ISQUA17-2215A CONCEPTUAL MAP FOR PATIENT-CENTRED CARE REQUIREMENTS: ENHANCING THE APPROACH OF SYSTEMS TO ACHIEVING PATIENT-CENTRED CARE

Abstract

Objectives: Genuine patient-centred care (PCC) is a sought after but challenging ideal for healthcare delivery. PCC can lead to improvements in the quality of health systems, clinical safety and self-management by patients. In many settings and circumstances, achievement of PCC fails to occur despite the rhetoric. This study aimed to identify and operationalise organisational requirements for PCC through developing a conceptual map (Trochim and Kane, 2005). Methods: A participatory concept mapping methodology was used to develop the conceptual map. Stakeholders from patient and carer, health professional, health service manager, education and professional organisational leader groups participated. Stakeholders contributed to 1) the development of statements regarding what patient-centred care requires, 2) the sorting of those statements into a conceptual map, and 3) rating those statements according to importance, feasibility, and how well they are achieved. Analysis included development of a similarity matrix, multidimensional scaling, hierarchical cluster analysis, selection of number and labels for clusters through qualitative and quantitative analysis, and quantitative representation of rating data. Ethics approval was obtained from the local Human Research Ethics Committee. Results: The research identified 123 statements relating to what PCC requires. The statements were sorted into 13 clusters which were labelled: shared responsibility for personalised health literacy; patient provider dynamic for care partnership; collaboration; shared power and responsibility; resources for coordination of care; recognition of humanity - skills and attributes; knowing and valuing the patient; relationship building; system review evaluation and new models; commitment to supportive structures and processes; elements to facilitate change; professional identity and capability development; and explicit education and learning. These clusters were grouped into three overarching themes that represent a crosssectoral approach to PCC: humanistic and partnership elements; career spanning education and training elements; and health systems, policy and management. Preliminary rating data illustrates the usefulness in further characterising the statements on the conceptual map according to their importance, feasibility, and how well they are achieved. Conclusion: The requirements for PCC have been articulated using concept mapping, a methodology which enables ideas and their complex relationships to be visually represented. We found that PCC requires a cross-sector approach, between service delivery, patient involvement, education and training, and health systems, policy and management. This shared conceptual understanding of the requirements for PCC offers mechanisms for actioning PCC at organisational, team and individual levels.