Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

Abstract

BackgroundGrowing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance.MethodsWe conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus.ResultsInnovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation.ConclusionsPatient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for innovation.

Developing and testing the patient-centred innovation questionnaire for hospital nurses

“…Berry, Seiders, and Wilder () noted that, when providing PCC, regional restrictions on the usage of health care resources for patients should be properly considered. In addition, other scholars have also advocated access as the core element of PCC (Rathert et al., ; Reed et al., ). Furthermore, Stewart et al.…”

“…Reed et al. () also believe that, from the view of PCC, health care providers should make clinical decisions based on the values of the patients and strengthen patient participation in the decision‐making process. In this way, participation in clinical decision‐making is a necessary element in PCC.…”

“…Patient‐centred care requires medical staff to empower the patient, share power with the patients and regard patients as “people” with an interactive relationship between the mind and body. PCC also emphasises that medical staff should be committed to delivering health care that addresses the concerns of every patient (Rathert, Williams, McCaughey, & Ishqaidef, ; Reed, Conrad, Hernandez, Watts, & Marcus‐Smith, ). Stewart et al.…”

Perceptions of Shared Decision Making Among Patients with Spinal Cord Injuries/Disorders

“…35,36 Further, research suggests that SDM does not adversely affect patient outcomes 34 and may in fact improve outcomes such as adherence to treatment 21 and satisfaction with care. 20 Though past research 14,24,25 has shown an impact of personal characteristics, such as age and race, on SDM, these relationships were not significant in the present study.…”

Nursing students' understanding of the Fundamentals of Care: A cross‐sectional study in five countries

“…Patients, although not always explicitly, aware of the concept of PCC, value emotional support, care coordination, participation, attention and comfort (Jangland, Kitson, & Muntlin Athlin, ; Lorig, ; Marshall, Kitson, & Zeitz, ). Organisations, on the other hand, feel that PCC is best achieved through payment reforms, sharing in decision making, cost‐effective care and the process of care delivery (Rathert et al., ; Reed, Conrad, Hernandez, Watts, & Marcus‐Smith, ). The FoC are a significant part of a patient's perspective of PCC.…”