Mission – Patient-centred care - myth or reality?

Patient-centred care (PCC) has gained increasing attention in health care. Whilst the rhetoric is strong the reality may be a Mission Impossible. This paper describes our journey in trying to further the understanding of PCC to underpin an acute care redesign process.
Background In a desire to improve acute ward based care through a patient centred care redesign process we realised there currently lacked a widely accepted definition of PCC, with much of the literature based on definitions formulated by health professionals and researchers. In turn no tools were available to enable us to measure any success of a patient centred redesign process. This lead us to embark on a literature review on PCC as it is described, defined and operationalised by different stakeholders within acute healthcare. This was followed by an exploration of patients’ experiences of acute care and their conceptualisation of what PCC would mean to them and their perceptions of what constitutes PCC.
Objectives To identify whether there are common, core elements of PCC across the different disciplines of healthcare policy, medicine and nursing and if so what are they. To identify patients’ understanding and conceptualisation of PCC.
Methods We commenced with a qualitative narrative approach to the literature review to summarise the different primary studies from which conclusions were drawn into an integrated interpretation. This was followed by a phenomenological study using a semi-structured interview to explore the patients’ care expe-riences and then explore the more abstract concept of PCC and how this was understood and given meaning by patients.
Results/Discussion The narrative review included a total of 27 nursing texts, 19 medical texts (medicine and primary care), 7 health policy and 7 aged care (4 nursing and 3 medical) related texts. This revealed few common definitions were found across the literature. Three core elements were identified:• patient participation and involvement;• the relationship between the patient and the healthcare professional; and• the context where care is delivered).Ten patients shared their experiences, 8 females and 2 males, with ages ranging from early 30s to late 60s. The length of time they had been in the hospital at the time of the interview ranged between 6 days and 4 months. The patient exploration revealed patients were unfamiliar with the concept, but were able to describe what the term meant to them and what wanted from their care. Patients equated the care they received with the staff that provided it, and themes of connectedness, involvement and attentiveness were prevalent in their descriptions of what they wanted from their care.
Conclusion/Implications The reality of PCC that emerges from the health policy, medical and nursing literature are three core elements with different professional groups tending to focus on or emphasise different elements. In turn, in reality, patients are unfamiliar with the concept but equate the care they received with the staff that provide it. The myth remains can these differing views of PCC be truly integrated to improve care for patients in the acute care setting.