead an organizational culture in which, of course, call bells are answered promptly, communication with nurses and physicians is open, and important information is reinforced―again, not because of a series of in-services or program roll-outs, but because that‘s the expectation throughout their hospital of how care is provided.

And therein lies the rub for many organizations striving to become more patient-centered. Patient-centeredness is not a check-list, a dashboard or an action plan. It is a cultural transformation. As such, it requires buy-in and engagement from all levels of the organization, it requires a long-term commitment, and a willingness to routinely challenge the ―that‘s the way we‘ve always done it‖ mentality.

What‘s more, patient-centeredness is not a goal to be achieved in order to move on to the next initiative. The true test of a culture of patient-centered care is its sustainability, and its ability to endure even in the face of high census days, staffing shortages, demanding patients and leadership turnover. True to any profound organizational culture change, the gradual shift to patient-centeredness comes with a natural ebb and flow of momentum. Rather than a reason to abandon efforts to become more patient-centered, these ebbs represent opportunities for revitalization, celebration of past accomplishments and setting new goals; the ―flows are opportunities to push through barriers to further advance the culture.

So, it is with this caveat that this Patient-Centered Care Improvement Guide is presented: to be truly effective, the practices contained within must be implemented as part of a long-term and comprehensive vision of organizational culture change. That shift of mindset is a profound one with the power to unleash a swell of passion, enthusiasm and activity within your organization that will go far beyond the launching of a series of new initiatives. Indeed, with time, patience and ongoing attention, it could result in sweeping changes with far-seaching effects that will be felt for years to come by your patients, their families, and staff.

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