Six Principles for Patient-Centred Care

By / June 23, 2014

Patientcentred care has become something of a buzzword in the the healthcare industry. As an idea, patient-centred care has been around for a long time. As far back as the 1970s, organizations like the Picker Institute and Planetree have been advocating for a transformation in healthcare delivery that centres on involving patients in their own care, to better meet the holistic needs of patients and their families.
However, in recent years, we have seen increased urgency and focus on patient-centred care. New technologies and better access to information enable individuals to have more control over their health and healthcare, increasing the pull towards patient participation. Meanwhile, shifting cultural norms undercut the old model of physician-as-omniscient-oracle, and patients increasingly expect (and are expected) to have their own voices heard in the treatment process.
Over the past few years, Bridgeable has worked on an increasing number of projects focused on different elements of patient centricity, working with organizations as diverse as hospitals, government agencies, pharmaceutical companies, and patient advocacy groups. Service design is a natural approach for helping organizations achieve their goals for being more patient-centric. However, many service design practices need to be adapted to be successful in this space. Based on our experiences, we have developed six key principles to keep in mind when using service design to help organizations deliver patient-centred care.

Principle 1: Remember that Patients Don’t Choose to Be There

Illness often limits the ability of people to participate in service design activities. Facilitating remote online sessions allows people to participate in a way that is compatible with their health status.

Illness often limits the ability of people to participate in service design activities. Facilitating remote online sessions allows people to participate in a way that is compatible with their health status.

Unlike other industries, healthcare services are most often thrust upon us. Outside of routine care, our interactions with the healthcare system are usually bittersweet: necessary, but difficult. This has many implications for service design, but from a purely practical perspective, illness often limits the ability of people to participate in foundational activities like user research, co-creation, or concept validation. If people are unwell, they may be physically and emotionally unable to participate. For serious illnesses, techniques like co-creation may simply be unworkable. You may have to plan on getting less time with each patient for research and validation, as energy levels are often low. You may also have to find creative ways to include patients in the process. In most of our projects, we strive for in-person workshops because we find them more effective; but for people who are in poor health, we may facilitate a remote online session so that people can participate in a way that is compatible with their health.

Principle 2: Take the Time to Enrol Healthcare Providers in Your Process

Illness often limits the ability of people to participate in service design activities. Facilitating remote online sessions allows people to participate in a way that is compatible with their health status.

When launching a new patient-centred care initiative, take the time to enrol healthcare providers in your process and back up your story with data that will resonate with them.

While patients might be the focus of a patient-centred care initiative, the physicians, nurses, and other healthcare providers (HCPs) are critical stakeholders. As service designers, we tend to concentrate on the larger ecosystem, so we intuitively understand why a poor encounter with hospital parking can negatively affect the overall patient experience. However, the combination of training and incentives prompts most HCPs to focus on specific therapies and clinical outcomes. In a vacuum, they will tend to dismiss service design efforts as administrative nonsense that is best avoided. But make no mistake – we can’t achieve patient-centred care without their support.
When launching a new patient-centred care initiative, we always take the time to help HCPs understand how focusing on the broader patient experience directly affects clinical outcomes, and we back up our story with data that will resonate with them. By talking in the HCPs’ language, they are able to see the value of our approach, and most HCPs become champions for service design and patient-centred care.

Principle 3: Segment Your Patients Carefully

In healthcare, it is critically important to segment your end users appropriately. Patient-centred care looks very different depending on the severity of the illness.

In healthcare, it is critically important to segment your end users appropriately. Patient-centred care looks very different depending on the severity of the illness.

Of course, as service designers, a deep understanding of the end user is always uppermost in our mind. But in healthcare, it is critically important to make sure you are segmenting your end users appropriately. Patient-centred care looks very different for someone who is basically healthy with a mild illness compared to someone who is gravely ill with a life-threatening condition. Personas and appropriate scoping becomes critical. For instance, we are currently working on a program for prostate cancer patients, but we have worked closely with clinicians to narrow our target audience based on specific disease pathology such as tumour size and degree of spread. Without this level of clinical specificity, our service would not be delivering patient-centred care, because it would not be appropriate for all the patients who accessed it. For advanced cancers, the service will have more aspects of palliative care than rehabilitation, while for very early cancers there may be no need for an invasive procedure at all. There is no one-size-fits-all solution.

Principle 4: Patient-Centred Care isn’t Really About ‘Patients’

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‘Patient-centred care’ will likely persist as terminology, but the idea encompasses the patient’s experience beyond their medical condition and their network of friends and loved ones.

Medical conditions, especially serious ones, often permeate every aspect of a person’s life. For example, when we conducted ethnography with people with obesity, they talked about how their medical condition affected every facet of their lives, from the decision to attend events at their children’s school, to the furniture they sat in. Nonetheless, people certainly do not want to be defined by their condition. Whereas in other industries, people are usually quite happy to think of themselves as customers, the same is not true in healthcare. In healthcare, end users resist being labelled as patients, and always want to be understood as a person who happens to have a medical condition. This carries through in our choice of language: we never refer to someone as a ‘schizophrenic’ or a ‘diabetic.’ Instead, it’s a person with schizophrenia, or a person with diabetes.
Along similar lines, patient-centred care is also about the family and friends who support the patient through their healthcare journey. Caregivers of all types have a profound effect on patient care, and service design efforts should absolutely include them. We think ‘patient-centred care’ will persist as terminology, but the idea certainly encompasses the whole person and their network of friends and loved ones.

Principle 5: Be Ever Mindful of Regulation

Regulations create constraints for service design methods; the idea of prototyping in healthcare must be handled with care.

Regulations create constraints for service design methods; the idea of prototyping in healthcare must be handled with care.

Healthcare is a highly-regulated industry. Legislation dictates how you must handle personal healthcare information, and there may be regulatory oversight from an organization like the FDA. From the outset of any project, we must be aware of the specific laws and regulations that apply in the jurisdiction where we are working, because they often create constraints on what we can do and/or have meaningful implications on implementation of service design solutions.
Regulation also has a big impact on our ability to prototype. Within healthcare, prototyping is unfamiliar and scary. As service designers, our ethos is to fail quickly and cheaply, while in healthcare the prevailing approach is to test everything rigorously until efficacy has been proven. This caution is certainly warranted in some cases – nobody wants to be the subject of a prototype for a new surgery! However, very often organizations are falling short of patient-centred care on non-therapeutic factors: the wayfinding in the hospital, the educational materials they provide, the way data is transferred between different HCPs. In those cases, our prototyping tools are still appropriate because the cost of a failed prototype is low. However, we have to make sure we take the time to explain our terminology to our stakeholders and mitigate risk in the prototyping process as much as possible.

Principle 6: Patient-Centred Care is Still About Shared Value

An effective model for patient centricity should create value for both patients and the broader healthcare system that serves them.

An effective model for patient centricity should create value for both patients and the broader healthcare system that serves them.

Because we are often dealing with patients who are unwell and in pain, there is a tendency to conflate ‘patient-centred care’ with ‘doing nice things for patients.’ Of course, in applying service design techniques, we expect to develop and prototype ideas that make the experience ‘nicer’ for patients in some way. But as with any other industry, the goal is to create shared value. An effective model for patient centricity doesn’t just work for the patient; it also works for other stakeholders. Whether that means generating more revenue, cutting costs, or saving time, patient-centred care must be creating value for healthcare providers, administrators, and payers in addition to improving the experience for patients. Therefore, it’s important to go beyond traditional metrics like patient satisfaction when measuring the success of initiatives. By using metrics like improved patient adherence to medication regimes, or reduced hospital-acquired infections or readmission rates, we can make sure we are assessing our initiatives based on the value they generate for patients and the many other players in the healthcare system.