The Economist (Intelligence Unit) – Creating Healthy Partnerships (2019)

12

THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS

Going beyond such specific instances, the general meaning of patient-centred care in practice

is complex. Indeed, the terminology itself is not fixed but continues to evolve: the World Health

Organisation, for example, prefers the term “integrated people-centred care” to emphasise the need

to look beyond healthcare systems to health in the community. The core idea remains but the words

used to describe it may change in a few years.

Amid these terminological differences, several organisations have produced definitions that tend to

boil down to lists of key elements.^17 These inevitably vary, but more in detail than substance. Broadly

speaking, the items on these lists fall into three general categories:

 The first is a necessary pre-condition of any meaningful, integrated healthcare: access to an

effective, efficient system organised around the patient journey.

 The second covers the status and authority within the system of patients (as well as of families

and carers where relevant): they need to be co-creators of care with control over choices involving

their own individual treatment as well as holding a meaningful role, where relevant, in broader

system decisions, such as funding choices.

 The third category covers the processes and mechanisms needed throughout the healthcare

system to make possible, and to support, both integrated care and an active patient role. This

includes a wide range of items, from, for example, patient education and activation measures,

through system measurements that reflect appropriate choices on valued outcomes, to financial

incentives that reward the creation and maintenance of integrated care pathways.

Worth stressing amid all the calls for change is that advocates of patient-centred care are not looking

to replace healthcare providers but for them to engage with the people they are treating more fully.

A finding from the survey of patient groups, conducted as part of the research for this report, is

instructive here. When asked about the biggest contribution that information technology (IT) could

make to patient-centricity, many respondents pointed to IT’s ability to simplify interaction with

clinicians, either by opening new channels of communication or making it easier to book traditional

medical appointments. Direct access to their own health records and independent data analysis,

by contrast, were cited as relevant by only a minority of respondents. Patient-centred care is about

partnering with, not removing, clinical experts.

But does patient-centred care work? The answer depends on what you are measuring and by what

yardstick. Studies have tended to look at specific initiatives that involve switching to a more patient-

centred approach in a particular area. Various literature reviews have shown either a positive link, or at

least no negative one, between patient-centric approaches and clinical effectiveness.^18

Clinical measures, however, are far from the only valid ones. A patient’s emotional reaction to care

is also important. Here, patient-centricity also appears to help. Extensive Japanese surveys have

found over the past two decades that health system user satisfaction is associated with good patient-

clinician communication and respect for patient autonomy.^19 Considering at length the gains outside

17. For some of the more influential, see
    Picker Institute; “Picker Principles of
    Person Centred Care;” Institute of
    Medicine, Crossing the Quality Chasm: A
    New Health System for the 21st Century,
    2001; World Health Organisation,
    “Framework on integrated, people-
    centred health services,” Sixty-ninth World
    Health Assembly A69/39: Provisional
    agenda item 16.1, 2016.


18. Cathal Doyle et al, “A systematic review
    of evidence on the links between
    patient experience and clinical safety
    and effectiveness,” BMJ Open, 2013; Lori
    Delaney, “Patient-centred care as an
    approach to improving health care in
    Australia,” Collegian, 2018.


19. Tomoko Kawashima, “What makes
    Patients Satisfied with their Healthcare?
    Nationwide Patient Experience Surveys
    in Japan,” Journal of Nursing & Care, 2015.