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. 8 9 10 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. 11 12 13 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. 6 16 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. 19 20 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.