What it is
What others have done
What to ask
How to succeed

What is person-centered care and why does it matter?

As a principle, person-centeredness posits that high-quality primary health care systems engage with people as equal partners in promoting and maintaining their health with trust at the foundation. 3 To be empowered users of the health system, patients must be educated and supported to make informed decisions and actively participate in their own care. 45 Person-centeredness is an important function for improving system performance from the perspective of the user. Person-centered systems contribute to a variety of benefits for both the user and the system including improved access to care, improved health and clinical outcomes, increased health literacy, higher rates of patient satisfaction, improved job satisfaction among the health workforce, and more efficient and cost-effective services. 36 Listed below are central questions stakeholders should consider when planning and implementing system reforms and interventions that prioritize person-centeredness:

  • In what ways can systems promote more person-centered care?
  • What policies and infrastructure should be in place to support person-centeredness?

Person-centeredness is at the cornerstone of high-quality primary health care 37 and crucial to the functions of first contact accessibility, continuity, coordination, and comprehensiveness.

  • Person-centered health systems acknowledge patients as partners in their own care and support trusting patient-provider relationships. Person-centered care is organized around the comprehensive needs of people rather than individual diseases. It engages and empowers people in full partnership with health care providers in promoting and maintaining their health. Person-centered care considers a patient’s social, career, cultural, and family priorities and determinants as important facets of health. Positive patient perception of patient-provider interactions and quality of care is associated with better health experiences. 8910 Various factors influence a patient’s perception of technical and non-technical aspects of care including a patient’s sociodemographic characteristics, health status, and culture. 111213 Systematic factors that negatively influence a patient’s perception of the quality of care relate to shortages of regular place of primary care, difficulties in communication with the primary care clinic, and a lack of coordination of care. 12 Addressing these gaps requires system-wide changes in the incentive structure and organizational culture of primary care systems to promote more person-centered care. 14 Key attributes of person-centered care involve: 6

    • Education and shared knowledge
    • Involvement of family and friends
    • Collaboration and team management
    • Sensitivity to non medical and spiritual dimensions of care
    • Respect for patient needs and preferences
    • Free flow and accessibility of information

    The realization of these person-centered attributes of care depends on their integration into implementation strategies at the system and organizational level. Widespread implementation of person-centered care requires a restructuring of the incentive structure and vision at the system level to increase to capacity of facilities to achieve person-centered high-quality primary health care. 6

    Integrated people-centered health services

    As outlined in the tools and frameworks section of this subdomain, the WHO Framework on Integrated-People Centered Health Services proposes five interdependent strategies for the development of responsive people-centered health systems that deliver high-quality, safe, and acceptable services for all. The below strategies are synergistic, a lack of progress in one area may undermine progress in another.

    • Empowering and engaging people and communities - This strategy aims to empower individuals (including underserved and marginalized groups) with the opportunities, skills, and resources to make decisions about their own health and be empowered and engaged users of quality health services. It aims to enable communities to be actively engaged in co-producing healthy environments for individuals and be capacitated to deliver informal care that improves the health of communities (training and networks for community health workers, social participation, community delivered care).
    • Strengthening governance and accountability - This strategy aims to strengthen governance using a participatory approach to policy formulation, decision-making, and performance evaluation at all levels of the health system. To reinforce good governance, a robust system for mutual accountability across stakeholders and a people-centered incentives system should be in place.
    • Reorienting the model of care - This strategy calls for a people-centered approach to primary health care for the design and delivery of efficient and effective services that are holistic, comprehensive, and sensitive to social and cultural needs and preferences.
    • Coordinating services within and across sectors - This strategy leverages multisectoral and intersectoral partnerships and the integration of health providers within and across settings and levels of care to promote care coordination. Coordination focuses on improving the delivery of care to better respond to the needs and demands of people.
    • Creating an enabling environment - This strategy involves creating an enabling environment to bring all stakeholders together to transform all of these strategies into an operational reality. In order to effect change, this task involves a diverse set of processes in the domains of leadership and management, information systems, quality improvement methods, workforce development, legislative and policy frameworks, and health financing and incentives.

    The policies and interventions that stakeholders adopt to achieve the realization of these strategies are context-specific, meaning they will need to be developed according to the local context, values, and preferences of the country at the national, regional, and local level. More information on the Framework on integrated, people-centered approach, including the implementation approach and the role of stakeholders, can be accessed here.

    At the Systems Level

    Person-centered health systems empower people at the center of the health system. Stakeholders at the national, regional, and local level (i.e. policymakers, institutions, and providers) must be accountable to the needs and preferences of the populations they serve. 3 While health systems are highly context-specific, attributes of systems that prioritize person-centered care motivate change through external incentives and a broader strategic vision for better care. Key strategies for leveraging change at the system level to influence the achievement of person-centered care at the organizational level include: 6

    • Public education and patient engagement - System-wide strategies empower patients to take a more active role in the care process through education and engagement initiatives such as health literacy campaigns and opportunities for self-management. 15 Patients should be made aware of information tools and technology to enhance patient’s decision-making role and promote informed choices. 616 Additionally, patients should be empowered and engaged in the health management process to keep stakeholders accountable to the tenants of person-centered care. More information on stakeholder accountability will be available in the Social Accountability module, to be released in 2019.
    • Public reporting of standardized patient-centered measures - Systematic measurement and feedback mechanisms that assess patient experience are in place to hold organizations accountable and allow for the process of change. 6 Quality measurements are publically reported to incentivize performance improvement. 17 Regular monitoring and measurement systems are in place to measure patient perception of quality. Patient perception measures assess the impacts of changes and are used as a tool for progress. 12 The following patient-reported outcome tools may help stakeholders to better understand various patient-reported health outcomes, available in multiple languages: PROMIS-10, PROMIS-29, EQ-5D(-5L), VR-12, SF-12, SF-36, WHO-5 Well-Being Index, and WHOQOL-BREF
    • Accreditation and certification requirements - Programs restructure broader external incentives to incentivize organizations to deliver patient-centered care. Pre-defined standards of patient-centered care are built into quality assurance programs and physician quality recognition programs. 6
    At the organizational level

    The realization of person-centered systems depends on the availability and accessibility of a skilled workforce motivated to deliver comprehensive coordinated care throughout a patient’s care experience. 3 Services should be well-communicated to patients and respond to their complex needs within and beyond a patient’s care experience. 18 Strategies designed to strengthen the capacity for person-centeredness and achieve person-centered care at the organizational level include:

    • Leadership and development training – Leadership is unified in their commitment to sustain the organization in a common mission for person-centered care. The strategic vision of the organization is in alignment with national policies and is well-communicated to every member of the organization. Professional development training opportunities are in place to empower and increase the competency of the workforce to provide person-centered care.
    • Involvement of patients and families - Patients and families are involved as full participants in their care and decisions related to their care at multiple levels.
    • Internal rewards and incentives and a supportive care environment - The workforce treat patients and families with dignity and respect. Patients are surrounded by a supportive and nurturing space and actively engaged in the co-production of their health. The workforce is incentivized to provide person-centered care and held accountable for patient-experiences and feedback.
    • Training in quality improvement - Ingrained quality improvement processes are in place for health workers at multiple levels in the organization. Health workers are trained in quality-improvement concepts and methods. Care teams are encouraged to be collaborative in their efforts for quality improvement through training and supervision. 1920 Accountability systems are in place to ensure respect for patient needs and preferences and sensitivity to nonmedical and spiritual dimensions of care.
    • Systematic measurement and feedback – Participatory systems for measurement and feedback are in place to monitor the impact of specific interventions, such as patient and family councils on patient experience. Interventions are adapted and improved based off this information.
    • Practical tools derived from an expanded evidence base - Supportive health information technology is in place to facilitate the transfer of information between patients and their caregivers. Care tools are used to improve the delivery of person-centered care, taking into account a patient’s unique set of conditions and the specific social determinants of their health (i.e. longitudinal care plans and patient complexity tools). Complexity tools aid patients and providers in the coproduction of care plans that take into account barriers to everyday decision making and well-being with the goal to empower patients to live healthier lives. 21  More information on patient complexity tools can be found in the Minnesota Complexity Assessment Method.
  • Person-centered reforms incorporate a rights-based approach to health systems strengthening, placing health as a human right at the core of the national health strategy. 3 This approach is vital for the realization of universal access to high-quality primary health care services and making progress toward the Sustainable Development Goals. Achieving person-centered health systems requires sustained political commitment, collective engagement, and strategic processes and plans backed by effective information systems and resources for delivering high-quality person-centered care. 2022 More information on the policies and infrastructure necessary to develop people-centered health systems and the role of cross-sectoral action for health can be found in the World Health Organization’s Framework on Integrated People-Centered Health Services and in the Governance and Leadership module.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

What has been done elsewhere to improve person-centered care?

  • In an effort to redesign the health system to better address the growing burden of chronic disease, Samoa is drawing from its long tradition of village-based governance 23 to shift away from a hospital-centric model and revitalize primary health care at the community level. 2425 Since the 1920s, Village Women’s Committees have played an important role in health promotion. Accordingly, the PEN Fa’a Samoa Initiative (Package of Essential Noncommunicable Disease Interventions Samoa) adapts the WHO package of essential noncommunicable disease (NCD) interventions to the local Samoan context through women-led, village-health activities to promote person-centered primary health care.

    The PEN Fa’a Samoa initiative trains women in the village to measure key NCD metrics, detect at-risk individuals, raise awareness, and counsel about NCDs, and refer individuals to the health system for further care. To promote person-centered design and coordination across the health system, the PEN Fa’a Samoa pilot initiative was developed through a three-stage process. 26 In the first stage, the Samoan Ministry of Health, National Health Service, and the World Health Organization adopted national guidelines and adapted the PEN package to the Samoan context. Additionally, villages were instructed to designate up to three members of women as local facilitators. The local facilitators then partnered with health care workers to create cross-disciplinary outreach teams who followed up with at-risk individuals with a personalized management plan, risk factor consultation, or both. This initiative is in the process of scale-up, viewed as an opportunity to leverage a person-centered community-based approach to improve health outcomes and achieve universal health coverage. 24

  • Facing high-rates of dissatisfaction among patients and care staff and low rates of health literacy, Scotland implemented a series of interdependent strategies to improve person-centered primary health care services. 27 Scotland’s House of Care program invokes an integrated model of health that combines community and social support to empower patients to be well-informed and equal partners in promoting and maintaining their own health. The program is supported by clear information pathways for both patients and providers to strengthen the interoperability of information systems, increase collaboration among care teams, and form linkages of support between patients and the community. This is facilitated in part through “A Local Information System for Scotland (ALISS)”, a collaborative search engine that allows patients to share and locate key information and support services. 27

    At the core of the House of Care is a personalized, coordinated care plan. 28 The creation of a patient’s care plan follows a series of consultations. On their initial visit, patients receive a full screening along with their results. At their follow up visit, patients engage in a care and support planning conversation with a health professional to set priorities and discuss the psychosocial aspects of their lives and together determine goals. Health professional teams are trained to support and collaborate with patients throughout the planning process and help link patients to local services and resources that support health and well being. 2728 In sites where the House of Care has been implemented, patients report feeling an increase in their overall sense of well-being and both providers and patients have reported a higher perception of agency and meaningful engagement.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

What questions should be considered to begin improvements?

The questions below may be a useful starting place for determining whether Person-Centered Care is an appropriate area of focus for a given context and how one might begin to plan and enact reforms:

What systems or processes are in place to ensure that patients are empowered in their care and engaged in the planning of their health systems?

Person-centered systems defend people’s right to health and active participation in the planning and implementation of their health care. Policies, strategies, and plans are implemented across all levels of the health system to empower patients with the opportunities, skills, and resources to make informed decisions about their health and take a more active role in the care process through education and engagement initiatives (such as health literacy campaigns, personalized care plans, and institutional mechanisms that encourage citizen participation in policy formulation and evaluation). Patients should be made aware of information tools and technology to enhance their decision-making role and informed choice. Stakeholders (across the health system and between health and nonhealth sectors) are unified by a shared vision to enact policies that promote equitable access to high-quality primary health care. Strong accountability mechanisms (strengthened by intersectoral action for health) and quality management infrastructure (including performance measurement systems incentivizing person-centered care) are in place to promote the realization of person-centered reforms. 2022

Are data collected on patient-perceptions of care? If they are, how are they used?

To hold organizations accountable and allow for the process of chance, systematic measurement and feedback mechanisms that assess patient experience should be in place. Quality measurements should be publically reported to incentivize performance improvement with regular monitoring and measurement systems in place to measure patient perception of quality. Patient perception measures should assess the impacts of changes and be used as a tool for progress.

Are there defined standards for person-centered care? If so, are they built into quality assurance programs? How are they monitored and used?

Broader external incentives should be structured to incentivize organizations to deliver person-centered care. This may involve setting new quality standards against person-centered performance indicators or building pre-defined standards of care into quality assurance programs and physician quality recognition programs. To create an enabling environment for patient-centered care, it is necessary to establish regulations that ensure providers and facilities deliver person-centered care. 3 Legal and regulatory frameworks that protect patient rights, establish social protection floors, and regulate the operation of facilities and providers (including required trainings, qualifications, and practice standards) should be enforced to strategize for person-centeredness as a part of the national health planning process. 29 In addition, quality management infrastructure should be in place at the national, regional and local level with a built-in capacity to measure and monitor person-centered care performance. 30

What trainings should providers and managers receive in person-centered care?

Standardized person-centered care training should be ingrained in all health care professional programs (including professional education and accrediting bodies). 30 In order to put knowledge into practice and transform workplace culture, continuing professional education and mentorship opportunities should be made available. Health workers across all levels of care should receive frequent, supportive supervision to assess their competencies and make action plans for building new skills or bolstering existing ones. Throughout the process, care teams and patients should be encouraged to be collaborative in their efforts for quality improvement, for example through patient advisory groups and programs for providers and patients to provide feedback on the experience of care. 30 To promote person-centeredness, accountability systems should be in place to ensure respect for patient needs and preferences and sensitivity to nonmedical and spiritual dimensions of care (such as compassion cultivation programs. 30

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

What elements should be in place to support effective improvements?

In order for interventions aimed at improving Person-Centered Care to be most successful, the following elements of the PHCPI Conceptual Framework should be in place or pursued simultaneously:

  • Governance is strengthened by a participatory approach to policy formulation, decision-making, and performance evaluation at all levels of the health system. To support the development of person-centered health systems, national health policies, strategies, and plans (including quality management infrastructure that aligns performance incentives with a person-centered approach) should be designed to promote integrated people-centered health services with primary health care as the first point of contact. 3 Stakeholders (across the health system and between health and non health sectors) must be unified by a shared vision to enact policies that promote equitable access to high-quality primary health care. Strong accountability mechanisms (strengthened by intersectoral action for health) and quality management infrastructure (including performance measurement systems incentivizing person-centered care) should be in place to promote the realization of person-centered reforms. 2022

    Person-centered systems defend people’s right to health and active participation in the planning and implementation of their health care. 331 Policies, strategies, and plans are implemented across all levels of the health system to empower patients with the opportunities, skills, and resources to make informed decisions about their health and take a more active role in the care process through education and engagement initiatives (such as health literacy campaigns, personalized care plans, and institutional mechanisms that encourage citizen participation in policy formulation and evaluation).

    Learn more in the Primary Health Care Policies and Quality Management Infrastructure Improvement Strategies modules.

  • The process of local priority setting is important to tailor health services to meet the needs and demands of people in communities. Local priority setting should leverage community engagement strategies to empower and support patients to be well-informed and equal partners in promoting and maintaining their own health. As a part of being empowered users of the health system, patients should be encouraged to be involved as full participants in their care and decisions related to the structure of the health system (such as through citizen groups, media platforms, and care forums). These systems should be accompanied by opportunities to hold stakeholders accountable to deliver person-centered care.

    Learn more in the Social Accountability, Local Priority Setting, and Community Engagement Improvement Strategies modules.

  • Person-centered health systems acknowledge patients as partners in their own care and support trusting patient-provider relationships. Primary care should be safe, effective (provide timely and accurate diagnoses and evidence-based care with minimal opportunity costs to the patient), and person-centered (taking into account social and cultural attitudes, beliefs, and concerns) to facilitate the delivery of quality care that patients respect and trust.

    Learn more in the Patient-Provider Respect and Trust Improvement Strategies module.

  • Strong leaders must have or develop particular competencies and personality traits to effectively manage and motivate the workforce to deliver person-centered care. The leadership should be unified in their commitment to deliver person-centered services and communicate this vision to every member of the facility. Managers should be properly equipped with the tools, systems, and skills to productively assess the health workforce within a facility and provide supportive supervision and professional development training opportunities to empower and increase the competency of the workforce to provide person-centered care.

    Learn more in the Facility Management Capability and Leadership Improvement Strategies module.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

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