THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSThe scorecard indicator, however, looks for any evidence of some patient-centred education in training
for any medicine-related profession. By design, it does not assess the extent to which these curricula as
a whole prepare clinicians for patient-centred care.
The reason is that no country has reformed education very well in this direction. Experts interviewed
for this study could point to individual institutions doing interesting work in this area, such as the
relatively new Dell Medical School in Austin, Texas, the Radboud University Medical Centre in the
Netherlands and the planned Kaiser Permanente School of Medicine in California. No interviewee,
though, identified any health system seeing widespread change. Mr Sehmi notes that change here,
while taking place, “is a slow process happening piecemeal”. Similarly, in Mr Graham’s experience, “we
have seen curricula adopt the language of patient-centricity, and people leaving medical school have
more understanding of the issue, but we have not seen a lot of patient co-operation or participation
in training.”
As a result, says Ms Sofia, the “medical community is still not prepared to deal with expert patients in
planning of medical care. The integration of patient engagement education in medical school would
greatly accelerate patient-centricity.” Dr McClellan agrees. Although, he says, most new clinicians, as
in the past, care greatly and want to help patients, they remain unprepared for the realities of doing
things in a patient-centred way.
Scoring around shared decision-making, funding and training, then, reflect little advancement as yet
toward patient-centred care. It is worrying though that, as later discussion of the scorecard results
will show, progress here has been notably faster than that seen in other elements of healthcare. As Dr
McClellan puts it, integrated, patient-centred care, despite “incremental steps in the right direction,
remains more a long-term vision and aspiration” than reality.
Barriers to change
Various challenges to progress help explain this halting, uneven improvement. These appear
throughout the report, but several are so fundamental as to be worth noting here.
First, the extent of the shift needed to get from traditional healthcare systems to patient-centric ones is
difficult to over-estimate. As Mr Graham notes, it involves “a rejection of the previous medical model”.
This brings substantial challenges associated with any large change, and healthcare is a field in which
innovation is notoriously difficult.^22
Just as important, despite acceptance at the policy level, not every stakeholder is fully on board with the
change or without ulterior motives. In Germany, for example, Ms Erb-Herrmann says that, among others,
physicians “are very slow in changing. They fear that they will lose power and influence: it was nice to
have respectful patients asking, ‘please tell me what to do,’ instead of informed ones coming in saying
‘this is what I think I have.’” Mr Graham adds that “true patient participation can be scary for professionals,
because inviting non-professionals to have an equal status is a threat to one’s standing.” Addressing this,
by recognising the separate expertise that patients and clinicians bring, is essential for progress.
- For a discussion of the general high
barriers of change in healthcare, see
Clayton Christensen et al, The Innovator’s
Prescription, 2009.