5 Assumptions about Patient Centricity that are Leading you Astray

Those who have been paying close attention to developing trends in healthcare have undoubtedly heard of “patient centricity.” Though not without skepticism and ambiguity, the term has become a key focus and a driving ambition for articulating the future of healthcare as both an intellectual and actionable agenda. Intellectually, patient centricity is approached as a philosophy that aims to answer, “what does it mean to place the patient at the center?” However, as a practice, patient centricity is approached empirically, and seeks to answer, “what does it look like?”

To date, patient centricity has been understood as the “inclusion of patient values, beliefs, and preferences at the core of care.” This has resulted in a diverse array of implementations, including the development of “patient focused care” or “patient centered care,” increasing patient satisfaction, and adapting to new patient demands. While these are all necessary and valiant goals for achieving a patient-centric healthcare system, we must also be careful and diligent in deconstructing the underlying assumptions that are embedded in the language and actions surrounding patient centricity.

It is this—the unraveling of patient centricity—that we have placed at the center of our health practice. We see patient centricity as the means through which we can ground health, healthcare, and healthcare delivery in the complexities and richness of human experience. Through anthropological inquiry and strategic investigation, we have found ourselves bridging the gap between the intention and the application of patient centricity, by calling attention to the hidden tensions and ways that patient centricity gets misappropriated and misconstrued.

Do we believe that patient centricity is a viable pursuit? Yes, absolutely. And we are also cognizant that its application will set the precedent for the future of healthcare. Thus, in this article, we take aim at five critical misleading assumptions around patient centricity and share our insights on how to better approach, understand, and act around the term.

Assumption 1: We know what it means, what it does, and how to use it

Patient centricity is the current term used to bring attention back to people under care. It is about embracing the unique circumstances and goals of each patient in decision-making, and it is a necessary counterpart to the inclusion of patients as stakeholders of medical outcomes and institutions. While this is a rightful and needed outlook, it lends to the assumption that patient centricity has a set definition, application, and result. However, when we focus on setting the concept of patient centricity in stone, the boundaries of what it should or should not be become the focus—rather than its quality and purpose.

In reality, patient centricity is fuzzy, flexible, and fluid.

The pursuit of a single interpretation of patient centricity stands in opposition to the inherent complexity of the term and the industry to which it is applied. Successful patient centricity relies on a multitude of diverse strategies, as it reflects the multiplicity of stakeholders and unique position of each sub-industry. There is no “one size fits all” method for patient centricity, because there is neither one static set of patient needs, nor one do-it-all place of health. Health itself is a complex, integrated, and holistic topic that extends beyond the absence of disease, encompasses mental and emotional wellbeing, and morphs across time and place. Consequently, the strength of patient centricity is in its fluidity and flexibility. Its fuzziness allows it to adapt to the needs, values, and preferences of patients not just as they stand now, but also in how they will change over time.

Assumption 2: We put patients at the center

Intuitively, patient centricity is understood as the effort to place patients at the center of care. While this is a true and valid goal, it is misleading in that it narrows our perception of where the challenges lie. Instead, it asks us to consider two questions: If patients are not at the center, what/who is? And if patients are not at the center, where are they? In other words, it is not simply that patients should be placed at “the center” of the healthcare system, but rather that the system has not had a sufficient place for the patient until this point. Historically, the priority has been the pursuit of operational and clinical success. While this has created great health institutions on paper, it has not been as adept at creating great health institutions for people in reality. As such, what we aim for when we say “put patients at the center” is in fact something bigger than the sum of its parts.

In reality, patient centricity aims for systemic and cultural change.

Each element of the healthcare system is essential and contributes a unique and necessary feature of a greater whole. Although, individually, what patient centricity means and how it operates is unique, each institution and organization involved depends on interconnected high-level strategy and low-level, tactical executions. In other words, when patient centricity is embedded in the mandates, goals, and policies of an organization or institution it also needs to be paired with structural, operational, and instructional changes on the front line. The patient experience is not isolated, but rather it is contingent on interactions and relationships with people. Therefore, part of taking care of patients and improving the patient experience is taking care of the people who deliver care. This trickle-down impact on the patient experience means having a deeper awareness of how senior-level decisions are made and what their implication will be both on patients and care providers. Patient-centric interventions and innovations are about the patient, but they are not always direct actions; understanding the indirect relationships involved in patient centricity is how individual actions can aggregate to create systemic and cultural change.

Assumption 3: We empower patients through information

The internet has opened the gates of information and created new channels for learning about diseases, treatments, and care spaces. As a result, institutions and experts are no longer the sole holders of medical information, patients have increasingly become more informed and engaged participants. However, focusing on information as the means to informed decision-making and empowerment overlooks the knowledge held by patients and their specific needs across multiple situations. Furthermore, while some patients may prefer being immersed in information, others may prefer being guided and have a more paternalistic encounter. In fact, a patient could seek both types of encounter in a single interaction or across their journey. Thus, in order for information to be empowering to a patient, it has to be contextualized in their beliefs, culture, context, and circumstances in addition to their medical history, comorbidities, and prognosis. Patient centricity is therefore not about more information or just improving medical literacy, but about an appropriate relationship built around relevant support to enable informed decisions.

In reality, patient centricity is empowerment through reciprocity.

Information itself is an open-ended term that extends beyond medical diagnosis, drugs, treatments, and trials. For the information to be relevant, you must first understand who is receiving it. “Patient” is a term that describes a very specific moment in time and defines a social role that exists only within a medical setting. However, who a patient is and what they are seeking is far more complex and integrated than the term suggests. Recognizing patients as persons simultaneously recognizes that illness does not begin and end in the hospital, but becomes a part of daily life—a constant and consistent part of everyday routines and the disruption of these routines. Thus, the information that patients are provided and how it is received should, ideally, be intrinsically connected to and reflective of their particular history and goals. Making people and their quality of life the priority allows for the information patients receive to be personalized and reflect the diverse ways in which people experience illness and desire care.

Assumption 4: We measure success as satisfaction

One of the main challenges patient centricity presents is how to measure if it is being done well and if it is actually improving the patient’s experience. One of the ways in which it is currently being measured is through satisfaction surveys. While this helps to kickstart conversations, it does not delve into the complexity of interactions and moments that create an experienceMeasuring satisfaction in this way can overemphasize gratification and misappropriate information, resulting in surface solutions or methods of “pleasing the patient” rather than of providing a continuous, meaningful engagement. Yet, satisfaction does touch on something important—the idea that patient experience is a key part of healthcare delivery.

In reality, patient centricity is not a single, measurable point.

Perhaps more important than whether satisfaction is the right measuring stick is the recognition that the patient experience is comprised of multiple steps and encounters and that each point is an opportunity for improving the patient experience. In this way, we move beyond the “how satisfied are you?” discourse and start to see the layered complexity behind what we are trying to improve: experience. Where satisfaction points to gratification, looking at experience gives a wider lens towards understanding the multifaceted nature of the patient journey and multiplicity of actors that contribute to it. This encompasses what it means to provide high-quality care, or how to improve the process of having difficult conversations and of dealing with the ups and downs of the journey. By including all of the smaller, nuanced situations and circumstances that impact the patient, experience takes a summative approach, rather than the linear approach, of satisfaction. Technology, pharmaceuticals, techniques, and treatments have all been vastly improved—and now it is time to look at unleashing the potential of how to integrate experience design, communication strategies, and empathy into healthcare practices.

Assumption 5: We need to start over  

When patient centricity was first introduced, it was seen as a revolutionary concept that would fundamentally change the way healthcare was conducted. Yet, the discourse around the humanization, and the counter-narrative around the dehumanization of the medical system, is nothing new. In fact, patient centricity has been around since the industrial era, it has just been called by different names. Nonetheless, this does not distract from the need for patient centricity to shift into the present. Counter to the “do over” narrative, patient centricity by no means implies reducing or stopping dedication to advancements in vaccinations, diagnostics, and medical procedures; clinical innovation can be patient-centric . In this way, patient centricity is a way to frame or organize what you do, rather than an imposition or a call to redo or undo what has already been done.

In reality, patient centricity is improvement, not a reset.  

Patient centricity suggests that, despite the success of our health system, something is missing and that that element needs to be rewound and reworked into the gaps in the care system. These gaps are then the starting point for bringing patient centricity into the healthcare system on a feasible, tangible, and doable scale. Whether it involves understanding how to organize operations, designing a service platform, or training staff, patient centricity, at its core, is about the continued desire to improve experience. Yet, despite all the complexity of experience, it starts at the scale of relationships and is mediated through the people who involved in every step of the patient journey. Therefore, patient centricity and the current care system should not be seen as mutually exclusive, but instead as one unified vision, working in tandem to continuously improve care by embedding science, technology, and healthcare resources into personalized and perceptive human-centered experiences.  

Conclusion

Patient centricity is not just about the parts that make the whole, but the glue that links each part together; it is the foundational philosophy and practice for how to adapt to the changes taking place and create the desired future of health. Patient-centered care, diagnosing the whole person, designing better hospitals, and creating new patient support programs are all required to make this change a reality—but each element is incomplete on its own. Patient centricity should be seen as an ongoing design thinking exercise, that seeks to brings forth a system with more human values. Acknowledging the complexity of people, the fragility of our humanness, and the ways in which health and illness can transcend daily life is one of the most powerful and meaningful tasks of patient centricity—and it is a task that involves everyone. Patient centricity is not just about the “end user,” it is about every step in the medical journey, the people and spaces involved in delivering care, and the inescapable fact that, at some point, every person could be a patient.

Photo: Jeremy Brooks

the author

Victoria Scrubb