Patient-Centered Care: PFCC Assessment and Improvement Strategy

Introduction

Patient-centered care is the goal of many healthcare organizations, but the ability of an organization to deliver it is influenced by a number of factors both internal and external. Business practices, regulatory requirements, and reimbursement can all impact patient-centered care in any healthcare organization. Promoting patient-centered care requires an organizational culture committed to this paradigm, which also needs to be embedded in the mission and values of the organization.

Executives and administrators create the organizational culture that promotes patient-centered care. All leaders in the organization are responsible for using patient-centered practices and communication styles in their interactions with patients and their families. Furthermore, administrators oversee the policies and procedures that directly impact the culture of care. By analyzing areas of weakness within the organizational structure and culture via established assessments like the Patient- and Family-Centered Care Organizational Self-Assessment Tool, it is possible to create multidisciplinary teams that promote the organization's vision of patient-centered care.

Factors Influencing Patient-Centered Care

Business Practices

Administrators and executives of the healthcare organization guide the business practices within their organization. The executive and managerial layers influence the organizational culture, guiding philosophies and values, spending practices, and the standard operating procedures that healthcare workers are expected to follow. Executive leadership and nurse leaders can both influence the ability of staff to administer patient-centered care in accordance with the organization's mission.

Patient-centered care can be defined as care oriented toward the best interests of the patient, above all other interests — including financial concerns. At the same time, executives are entrusted with the responsibility of keeping the organization viable and able to fulfill its mission in the community. Patient-centered care must therefore be balanced with financial realities. In some cases, there will be conflicts between the interests of the healthcare organization, its allied community partners, insurers, and government on one side, and the interests of the patient on the other. There are many managerial and leadership levels at which practitioners can resolve such conflicts — for example, choosing between a more profitable and a less profitable procedure of roughly equivalent efficacy.

Policies, procedures, regulations, organizational culture, and the influence of leadership are all factors that shape the front-line worker's ability to deliver patient-centered care. Each of these aspects of core business practice reflects the organization's priorities. If the organization holds patient-centered care as its main priority, the actions of front-line workers will reflect that. If not, those actions may fall short of a genuinely patient-centered standard.

Regulatory Requirements

Regulatory requirements sometimes create conflict between the interests of the patient and those of the healthcare organization. The organization may even experience tension between the legal framework and its own ethical principles. Regulatory requirements frequently present funding and financial challenges that further affect the ability to deliver patient-centered care.

For example, regulators are often concerned with patient safety, drawing on empirical studies that aggregate data from many patients across different populations. This data may conflict with what is best for a single individual patient. Nurses need to be empowered to make decisions within an evidence-based practice environment, working within the regulatory framework to avoid legal complications. When interests conflict, regulations must be upheld as long as the best interests of the patient can still be maintained and nurses can remain loyal to their ethical codes. When that balance cannot be achieved, the best course of action for the patient may risk violating a regulation. Adherence to regulatory requirements places the healthcare worker at this point of conflict, potentially constraining their ability to deliver truly patient-centered care.

Reimbursement

Reimbursement also influences the ability of a healthcare worker to deliver patient-centered care. Depending on organizational policy, a patient may only receive care for which reimbursement is available. Healthcare leaders can make patient-centered decisions that incur additional costs for the organization but nevertheless help fulfill its mission and goals. The most extreme example of reimbursement shortfalls arises when patients have no health insurance at all — they may receive only the bare minimum of care in an emergency room rather than the more comprehensive and proactive care they could benefit from. Nurses serve as patient advocates precisely for this reason, promoting patient-centered care as a normative professional standard.

Payers often exert significant control over care decisions — frequently determining, for example, which drugs they will and will not cover. Decisions made by parties outside the nursing profession, but which directly impact care delivery, represent a trade-off among the best interest of the patient, the provider's need to cover costs, and the payer's financial interests. Payers may occasionally reference clinical evidence when making coverage decisions, but unlike healthcare workers they are not ethically bound to evidence-based, patient-centered care. As a result, the procedures, treatment programs, or medications a payer will cover may not align with what the healthcare team would recommend.

As with regulators, payers typically base their decisions on aggregate data rather than on what might be best for a single individual patient. Reimbursement policies therefore tend to reflect a broader, population-level approach to policy-making rather than the patient-level focus of the healthcare organization. An epidemiological study's findings, for instance, may conflict with the optimal treatment for one particular patient seeking acute care. Common situations arise — such as a generic drug being ineffective for a specific patient while the patented alternative is not covered — that constrain the organization's ability to provide genuinely patient-focused care.

Healthcare professionals, and in particular healthcare leaders, should be aware of these trade-offs between financing and patient-centered care. Conflicts occur frequently enough that it is important to understand how they arise, how to resolve them strategically, and how those resolutions can ultimately improve patient care. Most importantly, providing patient-centered care requires understanding the organization's priorities so that when apparent conflict arises between the patient's best interest and a policy, regulation, or payer rule, the healthcare worker knows how to navigate that conflict. This is one of the major responsibilities of leadership in the healthcare organization.