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Moving beyond centeredness in patient experience

January 29th, 2015

by Jason A. Wolf

Last year I had the honor to co-author an article, Defining Patient Experience, for the inaugural issue of Patient Experience Journal, of which I also serve as editor. The exercise in conducting the research review and construction of the piece reinforced a fundamental shift I have seen occurring as we work to push the patient experience movement forward. That is, we are entering an era when the concept of centeredness, while critical and central, is no longer enough.

In our article we identified "experience" to encompass personal interactions, organization culture and patient (and family) perceptions, and reinforced that it crosses the continuum of care to include not only clinical encounters, but also the edges and transition points that bind the system together. Woven into these framing concepts were three key ideas:

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  • Experience gets to the integrated nature of care, i.e. the fact that quality, safety, service, cost, accessibility and more, are all part of one experience from a patient, resident or family perspective.
  • Positive experiences are grounded in the idea of partnership, which acknowledges the expanding vernacular of patient engagement and activation.
  • Experience is built upon the ideals of person-centeredness; we must move our attention in healthcare from an institution-first mindset to understand the perspectives and engage the voices and values of those receiving or engaging in care, be they patients, residents or family/support networks.

We must recognize every individual who engages in the healthcare system has an experience. Experience happens whether an organization has planned for it or not. Rather than a passive concept as some have suggested, experience is an active reality individuals have and it belongs to them. It is not something that is done to someone or simply a strategy to be employed.

Experience integrates the physicality of what occurs and the emotions it generates. It is about perceptions, what is understood and perhaps most importantly, what is remembered. Experience is what we will carry with us throughout our lives and will forever influence our decisions along the way. As a result, experience drives engagement and outcomes, from clinical to financial.

The idea of centeredness was clearly framed in the Institute of Medicine's (IOM) 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, in which it defined patient centeredness as "providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions." I believe we would all agree this is a fundamental part of the healthcare experience, but would also acknowledge experience now demands much more.

In addition, we are no longer looking at just clinical settings, but an integrative and cross-continuum approach to care, driven by a rapidly evolving healthcare consumer. The IOM report also offers six aims of improvement: safe, effective, patient-centered, timely, efficient and equitable. I suggest these all represent components of an individual's healthcare experience, and while distinguished from a provider perspective, are all part of one mosaic seen by those seeking care.

This is reinforced by the great work of the Institute for Healthcare Improvement (IHI), a collaboration partner, which acknowledges these IOM dimensions as well as quality and satisfaction outcomes are a means to gauge one element of the IHI Triple Aim, the patient experience of care. Here, too, I encourage us to look beyond the term "experience of care" to the healthcare experience overall, which encompasses both the clinical care encounters as well as the moments in between. This suggests that experience is inclusive of quality, safety and service, cost, accessibility, equity, community/population health outcomes and more.

Another significant and valuable contributor in this dialogue is the Institute for Patient- and Family-Centered Care (IPFCC), which presents patient- and family- centered care as an "approach." This reinforces the role of centeredness as a key component in achieving greater outcomes for those we care for and serve in healthcare systems around the world. It must and should remain a fundamental strategy.

Maintaining a focus on centeredness and on satisfaction (which in a recent blog I distinguish from experience) is a critical strategy to ensure the best in experience. So, too, are the process improvements to drive down errors or reduce falls, efforts to ensure understanding of medications or support adherence to healthy diets, commitments to ease of access, equity of care and process efficiencies, to offer just a few examples. In addition, providing opportunities for engagement and activation (the knowledge, skills and confidence to engage in and take ownership in our personal healthcare process and outcomes) also supports providing a stronger, more positive experience.

My hope in offering these thoughts is to begin a broader conversation on all the concepts that help us drive the best in experience in healthcare. I do not intend to diminish the contribution of any of the concepts I mention, but rather nudge us to see if we can begin to align our efforts toward a bigger idea. If we focus our continuous and unwavering attention on providing the best in experience, we may just create a healthcare system we truly aspire to be part of and ultimately from which we look to receive care.

Jason A. Wolf, Ph.D., is president of The Beryl Institute, a global community of practice focused on patient experience improvement and founding editor of Patient Experience Journal. Follow Jason @jasonawolf , The Beryl Institute @berylinstitute and Patient Experience Journal @pxjournal on Twitter.

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