Patient Centricity: A Manifesto

Currently, in healthcare, the term “patient centricity” is commanding significant thought and attention. While this, by and large, is a good thing, it is by no means uncomplicated or without nuance. Tracking the phrase means coming to terms with its complicated history and contested deployment. In one sense, patient centricity is nothing if not a curious, almost ridiculous term. How does something so fundamental and so intimate to human existence – health itself and how we take care of each other – arrive at a place where we require a term to remind ourselves of who lies at the center of care?

And yet, patient centricity arrives on our doorsteps with both great promise and great baggage, carrying with it the hope of a return to who and what has always been at the center of care: the patient. At the same time, there is a new drive, impetus, and mandate for reform, improved design, cooperation, and collaboration.

Making sense of patient centricity is an exercise in exegesis, but it is also more than that. In its subjectivity and variability, it also demands that we take a perspective and articulate a point of view. This is not so much to mark the boundary between what it is and what it is not, but, instead, to demonstrate its potential: what it can and aspires to be versus what
it is.

In this post, I don’t attempt to explain what patient centricity is or isn’t. Rather, this acts as a manifesto of sorts, a declaration of intent. Ultimately, we shouldn’t seek to contain or capture patient centricity and nail it down as this or that. Its broadness is part of its appeal, and is core to the ways in which it reflects humanity. Yet, we should seek to harness its energy, its push to the new, and its ethical foundations as a means to make it understandable and usable, to embed it more fundamentally at the core of how we think and do healthcare.

Patient Centricity: A Rapid Genealogy

Nevertheless, the promise embedded in the term is neutered if we don’t understand where it comes from. By this, we don’t mean who coined the term, or the genesis of thinking that coalesced in the phrase, but rather the conditions by which patient centricity came to be as a response to a previous state of being. Patient centricity, as both a term and a concept, is a product of the institutionalization and industrialization of healthcare, a process that began in the late 19th century. It came about with the organization of clinics and hospitals around rationalized or Taylorist modes of operation on the one hand, and the emergent demographic principles of “public health” on the other. The execution of medicine and healthcare – up to this point an intimate and personalized endeavor – became an experience that existed at the intersection of science and management.

To be sure, patient centricity is, and can only have life as, an institutional term. Patients themselves have always assumed – rightly or wrongly – that they are at the core of what healthcare is and does. This is evident today in the vast majority of conflicts that bubble up into the public sphere about healthcare; what they boil down to fundamentally is the conflict between the preservation of human values and the management of scarce resources.

Over the past few decades, as the healthcare system became increasingly complex, dominated by major institutions and massive corporations and government bureaucracies, the system focused its efforts on two things: the rationalization of care through technology and efficiencies, and the evolutions of science- driven medicine. In the process, patient experience has deteriorated, and in some cases seems to have been forgotten altogether. This is a tragedy that strikes us in our most fragile and vulnerable moments.

As with many things, the seeds of changes we are seeing today were planted in the late 1960s. As various liberation and equality movements sprouted, and a sea change in how authority was conceptualized and trusted in (Western) societies developed, a concomitant change in how patients were seen and saw themselves emerged. In fact, a broad movement for patient rights became the first evidence of these changes; a nascent, yet nonetheless growing skepticism of physicians’ authority began to shift the dynamics of doctor-patient interactions. Alternative practitioners slowly began to shake off the accusations of quackery, and started to edge increasingly into healthcare ecosystems. In doing so, they provided a radical counter-image to the experience that many people had in more traditional healthcare settings.

Today, we live in an era where the healthcare environment is increasingly complex and variegated. Caught between the seeming incommensurabilities of biomedicine on the one hand, and human values on the other, trends towards the rationalization of both care and costs have emerged and continue to develop rapidly. Similarly, the diversification of healthcare practitioners and services available offer people a range of different care experiences.

At the end of the day, the dichotomies that have been set up between human-centered care and the scarcity of healthcare resources, between people and science, and between technology and personalized touch, are all fictions that we would do well to discard.

From hospitals to the giants of the pharmaceutical world, and everywhere in between, the contours and constraints of care are changing.

The values vaguely gestured to in the phrase “patient centricity” are becoming increasingly relevant.

Patient Centricity: What We Believe

It is often said that patient centricity does not have a singular focus, definition, or mode of implementation. While true, this fuzziness often devolves into meaninglessness – just another industry buzzword or shiny wrapper in which to hide the inertia of the everyday. Patient centricity, however, isn’t just a new way to spin an old offering. In my experience, these offerings should evolve out of the very values that infuse patient centricity, rather than simply being adjusted to accommodate them. In other words, it’s not about jumping onto the patient centricity bandwagon, but about locating the human within patient needs, which is already at the center of these founding disciplines: human-centered design and medical anthropology.

That said, it was only as a result of beginning to see these values taking hold in the health space that I saw, and continue to see, an opportunity to do good work. In short, patient centricity isn’t a way to infuse health with humane, ethical, sustainable, efficient, and caring values. It is the only way. All of this, then, begs an important question:

What does patient centricity actually mean?

Rather than deploy a specific definition of what patient centricity is or is not, it’s best to think of it as a movement, a philosophy, an accumulation of values and aspirations, and a set of possibilities. At its core, we see patient centricity as an effort to re-ground health, healthcare, and healthcare delivery in the fullness of the human experience.

This deceptively simple statement by no means eschews complexity. This means acknowledging that the actors in any health experience – starting, of course, with the patient – are more than just the sum of their biology or their pathology. In the case of HCPs, it means recognizing the constraints in which they act, and acknowledging that they themselves are more than just the products of their training or their scientific authority. Patient centricity aspires to re-orient the culture of healthcare, and yet it manifests in various ways. This includes humble efforts to improve patient navigation through healthcare spaces, both physical and virtual, all the way to supporting the broader social, emotional, psychological, and physical health of patients.

Patient centricity also fundamentally challenges the traditional scope of care to include a diversity of stake- holders. Doing away with the hierarchy of actors that once privileged the sanctity of the doctor-patient relationship, patient centricity encourages a more social experience of health; it advocates for the incorporation of caregivers, family members, friends, and others into the care equation. By acknowledging the community of care in any health experience, patient centricity strives to recognize that, no matter their individual isolation, no person is sick alone. The ramifications of health and illness reverberate outwards to encompass everyone.

Finally, while it is possible to edge towards patient centricity via an accumulation of singular tools, tactics, and programs, the ambitious promise of centricity is, and can only be, systematic in nature and in scope. Successful patient centricity is much more than the sum of its parts. Rather, in order to really mean something, the parts add up to something greater; they must speak to, and ultimately demonstrate, change on a cultural level. Fundamentally, patient centricity is about a change in mindset and thinking about the very foundations of care. At its very best, patient centricity aspires toward and pursues cultural change.

A Manifesto for Change

The promise of patient centricity is also its peril. In setting up a suite of heightened expectations for patients and others in the healthcare system, we need to identify paths toward realization and implementation. New rhetorics, vocabularies, and shared hopes are a good beginning, but they also demand the need for someone to take responsibility for actual change.

There is no doubt that patient centricity, when done correctly, is not just the right thing to do, but good business as well. In fact, as we move forward, the lines between these two things – doing the right thing and good business – are increasingly fuzzy and non-existent.

At some point in our lives, each and every one of us is a patient.

This fact alone provides us with a broad mandate for change. This manifesto – a statement of core beliefs – is my stake in the ground.

the author

Dr. Marc Lafleur

Dr. Marc Lafleur is VP, medical anthropology at Idea Couture. See his full bio here.