Promoting patient-centered care:a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience

摘要

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.