Patient Welfare Services

Compiled and Collated by

Chhavi Deshwal
 What is Patient Centered Care?
Institute of Medicine defines Patient Centered
Care (PCC) as:
“Health care that establishes a partnership
among practitioners, patients, and their families
(when appropriate) to ensure that decisions
respect patients’ wants, needs, and preferences
and that patients have the education and
support they need to make decisions and
participate in their own care.”
 Key Attributes/Dimensions of PCC
1. Respect for patient values, preferences and
expressed needs
2. Coordination and integration
3. Information, communication and education
4. Physical comfort
5. Emotional support and alleviation of fear and anxiety
6. Involvement of family and friends
7. Transition and continuity
8. Access to care
 Key Attributes/Dimensions of PCC
• Respect for patient-centered values, preferences, and expressed needs,
including an awareness of quality-of-life issues, involvement in decision-
making, dignity, and attention to patient needs and autonomy.

• Coordination and integration of care across clinical, ancillary, and support

services and in the context of receiving “frontline” care.

• Information, communication, and education on clinical status, progress,

prognosis, and processes of care in order to facilitate autonomy, self-care,
and health promotion.

• Physical comfort, including pain management, help with activities of daily

living, and clean and comfortable surroundings.
 Key Attributes/Dimensions of PCC
• Emotional support and alleviation of fear and anxiety about such issues as
clinical status, prognosis, and the impact of illness on patients, their families
and their finances.

• Involvement of family and friends in decision-making and awareness and

accommodation of their needs as caregivers.

• Transition and continuity as regards information that will help patients care for
themselves away from a clinical setting, and coordination, planning, and
support to ease transitions.

• Access to care, with attention to time spent waiting for admission or time
between admission and placement in a room in the inpatient setting, and
waiting time for an appointment or visit in the outpatient setting.
 The Planetree Model
Planetree was founded by a
patient 25 years ago as a nonprofit
organization to advocate for the
patient's perspective in
healthcare. Planetree's first
demonstration site, opened in
1985, was a 13-bed medical-
surgical unit in San Francisco,
which brought together the design
concept of a “healing
environment” and a patient-
centered approach to delivering
care. 
The 9 elements of Planetree Model
1. Explicitly recognizing the importance of human interaction in terms of
personalized care, kindness, and being “present” with patients.
2. Informing and empowering diverse patient populations through consumer-
oriented health libraries and patient education.
3. Integrating health partnerships with family and friends in all aspects of care.
4. Attending to the nurturing aspects of food and nutrition.
5. Incorporating spirituality and inner resources for healing into care of patients.
6. Incorporating massage and human touch.
7. Incorporating the arts (music, visual art forms) into the healing process.
8. Integrating complementary and alternative practices into conventional care.
9. Creating healing environments through architecture and design.
 Barriers to Patient Centered Care
System-related Factors:
1. Fragmentation of care: patients come across a number of different
care professionals over the course of their hospital stay; who are
usually involved only with one aspect of patient’s problem – which
takes the focus away from patient as a whole person.
2. Shortage of workforce and excess workload on existing staff: Greater
focus on task completion results in lack of continuity of care and
hesitation among patients and their families to ask questions to busy
staff.
3. Power imbalance between patients and healthcare professionals:
traditional view that medical professionals are in-charge of your
health, therefore the patients and families assume a more submissive
role.
 Barriers to Patient Centered Care
Healthcare professional-related factors:
1. Belief held by medical professionals about
their role as the saviour can reinforce power
imbalance; therefore, the patient remains a
passive recepient of care.
2. Negative staff attitude, lack of communication
and commitment can also act as a barrier. This
discourages patients from making well
informed choices.
 Barriers to Patient Centered Care
Patient-related Factors:
1. Fear and anxiety about the medical condition might prevent patient
and his family from active engagement
2. Unfamiliarity with medical jargon and hospitals; lack of understanding
of customs, procedures and practices used to manage day-to-day tasks
in healthcare setting; and life-threatening situations intimidate the
patient often making them meek and submissive
3. Unequal power relation jeopardizes decision-making
4. Cross-cultural factors like differences in language, gender attitudes,
customs and beliefs, etc. also impede active involvement of patients.
5. A lack of health literacy, which could be due to age, education, social
status, mental health status, occupation, etc.
 How to offer Patient Centered Care?
EXAMPLES FROM THE “CLEVELAND CLINIC”:
• Institute Experience Council – comprises of doctors and nurses from different
Cleveland clinics across the world
• Patient Experience Team – doctors, nurses, housekeepers and other
personnel meet regularly to review patient surveys and address negative
comments.
• Patient Advisory Council – made up of existing and former patients meet
regularly to discuss issues affecting patients and their families; they review
new policies affecting patient experience and advise organization on suitable
changes.
• Online Panel of Patients – patients are regularly contacted once or twice a
month to ask questions about patient issues and get creative ideas.
• Chief Experience Officer – the overall in-charge of improving patient’s
experience.
 Examples from Cleveland Clinic
• Parking space in front of the hospital to be reserved for patients
• Making medical records more accessible to patients; they could view them whenever they
liked.
• Addressing long waiting hours
• Attendants encouraged to visit the patients whenever they liked and to spend as much time
as possible (with the exception of ICUs)
• Changing the design of patient gowns; making them less revealing
• REDCOATS - greeters in red coats whose sole job is to orient patients, provide directions, get
wheelchairs, etc.
• Designing facilities which have wide open spaces, feel homier, are bathed in natural light,
have green spaces and rooftop terraces and gardens
• Improving the menu and quality of food – tastier and healthier
• Medical concierge to take care of patients coming from other countries and states.
• Therapy dogs to provide emotional support, increase the number of smiles and reduce
anxiety
• Use of green products to reduce carbon footprint
 Examples from Cleveland Clinic
• Introduce initiative like HUSH (Help us Support Healing) outlined
measures to reduce noise in the hospital. From 9p.m. to 7a.m.Patients’
doors are closed, pagers and phones put on vibration, patients are
offered ear-plugs and eye masks, TVs are used with headsets and
caregivers are asked to hold conversation in a quiet, respectful manner.
• “What to expect during your hospital stay” brochure which explains the
various kinds of professionals a patient will encounter during their
hospital stay and what to expect regarding medications, the hospital
environment and discharge process. It also encourages patients to ask
questions and jot down concerns as they arise.
• Patient Service Negotiators (PSNs) assist with communication between
patients and caregivers. PSNs are patient advocates and help address
patient and family concerns. They visit patients daily.
 Examples from Cleveland Clinic
• Addressing each patient as Mr. Ms. Miss. Or Mr.
• Different coloured SCRUBS for different categories of
personnel
• Installation of museum-quality artwork on the walls and
public areas
• Department of healing services for spiritual and emotional
healing employs chaplains, medical social workers, massage
therapists, meditation experts, etc.
• CODE LAVANDER – in case of an emotional emergency Code
Lavender team provides immediate comfort, counseling, and
therapies that extend across two or three days.
 Examples from Cleveland Clinic
• Bringing a cultural change; try to align the
organization’s mission of empathetic care with
attitudes of the caregivers.
• Provide H.E.A.R.T. (Hear, Empathize, Apologize,
Respond, Thank) training to all caregivers.
• Training to improve patient-provider
communication
• Teaching medical graduates communication skills