One of the most important elements on which the contemporary health care system is based in the doctrine of patient-centered care. However, even though adherence to its principles has been shown to result in better patient health outcomes (Barry & Edgman-Levitan 2012), in certain cases, their implementation becomes difficult due to a number of contradictions with other principles of health care provision. In particular, some such problems emerge from the requirements of patient safety and risk management. In this paper, the concepts of patient-centered care, patient safety, and risk management are discussed, a number of possible problems that may result from their conflicts are considered, and some solutions for these problems are offered.
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The Concept of Patient-Centered Care
Patient-centered care is a type of health care in which respect for the patient occupies the central place; it is aimed at taking into account the patient’s personal needs, preferences, values, cultural traditions, lifestyle, and the situation of their family while serving the patient and providing them with medical care (Sine & Sharpe 2011). One of the key aspects of patient-centered care is that patients are supplied with the opportunity to make the key decisions pertaining to their health and their life.
These decisions need to be informed and are made by the patients together with medical care specialists. In fact, it is stated that in patient-centered care, “the patient is considered a vital member of the healthcare team” (Shuss et al., 2015).
The concept of patient-centered care includes a number of principles that define the relationship between the clinician and the patient. Some of these principles are: building a therapeutic relationship with the patient and maintaining it, not only during illness but also after the client regains their health; addressing the holistic needs of the customer and taking into account their preferences; openly sharing information with the patient (which includes admitting to making medical mistakes); creating a supportive atmosphere which benefits the client; stimulating the members of the patient’s family to participate in the process of healing (only, of course, if the patient so desires); and extensive cooperation between all the members of the healthcare team (Shuss et al. 2015).
It is also important to note that the practice of patient-centered care is grounded upon the ethical concept of the autonomy of an individual (Sine & Sharpe 2011). Whereas in health care settings of the past, medics created plans for treatment that were based only on the diagnosis, nowadays, the practice of patient-centered care has made the patient the key decision-maker in the process of treatment (Shuss et al., 2015). Therefore, patient-centered care, viewing the patient as an autonomous individual and not just an object to which medical treatment is to be given, provide the client with a certain degree of control over their own health and life, instead of simply making them a passive object in the hands of medical personnel (Sine & Sharpe 2011).
The Concept and Key Points of Patient Safety and Risk Management
The concept of patient safety in medicine and health care is rather simple; it is of critical importance to make sure that the patient is not harmed in the process of treatment and that all the conditions which threaten their health and their life are addressed with due speed and care at the proper level of expertise so as to eradicate, or at least minimize the risks.
It is clear that in order to achieve this, it is necessary to organize the medical routine properly; for instance, nurses working in hospitals need to have ward rounds and regular meetings; there should be an efficacious exchange of information between different members of the medical staff; the medical personnel needs to receive proper training and be well-informed, and up-to-date, with regards innovations within the fields of medicine and nursing care; and there should exist an appropriate organizational culture, so that members of staff are committed to providing high-quality care to their patients, especially with regard to their safety (Young 2014).
Clinical risk management is one of the basic elements of patient safety. The crux of it is the identification of key factors that may pose a risk or danger to the patient and, once identified, the minimization of their impact. These factors are mainly related to the conditions and ways in which health care is provided; for example, they include the conditions and setting in which medical care is supplied, the standard procedures that are utilized by the members of the medical personnel, and the level of education and competence that the representatives of the medical staff have. It is paramount that risk management remains a priority in medical care, for negligence in this area may lead to serious adverse consequences for the patient.
Anthony (2014) points out that certain breaches and/or the systematic overlooking in medical routines may have lethal consequences for the patient. For instance, drugs that need to be taken orally but are drawn from their package using hypodermics for measurement are sometimes mistakenly administered intravenously; or indicating doses of medication (e.g., insulin) in u’s rather than units in the prescription documents may lead to errors when the “u” is confused with a zero, which causes a tenfold increase of the dose.
The author states that it is necessary to carry out a “thoughtful analysis of systemic factors that led to errors” rather than discipline the representatives of health care personnel who committed the mistake (Anthony 2014). Therefore, appropriate risk management is of the essence if patient safety is to be realized.
Conflicts between the Implementation of Patient-Centered Care, Risk Management and Patient Safety
It should be noted that the implementation of the principles of patient-centered care sometimes may be inconsistent with certain medical considerations related to the problem of patient safety. For instance, according to the principles of patient-centered care, a seriously ill person can refuse to be hospitalized, despite the fact that their health condition is highly adverse and threatening, and demand to be provided with medical care at their home.
This will likely contradict the decision made according to the principles of risk management, for it is considerably more difficult to supply high-quality care and treatment at home than in a hospital (Sine & Sharpe 2011). Some patients may also be unwilling to follow what would be seen as the best way of treating their disease; this can be a result of a wide array of factors such as misunderstanding of the medical procedures and other nuances by the patient due to, for example, the staff’s failure to properly explain things, or the patient’s own personal preferences, and/or suboptimal communication inside the health care team (that includes the patient and their family).
In addition, there exist certain circumstances in which some of the principles of patient-centered care become extremely difficult to implement; this may happen, for instance, in a psychiatric setting or in situations in which the patient’s condition prevents them from making decisions, and the members of the patient’s family are not present or have conflicting views on the steps which need to be taken. Such situations often prove challenging to the health care personnel and may require that ethical decisions are made (Sine & Sharpe 2011).
In addition, the key principle of patient-centered care – that the patient makes key decisions pertaining to their treatment – is limited in practice by the capacity of the client to make decisions and to participate in the process of informed consent. It is also important to point out that this capacity is often not stable; it may change over time as the patient’s condition changes (Sine & Sharpe 2011).
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It is stressed that as the risks resulting from decisions about treatment go up, “the stringency of the test for capacity increases, and the expected level of the patient’s capacity for judgment required to accept or refuse the medical intervention also increases,” and, consequently, the line dividing a patient capable of making a decision about treatment and one who is incapable of doing so is usually rather blurry, making the assessment difficult (Sine & Sharpe 2011, p. 33). As a result, conflicts between patient-centered care and optimal risk management might potentially emerge (e.g., should the patient be allowed to make their own decisions, or should medics take decision-making into their hands in order to lower the risk of adverse outcomes?).
Another set of problems emerges as unintended consequences of the policies of patient-centered care and the focus on accountability for the issues of patient safety and risk management. For example, Andersson and Liff (2012) discovered that in the psychiatric setting in Sweden, the need to minimize the risks for the patient and the strict accountability of the medical personnel for the patients’ risks resulted in the increase of the personal risk for the health care professional and, consequently, in considerable psychological pressure and the attempts of health care providers to minimize their own risks.
In addition, as health care institutions are accountable for the risks as well, so they might also make attempts to minimize their risks As a result of this; both doctors and unit managers might sometimes send patients elsewhere, specifically in order to avoid potential problems for themselves, their colleagues, and/or their organization. Indeed, the authors provide a number of examples where doctors and unit managers worked together in order not to admit patients where the potential consequences of accepting responsibility for them might be serious (Andersson & Liff 2012, pp. 264-265).
Therefore, it is concluded that the pressure to lower the risk for the clients by increasing the responsibility of medical institutions and their staff might have new risks for the patients as one of its unintended results. It is also highlighted that these unintended results lead to non-compliance with the principles of patient-centered care and patient safety (Andersson & Liff 2012).
As outlined in this paper so far, there are, undoubtedly, a variety of unpredictable pitfalls associated with the practice of patient-centered care and its alignment with the principles of patient safety and risk management. However, it is the opinion of the author of this paper that the practice of patient-centered care is paramount in the contemporary medical setting, for it still yields better results overall for the patient.
For example, it is stated that patient-centered care, including the process of shared decision-making, often results in better knowledge and enhanced comprehension of health issues, a greater number of decisions made in accordance with the patients’ values, and improved patient activity, increasing patient health outcomes. It is also stressed that shared decision-making might help solve the problems of over-treatment (Barry & Edgman-Levitan 2012).
It is important to treat patients as individuals and to take into account their personal preferences, values, and wishes if ethical norms are to be accounted for (Sine & Sharpe 2011); it appears contradictory to provide care for patients against their desires. Simultaneously, the practices of risk management and the principles of patient safety also remain essential in the health care setting, for their negligence leads to highly adverse patient outcomes (Anthony 2014).
Thus, the need to align patient-centered care, patient safety, and risk management arise. In order to do this, it is crucial to discover the concrete effects of these three entities so as to determine which of them lead to unintended adverse consequences and to substitute them for more appropriate ones. As Andersson and Liff (2012) point out, researchers should scrutinize not only the general or “global” effects of this or that principle or procedure but also their consequences on the micro-level – that is, the behaviors and practices of concrete medics and patients in a variety of settings and situations.
To sum up, it should be stressed that patient-centered care has become a cornerstone for the provision of health care nowadays. It demands that a patient is viewed as an individual and that their holistic needs, desires, and personal values are taken into account when providing medical attention. Simultaneously, the principles of patient safety mean that it is paramount that the patient is not harmed and that they are provided with treatment adequate to their health condition. In addition, risk management is aimed at reducing the risks to the patients, often those risks which result from certain medical routines and procedures.
However, the need to maximize patient safety and the practices of risk management may, in reality, contradict the principles of patient-centered care, and their implementation, sometimes, may have unintended adverse consequences. Thus, it is necessary to determine the best practices to help avoid these conflicts between patient-centered care, patient safety, and risk management.
This paper concludes that additional research is required in order to uncover the potential hidden pitfalls in concrete decisions and practices guided by the principles of either patient-centered care, or patient safety, or risk management. Such future studies should examine not just the “global picture” but also the micro-practices that take place in concrete clinical settings. However, it is important that the three groups of principles remain central in the contemporary health care system and that the practices resulting from them are matched, for their use has been shown to result in considerably enhanced patient health outcomes.
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Barry, MJ & Edgman-Levitan, S 2012, ‘Shared decision making – the pinnacle of patient-centered care,’ The New England Journal of Medicine, vol. 366, no. 9, pp. 780-781.
Shuss, S, Lockhart, L, Kelton, D & Davis, C 2015, ‘Patient-centered care pointers,’ Nursing Made Incredibly Easy, vol. 13, no. 3, pp. 20-27.
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Young, L 2014, ‘Patient safety,’ Nursing Standard, vol. 28, no. 25, p. 54.