Exploring the practice of patient centered care: The role of ethnography and reflexivity (original) (raw)
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Discussion of Patient-Centered Care in Health Care Organizations
Quality Management in Health Care, 2012
The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient-centered care. At the organizational level, patient-centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient-centered care have not been fully achieved. In this article, we used a critical social theory lens to examine the discursive influence of power upon the integration of patient-centered care into health care organizations. We begin with an overview of patient-centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge of health care providers and shed light on how these long-standing traditions have impeded the integration of patient-centered care. We conclude with a discussion of viable solutions that can be used to implement patient-centered care into health care organizations. This article presents a perspective through which the integration of patient-centered care into health organizations can be examined.
Discussion of patient centered care in health organizations
2021
The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient centered care. At the organizational level, patient centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient centered care have not been fully achieved. In this article, we employ a critical social theory lens to examine the discursive influence of power upon the integration of patient centered care into health care organizations. We begin with an overview of patient centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge...
Health expectations : an international journal of public participation in health care and health policy, 2017
Patient-centred care is now ubiquitous in health services research, and healthcare systems are moving ahead with patient-centred care implementation. Yet, little is known about how healthcare employees, charged with implementing patient-centred care, conceptualize what they are implementing. To examine how hospital employees conceptualize patient-centred care. We conducted qualitative interviews about patient-centred care during site four visits, from January to April 2013. We interviewed 107 employees, including leadership, middle managers, front line providers and staff at four US Veteran Health Administration (VHA) medical centres leading VHA's patient-centred care transformation. Data were analysed using grounded thematic analysis. Findings were then mapped to established patient-centred care constructs identified in the literature: taking a biopsychosocial perspective; viewing the patient-as-person; sharing power and responsibility; establishing a therapeutic alliance; and ...
Journal of Service Management, 2020
PurposeHealthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.Design/methodology/approachThis paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.FindingsThe paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient...
BMC Health Services Research
Background Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of ‘quality improvement’ when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. Methods We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. Results When patient participants tried to influence quality improvement or discussed different ...
BMC health services research, 2018
Healthcare organizations increasingly are focused on providing care which is patient-centered rather than disease-focused. Yet little is known about how best to transform the culture of care in these organizations. We sought to understand key organizational factors for implementing patient-centered care cultural transformation through an examination of efforts in the US Department of Veterans Affairs. We conducted multi-day site visits at four US Department of Veterans Affairs medical centers designated as leaders in providing patient-centered care. We conducted qualitative semi-structured interviews with 108 employees (22 senior leaders, 42 middle managers, 37 front-line providers and 7 staff). Transcripts of audio recordings were analyzed using a priori codes based on the Consolidated Framework for Implementation Research. We used constant comparison analysis to synthesize codes into meaningful domains. Sites described actions taken to foster patient-centered care in seven domains...
BMC health services research, 2015
Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. When patient participants tried to influence quality improvement or discussed different dimensions of quali...
Erving Goffman argued that workers in psychiatric wards must enforce bureaucratic rules that undermine the image that patients possess a self while also engaging in acts of deference that uphold it. Since that time, scholars have debated whether other hospital workers now face a similar dilemma as their organizations take on the more impersonal characteristics of a total institution while also promoting an ideology of patient-centered care. Although these writings suggest how care providers relate to their work and talk about patient encounters, they fail to compare the effects of providers' work orientations on how and when they engage in practices that dignify patients. Hence, they shed little light on the conditions under which care workers might craft patient-centered cultures differently. Building on the insights of identity theory and practice theory, we seek to remedy this situation by developing an approach for studying and explaining frontline hospital workers' diverse styles of caring for the selves of patients. Consistent with expectations, we find that hospital nurses who most closely identify with their roles and primarily value them for their social usefulness (rather than their professional advancement or financial rewards) not only perceive more opportunities and engage in more tangible acts to affirm patients' sense of selfhood, but they also more selectively apply practices to situations. We discuss the implications of our results for research on helping professionals, " internal activists, " humanizing ideologies, and patient-centered care.
Limping along in implementing patient-centered care: Qualitative study
2020
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran 3 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran 4 Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran