Patient-Centeredness

Veterans and Their Health Care Team: A Partnership!

VHA Core Principles

• Honor expectations of safe, high quality and accessible care.

• Enhance the quality of human interactions and therapeutic alliances.

• Solicit and respect the client’s values, preferences and needs.

• Systematize the coordination, continuity and integration of care.

• Empower through information and education.

• Incorporate nutritional, cultural and nurturing aspects of food.

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VHA Core Principles

• Provide physical comfort and pain management.

• Ensure emotional and spiritual support.

• Encourage involvement of family and friends.

• Ensure architectural layout and design conducive to health and healing.

• Introduce creative arts into the healing environment.

• Support and sustain an engaged work force.

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Elements of Patient Centeredness

Definition

“A fully engaged partnership of Veteran, family and health

care team, established through continuous healing

relationships and provided in optimal healing environments,

in order to improve health outcomes and the Veteran’s

experience of care.”

VA-USTF, 2009

Patient Centeredness

Key Points

• Patient-Centeredness is anchored in respect and is effectively deployed in a partnering relationship.

• There are six major overlapping Patient-Centered domains

• Patient-Centeredness impacts all levels of the organization

• Continuous Patient-Centered thinking is a challenge for health care workers

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It’s A Dog’s World

Used with Permission: CRM Learning

Effective Communication

Teamlet Table Discussion

• Self Discovery –Step into the Patient’s Shoes– Please share one favorable or

unfavorable health care experience you had as a patient – or as a family member or friend of a patient.

– After you share this short account, discuss the following with your teamlet members:• What can I learn from this

experience?• What do these lessons mean to

me as a clinician/ teamlet member?

• As a care giver, how might I act if I found myself in a similar situation?

10Adapted from the IHI Open School “The forgotten team member: Engaging patients in improving care.”

Whole Person Orientation“ …you ought not to attempt to cure the eyes without the

head or the head without the body, so neither ought you to attempt

to cure the body without the soul . . . for the part can never be well

unless the whole is well.” Plato

Collaborative Partnership

Lussier, M-T, Richards, C., Because one shoe doesn’t fit all: A repertoire of doctor-patient relationships. Can.Fam. Phy.:2008, 4; 1089-92.

Patient Centeredn

essShared Decision

Making

Dimensions of Partnership—Patient View

Desire to Make Decisions

High Low

High

Desire toActivelyParticipate

Low

Full partnership: “My health is important to me, and I want to take an active role in my health care and in decisions that affect my health.”

Patient wants clinician to make decisions: “I’m not a health professional. Whatever you think I should do is OK with me.”

Patient wants to make decisions: “It’s my body. I’ll listen to your recommenda-tions, but I decide what’s best for me.”

Patient doesn’t want to partner with clinician now: “Just tell me what to do so I can get out of here. I just want to get on with my life.”

Dimensions of Partnership—Clinician View

Desire to Make Decisions

High Low

High

Desire toActivelyParticipate

Low

Full partnership: “It’s important for me to work with patients to build treatment plans we can both live with, no matter what the obstacles are.”

Clinician wants patient to make decisions: “It’s not my role to tell patients what to do. I give them lots of information and offer them options, and they choose.”

Clinician wants to make decisions: “I’m supposed to take care of patients and that includes deciding the best course of action.”

Clinician doesn’t partner with patient: “I could partner more with this patient, but now’s not the time.”

How Clinicians Can Enhance Partnering

Patient Desire to Make Decisions

High Low

High

Patient Desire toActivelyParticipate

Low

Full partnership:

Solicit patient’s questions and concernsEncourage discussionJoint planning and problem solving

Patient wants clinician to make decisions:

Give patient a sense of controlAsk patient to take some responsibility

Patient wants to make decisions:

Focus on goals of therapyProvide information re: optionsShare own treatment recommendations

Patient has no interest in partnering with clinician at this time:

Accept situation and patientProvide new informationOffer to help when patient is ready

Personal Action Plan

Arrange:Specify plan for

Follow-up

Assist:Identify Barriers,

Strategies, & Social Support

Agree:Collaboratively set

Goals based on Patient’s Confidence

to Change Behavior

Advise:Provide Information

about Health Risks

& Benefits of Change

Assess: Beliefs, Behavior, & Knowledge

The 5 A’s Behavior Change Model

2002 Glasgow et al, Whitlock et al

Faculty Spark! Questions

• How will you make these changes happen when you return?

• With attention to what you discovered from this discussion, what other areas of the medical center could be changed or be enhanced through concepts of Patient Centeredness?

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Faculty Spark! Questions

•  Do I believe that patients/ families bring unique expertise? 

• Do I believe that the patient’s perspective and opinion is as important as professionals?

•  Do I feel comfortable sharing decision making with patients/families?

• Do I consistently look for ways that I and my organization can be more patient centered?

• Adapted from the Institute of Family-Centered Care

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Faculty Spark! Questions

• What would it be like to use this approach in your daily work? 

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Respect Patient Choice - Exercise

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What we ask of our Veterans……

•Everyone, please stand up.

Those of you who – Are over their ideal body weight– Drink alcohol above

recommended limits (2 drinks for men per day and one drink for women per day)

– Smoke cigarettes, cigars or chew tobacco now or in last 5 years

– Are not up-to-date on your vaccination status against pneumoniae, influenza, tetanus, Zoster and viral hepatitis

•Please sit down    

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• If you have not followed the guidelines for skin, breast, cervical, prostate and colorectal cancer screening and testicular self-exams

• If you have not been following the recommend UV light avoidance and regular sun screen use- please sit down

•Please sit down

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• If you do not wear seatbelts 100% of the time – especially within 5 miles of home

• If you do not walk or exercise at least 30 minutes per day

• If you do not brush you teeth twice a day after meals

•Please sit down

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• If you do not floss twice a day

•Please sit down

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Commitment Exercise• Please write down 2 things

that you learned today (those “AH-HA!” moments) that you will apply to your work.

• Tell them to teamlet members you shared ideas with at the beginning of this session.

• Take your ideas home with you and review them with your teamlet members the first day you are back to work.

• Review your written ideas one week after you return and each week after that.

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As you return home……

One person awake can awaken another,

The second can awaken a next door neighbor.

Three awake can rouse the town,And turn the whole place upside

down.And many awake can raise such

as fuss,That it finally awakens the rest of

us.One person up with dawn in their

eyes, multiples. (Unknown)

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