Organizational Ethics and Patient-Centered Care

I recently reviewed a Commonwealth Fund report on “Patient-Centered Care: What Does it Take?” Although the word “ethics” appears only once in 34 pages, the report makes a substantial contribution to organizational ethics.

There is a vast literature on the concept of patient-centered care, defined in the 2001 Institute of Medicine "Crossing the Quality Chasm" report as:

"Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care."

Unfortunately, there is an equally vast literature documenting the degree to which our health system falls short of this vision.

The very practical Commonwealth Fund discussion identifies seven factors as most important for achieving patient-centered care:

• Leadership at the level of the CEO and board of directors
• A strategic vision clearly and constantly communicated
• Involvement of patients and families at multiple levels
• Care for the caregivers through a supportive work environment
• Systematic measurement and feedback
• Quality of the built environment
• Supportive technology

In classes and consultations I have often been asked “what is ethics?” I have found it useful to distinguish between three components: analysis, advocacy, and administration. (Three “A” words – what a coincidence!)

Analysis is what is required when our question is – “what is the right thing to do in this situation?” When we are clear about what (we believe to be) the right course of action, advocacy is the key activity – “patient-centered care really matters – let’s embrace it!” When we are aligned in our values, administration is the needed component – “let’s make sure we consistently provide patient-centered care and let’s make it as easy as possible to do it.”

“Patient-Centered Care: What Does it Take?” speaks to the administrative side of ethics. The ideals of patient-centered care are (quite properly) taken as the starting point. The seven factors provide an organizational strategy for making it happen.

I believe that anyone who has practiced medicine will understand the importance of the seven factors. While they are conceptualized for organizations, they are relevant for a solo practitioner as well.

Applying the factors doesn't necessarily require rocket science skills. In my psychiatric practice a crucial part of the “built environment” is having enough room for three chairs in addition to mine to make it easy to see family members with my individual patients. And with regard to supportive technology, when voice mail became available, being able to give patients a telephone number they could call 24/7 and know I would get the message no later than the next day made a big difference.

“Just do it!” has been a great slogan for Nike, but it doesn’t cut the mustard for promoting patient-centered care. The Commonwealth Fund report gives us a better game plan.