A patient-centred approach to the design, delivery and evaluation of healthcare services will improve patient outcomes, the quality of care and reduce costs. We look at seven practices that healthcare leaders can adopt to make patient-centred care a reality.
We are in the age of the customer. Individuals are increasingly in control of and vocal about the products and services they consume. Organisations in most sectors are increasingly using information about what their customers want and need in order to drive strategy and measure their success.
Healthcare is no different, and there is a growing recognition that healthcare organisations need to shift to patient-centred approaches and understand how to deliver positive patient experiences. For example the Productivity Commission’s report, ‘Shifting the Dial – 5 year productivity review’, recommended that “all Australian governments (should) re-configure the health care systems around the principles of patient-centred care”.1
Outside of these policy drivers however, the case for change is clear; there is robust evidence that a patient-centred approach to the design, delivery and evaluation of healthcare services will improve patient outcomes, the quality of care and reduce costs. The question is of course, if there is compelling evidence to transform our health services to provide better patient experiences, what should be done to get there?
Through learnings from the literature, extensive conversations with other Australian and international healthcare organisations, and our own experience, we have identified seven practices which can be put into place in order to support patient-centred care:
Leadership commitment may be the single most important contributing factor to the delivery of patient-centred care.2 Sustained commitment over time is critical in moving organisations away from a provider orientation and towards one which is truly focused on patients. In Australia, our current health system is built on foundations that are often decades if not centuries old: roles, behaviours and practices centred on the needs of those giving, rather than receiving care. As such, making the shift to patient-centredness is a paradigm shift for most health care organisations – it demands an unambiguous and durable commitment from the organisations’ most senior leaders to change.
Commitment over time however, can yield significant benefits. For example following a financial crisis in early 2000s, Virginia Mason, a health services provider in the United States, undertook a lean transformation of their hospital services. Using the Toyota Management System as a starting point, the organisation developed the ‘Virginia Mason Production System’ (VMPS). Through sustained commitment of their leaders, Virginia Mason has reaped extensive benefits, not only in terms of maintaining their financial viability but also in relation to their ability to provide outstanding patient experiences. For example, by reducing inefficiencies in practice, waiting areas have been completely removed in some clinics, as the need for them has been made redundant as patients simply do not have to wait.3
If an organisation is patient-centred, this must be reflected in its vision and mission. These public statements are key in establishing shared expectations of care – shared across not only those in leadership and frontline care delivery roles, but also between the health care organisation and its patients. For example, the University of Pittsburgh Medical Centre’s mission includes a commitment to “…put our patients, health plan members, employees, and community at the centre of everything we do and create a model that ensures that every patient gets the right care, in the right way, at the right time, every time…”.4
Involving patients in establishing a vision is important and organisations must work to ensure that patients understand what this means. Strategies such as establishing a charter of health care rights may be one potential mechanism to achieve this.5
For organisations that are genuinely patient-centred, these statements are more than just symbolic. They form an integral part of a simple, and compelling narrative that is able to be used by staff and management on a day to day basis.
In organisations with a patient-centred culture there is a shared perception of the importance and value of the patient experience. Staff across all levels of the organisation and from all disciplines and professional backgrounds hold a high level of awareness of and demonstrate a commitment to the behaviours, values and assumptions that place the patient at the centre of care.
To support the development of a patient-centred culture, there are a range of culture-change strategies which could be used. At the Cleveland Clinic in the United States for example, a whole of organisation transformation was undertaken through the introduction of a number of strategies, including one focused on embedding a culture of ‘serving leadership’. Initially introduced through workshops commencing at the leadership level and subsequently cascaded down through the entire organisation, the culture of serving leadership has since become embedded, with all of the clinic’s managers (in excess of 3000 personnel) receiving serving leadership training.6
We have discovered that one of the major challenges in Australian health care organisations is that the responsibility for patient experience typically sits with a particular individual or role – often a quality manager, or patient liaison officer. For organisations who demonstrate maturity in their patient-centred practice, accountability looks quite different – with patient experience being everyone’s responsibility. These accountabilities are articulated in organisational policy and staff from all levels of seniority, disciplines and professional backgrounds have their individual responsibilities as they impact the experience of the patient specified in their position description. For example the serving leader competencies associated with the Cleveland Clinic’s initiative described above are built into the clinic’s performance management system.7 In other provider organisations, individual clinicians are responsible for and measured upon indicators of experience that patients have identified as important to them.
Historically, collecting patient reported measures at scale and in a timely manner has not occurred in the majority of Australian health care organisations. Earlier this year OECD Health Ministers released a statement urging investment in “measures that will help us assess whether our health systems deliver what matters most to people”.8 Organisations will benefit from automated systems which ask every patient for feedback and make data available in real time. The true value in measurement of course lies in using it to design and implement processes to improve patient experience and patient-centred delivery.9 Organisations which develop a ‘reporting culture’ learn to embrace this level of transparency and information as a key driver for ongoing service improvement.
Including patients in the design and redesign of health care services is fundamental to enhancing the patient experience. Without patients’ input, we are left to assume that we understand what patients want and need and risk simply perpetuating current practices. The inclusion of patients should be considered the standard way of doing business and occur at multiple levels of the organisation, including the point of care delivery, at the clinical microsystem level and at the organisational leadership level.10 For example, The Hospital for Sick Children in Toronto (SickKids) involves patients and their families at three levels: in direct care, where patients are each asked how they would like to be involved in decision making about their own care, in organisational design initiatives, and at the policy making level.11
Patients’ involvement need not be complex. There are a range of mechanisms that can be utilised to involve patients in all parts of their health care, such as working groups, designing facilities, and serving on advisory committees.12 For example at Beth Israel Deaconess Medical Centre, patients are brought into decision-making processes related to quality and safe care through patient and family councils, acting as advisors on staff committees, and project-based feedback opportunities.13 More locally, at the Royal Children’s Hospital in Melbourne, consumers are involved in senior staff appointments. The fundamental tenet is to have a defined strategy for codesign in your organisation, then sticking to it.14
Digital technologies are an important enabler for patient-centred care. Health IT can be harnessed to support the sharing of information, the provision of patient education and the promotion of health literacy.
Solutions which facilitate the accurate and timely sharing of information about the patient’s care between care givers continues to be of utmost importance in enabling patient-centredness; this is particularly the case when patients can access (and even contribute) to this information source and digital health solutions are the clear mechanism through which do make this happen.
Health IT also provides great power to address problems that patients routinely highlight as having an impact on their experience, such as waiting times. For example, at the Children’s Hospital in Melbourne, scheduling and queue management systems are in place which allow for patients to self-check in via an app when within a one kilometre radius. They are then sent a text message 10 minutes prior to their own appointment; thus allowing patients to wait in areas of the hospital which suit them, rather than spending extensive time in the waiting room.15 The important caution here is that while technology can help solve problems that impact on patients’ experience – it is not a panacea to end all ills.
We believe there are several characteristics of a patient-centred organisation. It has:
So where is a healthcare organisation to start on its journey towards a more patient-centred approach? Considering the maturity of each organisation in relation to each of these enablers may be one way to initiate action, as every organisation will present with areas of strength as well as opportunities for improvement. Without doubt however, winning the hearts and minds of leadership is critical not only to initiate action, but also to sustain the necessary focus over time.
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