Across the Chasm Aim #3: Health Care Must Be Patient-Centered

Information for this feature story was obtained from the IHI Calls to Action series, Implementing the Quality Chasm Report.
You might not think our health care system needs to be reminded to center its efforts on the patient. But as the system has grown more complex and fragmented, and as providers feel more pressure to see more patients in less time, care has become centered not on the needs of patients, but around the needs of the system itself. (A 1984 study of physician-patient interactions showed that a physician will listen to a patient’s concerns for an average of 18 seconds before interrupting.[1]) Hence patient-centeredness is one of the "Aims for Improvement" in the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century.
Care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient an integral part of the care team who collaborates with care providers in making clinical decisions. Patient-centered care puts responsibility for important aspects of self-care and monitoring in patients’ hands — along with the tools and support they need to carry out that responsibility.
Making care more patient-centered means adjusting nearly every aspect of practice, in every realm from the administrative to the clinical to the technological. To be effective partners in their own care, patients need better, sometimes non-traditional, access to information and to health care providers. Better information comes not only from access to one’s own patient record (the old notion that patients should not see their own medical records is counterproductive), but also from new forms of consultation with their care providers. With telephone and email consultations, providers and patients alike are finding a new freedom to communicate. Some health care organizations are beginning to offer patients the ability to manage information via the Internet, with access to secure websites that contain their medical records plus tools to chart and track personal health information, check on test results, request appointments, seek referrals, look for drug interactions, renew prescriptions, and send email to their care providers.
"We think the patient-centeredness of our current systems [is] far from what it should be," says Donald M. Berwick, MD, MPP, former President and Chief Executive Officer of the Institute for Healthcare Improvement and one of the Chasm report’s architects. He reminds health care professionals that "We are guests in our patients’ lives instead of hosts in our health care organizations."



[1] Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Annals of Internal Medicine. 1984 Nov;101(5):692-696.

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