Promoting Patient-centered Care

A Qualitative Study of Facilitators and Barriers in Healthcare Organizations With a Reputation for Improving the Patient Experience

Karen Luxford; Dana Gelb Safran; Tom Delbanco


Int J Qual Health Care. 2011;23(5):510-515. 

In This Article

Abstract and Introduction


Objective To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience.
Design A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment, measurement and feedback mechanisms, patient engagement and information technology and access.
Setting Eight health care organizations across the USA with a reputation for successfully promoting patient-centered care.
Participants Forty individuals, including chief executives, quality directors, chief medical officers, administrative directors and patient committee representatives.
Results Interviewees reported that several organizational attributes and processes are key facilitators for making care more patient-centered: (i) strong, committed senior leadership, (ii) clear communication of strategic vision, (iii) active engagement of patient and families throughout the institution, (iv) sustained focus on staff satisfaction, (v) active measurement and feedback reporting of patient experiences, (vi) adequate resourcing of care delivery redesign, (vii) staff capacity building, (viii) accountability and incentives and (ix) a culture strongly supportive of change and learning. Interviewees reported that changing the organizational culture from a 'provider-focus' to a 'patient-focus' and the length of time it took to transition toward such a focus were the principal barriers against transforming delivery for patient-centered care.
Conclusions Organizations that have succeeded in fostering patient-centered care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus.


Health care organizations seek increasingly to improve quality by refocusing organizational policy and care delivery around the patient, bolstered by evidence for benefit in clinical outcomes, patient experiences and a business case that support movement toward 'patient-centered care'.[1–7]

Focusing care delivery on patient needs and preferences is a useful way to define patient-centered care. Starting in the late 1980s, researchers worked to identify core components of such care, and in 1993 the Picker Institute identified eight domains: respect for patient preferences and values; emotional support; physical comfort; information, communication and education; continuity and transition; co-ordination of care; involvement of the family and friends and access to care.[8]

Further research has yielded similar core concepts,[9–12] and the International Association of Patient Organizations identifies respect for patient needs and preferences as the most consistent element of definitions of patient-centered care.[13]

Given such constructs, improving patient care experience is integral to improving the overall quality of care received by a patient, with 'patient-centeredness' included as a dimension of quality in its own right.[1,14] While the domains of quality identified in the IOM 'Crossing the Quality Chasm' report have gained broad support within healthcare, implementing a patient focus is challenging. Shaller[10] developed a framework suggesting seven key factors for achieving patient-centered care at the organizational level: engagement of the top leadership; a strategic vision clearly and constantly communicated to every member of the organization; involvement of patients and families at multiple levels; a supportive work environment for all employees; systematic measurement and feedback; the quality of the built environment; and supportive information technology.[10]

Health care organizations have devoted considerable effort to applying established strategies for quality improvement. With mixed degrees of success, they have focused on systems for risk management, incident reporting and quality assurance.[15] Despite such industry-based approaches, research suggests that current quality improvement strategies, such as clinical audit and feedback, are insufficient to ensure the widespread implementation of patient-centeredness throughout an organization.[16,17]

Organizations are struggling to involve patients and learn from their experience,[16,18,19] A comprehensive, organization-wide approach, fundamentally linked to organizational strategy, may be required.[20] Hypothesizing that 'exemplar' institutions might furnish particular insights, we undertook a qualitative research study to examine both facilitators and barriers within organizations renowned for improving patient care experience.


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