Patient-centered care is becoming increasingly crucial in modern healthcare. The American Medical Association (AMA) emphasizes a “mutually respectful alliance” in the patient-physician relationship, highlighting the importance of patient and family-centered care (PFCC). This approach respects patient values in care decisions and recognizes patients and families as essential partners in improving healthcare practices. The Picker Commonwealth Program For Patient Centered Care significantly influenced this movement, shaping the dimensions of what constitutes truly patient-centered healthcare.
The Rise of Patient-Centered Care and the Picker Commonwealth Program
Patient-centered care, sometimes referred to as PFCC, is characterized by a two-way partnership between healthcare providers and patients. This partnership is gaining prominence as the healthcare industry shifts from valuing volume to valuing the quality of care provided. Legislation like the Medicare Access and CHIP Reauthorization Act (MACRA) in the US, which ties physician compensation partly to patient experience and outcomes, demonstrates this shift.
However, the core ethical strength of PFCC lies in its deep respect for patient autonomy and perspectives. Integrating PFCC principles into organizational culture signifies a profound ethical commitment. As noted by experts, prioritizing patient preferences should be a moral imperative in healthcare. Furthermore, research demonstrates a strong link between patient-centered care and improved patient safety and clinical effectiveness, ethically desirable outcomes in themselves. Engaged patients tend to experience better health results and often contribute to lower healthcare costs overall.
One effective methodology for implementing PFCC is the Patient- and Family-Centered Care Methodology and Practice (PFCC M/P), developed at the University of Pittsburgh Medical Center (UPMC). This approach empowers patients and families to be active participants in reshaping the entire care process. The PFCC M/P’s six-step approach is directly influenced by the foundational work of the Picker Commonwealth Program for Patient Centered Care, initiated in 1987.
The Picker Commonwealth Program played a pivotal role in defining patient-centered care by deriving its categories from patient focus groups. They underscored the ethical dimension of this approach, emphasizing that respecting each patient’s individuality is fundamental to compassionate medical care. The significance of the Picker Commonwealth Program’s work was further highlighted in a 2001 report by the Institute of Medicine (now the National Academy of Medicine). This report identified patient-centered care as one of the six essential goals for a 21st-century healthcare system. Donald Berwick, founder of the Institute for Healthcare Improvement, has also stressed that patient-centeredness is a critical dimension of overall healthcare quality.
Implementing Patient-Centered Care: The PFCC Methodology and Practice
Acting ethically to enhance clinical outcomes is a central principle of the PFCC M/P. This methodology adapts the six dimensions identified by the Picker Commonwealth Program into actionable steps. It encourages healthcare providers to view all aspects of care through the patient’s and family’s experiences. Crucially, patient-centeredness becomes a shared responsibility across the entire healthcare organization, not just for doctors, but for everyone involved in a patient’s care journey.
The PFCC M/P’s six steps provide a structured approach to improving patient care experiences:
- Define the care experience: Clearly outline the specific care process needing improvement, including its start and end points.
- Create a PFCC Guiding Council: Establish a leadership group to oversee the improvement efforts and address any obstacles.
- Define the current state: Assess the current patient care experience using methods like shadowing, surveys, and other feedback tools.
- Expand to a PFCC Working Group: Broaden the Guiding Council to include representatives from every “touchpoint” of the patient experience identified in the shadowing phase.
- Write the ideal story: Develop a narrative describing the ideal patient experience from the patient and family’s perspective, written in the first person.
- Create PFCC Project Teams: Form teams to develop and implement projects aimed at bridging the gaps between the current and ideal states of patient care.
Successful Applications of Patient-Centered Care Principles
The ethically grounded and patient-focused nature of the PFCC M/P, inspired by the Picker Commonwealth Program, has demonstrably led to positive changes in healthcare settings.
For instance, Wake Orthopaedics in North Carolina revamped its pre-operative processes, prioritized patient communication, and improved pain management strategies based on patient feedback. Within a year, they achieved significant improvements: surgical infection rates dropped to zero, readmissions decreased, patient satisfaction scores increased substantially, and per-patient costs reduced.
Harvard-Vanguard Outpatient Women’s Services used PFCC M/P techniques, including patient shadowing, to redesign their physical space. This led to increased patient privacy during consultations and improved staff collaboration, addressing patient concerns about team cohesion.
The Royal United Hospital in Bath, England, applied the PFCC M/P to improve end-of-life care. Prior to implementation, staff expressed a lack of confidence in handling critical end-of-life decisions. However, within nine months of implementing PFCC M/P, significant improvements were observed. Documentation of end-of-life discussions by physicians increased to 100%, family discussions also reached 100%, and communication of advance care planning to primary care teams became universal. Furthermore, junior doctors received enhanced mentorship and support in end-of-life care.
The Value and Efficiency of Patient-Centered Approaches
Despite the proven benefits, some clinicians still perceive PFCC as a resource-intensive or overly sentimental approach. However, the PFCC M/P has typically achieved positive outcomes by strategically reallocating existing resources, without requiring budget increases or additional staff. In fact, as seen in the examples, it can lead to reduced healthcare expenditures. Participating physicians may spend a relatively small amount of time per week on PFCC M/P activities, which is often offset by time saved from dealing with inefficient processes. Research emphasizes that the benefits of patient-centered care extend beyond the “nice-to-have” aspects, leading to tangible improvements in clinical results and cost efficiency.
The PFCC M/P team’s experience indicates that while initial skepticism from experienced clinicians is common, it usually dissipates once they engage in patient shadowing and directly observe the care process from the patient’s perspective. Clinicians often report feeling more fulfilled in their work as a result of addressing the frustrations experienced by both patients and healthcare providers.
The core principle of PFCC M/P aligns with the Hippocratic oath’s foundational principle of “First, do no harm.” It extends this ethical consideration to encompass not just clinical harm, but also other forms of harm patients might experience within the healthcare system, such as loss of personal belongings. By systematically addressing these issues through patient-centered approaches, healthcare organizations can create a more compassionate and effective care environment.
Conclusion: The Enduring Legacy of the Picker Commonwealth Program
Patient- and family-centered care is becoming an indispensable aspect of modern medicine, driven by both internal professional values and external pressures for value-based payment models. The PFCC M/P, grounded in the ethical principle of partnership with patients and families, provides a structured method for realizing patient-centered care. Inspired by the foundational work of the Picker Commonwealth Program for Patient Centered Care, it empowers clinicians to identify and address patient-centric issues and develop effective, patient-driven solutions. By incorporating continuous improvement and accountability, the PFCC M/P effectively translates ethical intentions into ethical actions throughout healthcare organizations.
Drawing inspiration from Hillel’s timeless questions about selflessness and service, patient- and family-centered care reminds all healthcare professionals of the core ethical values that motivated their entry into the field and the ongoing need for proactive, patient-centered action.
