The relationship between the quality of patient-centered care in the context of organizational culture.

In recent years, patient-centered care and cultural competence have been promoted as integral to improving health care quality. Although patient-centered care and cultural competence have grown out of separate traditions, each with its own focus have many similarities. Health care that is patient-centered is likely also to be culturally competent, and culturally competent care is likely to be patient-centered. Proponents of patient centered care may therefore view cultural competence as within its purview; likewise, proponents of cultural competence may view patient centered care as an essential element.

The term “patient-centered medicine” was to express the belief that each patient “has to be understood as a unique human being.The concept has evolved and expanded, and today, no one would deny that health care should be patient-centered.However, despite universal endorsement of patient-centered care,there is considerable ambiguity in its definition and use across settings.

The Picker–Commonwealth Program for Patient-Centered Care began in 1987 to promote a patient-centered approach to hospital and health services focusing on the patient’s needs and concerns.Seven dimensions of patient-centered care were identified as respect for patients’ values, preferences, and expressed needs; coordination and integration of care; information, communication, and education; physical comfort; emotional support and alleviation of fear and anxiety; involvement of friends and family; and transition and continuity. The program clearly went beyond the more narrow interpretation of patientcenteredness as a way for physicians to interact with patients, and moved toward a more comprehensive way of delivering health services.The term “patient-centered care” is not limited to communication and often focuses on other aspects of care such as availability of office hours, ability to get appointments when needed, being seen on time for appointments, and having conveniently located services.

The issue of cultural competence in health care emerged later than did patient centered care .Within the past 10 years, myriad programs addressing cultural competence in health care have been developed, national standards for health care systems have been published, a recurring national conference has been established, and federal mandates to increase cultural competence have been issued. The primary impetus for the cultural competence movement of the past decade has been the demonstration of widespread racial and ethnic disparities in health care, and the consequent publicity surrounding this issue. However, the principles of cultural competence are rooted in efforts that precede the high visibility the issue has received in recent years.For decades, health care leaders and educators have recognized that cultural and linguistic barriers between health care providers and patients can interfere with the effective delivery of services. Greater attention to these barriers gave rise to programs and curricula bearing the monikers “cross-cultural medicine,” “cultural sensitivity,” “transcultural nursing,” and “multicultural counseling.” Programs largely focused on “whose health beliefs may be at variance with biomedical models.”

Although the principles underlying these programs were considered applicable to patients of all backgrounds, they targeted primarily immigrant or refugee populations with limited English proficiency and exposure to Western cultural norms.The expansion of the scope of cultural competence was driven largely by events that revealed racial disparities both in health status and in the quality of health care in the United States.One of these events was the 1985 publication of the Department of Health and Human Services Secretary’s report on black and minority health, which documented substantial and pervasive disparities in the health of people of color, particularly African Americans, as compared with the white population. During the 1990s, these disparities became a central focus under the Clinton Administration.

At the core of both patient centered care and cultural competence is the ability of health care providers to see patients as unique individuals; to maintain unconditional positive regard; to build effective rapport; to use the biopsychosocial model; to explore patient beliefs, values, and meaning of illness; and to find common ground regarding treatment plans. The patient-centered model for patient–physician interactions, in addition, includes a detailed set of knowledge and skills that health care providers should possess. Proponents of cultural competence often make reference to the patient-centered approach when suggesting methods of interaction between patients and physicians. Thus, while these characteristics are not explicitly the focus of cultural competence, most can be endorsed as being aspects of cultural competence.Because the cultural competence and patient-centered care movements both aim to improve health care quality in similar ways, there has been debate about whether it is better to keep the movements separate or combine efforts into a single agenda.

While many features are similar, important aspects of each remain that have not been formally adopted by the other.Cultural competence and patient centered care are both important considerations when thinking about high-quality relationships in health care and health care delivery systems. Patient-centered care has broadly focused on the needs of individual patients, while cultural competence has historically focused on the specific needs of people and communities of color. Although separate movements with separate focuses, both patient centered care and cultural competence may look fairly similar in practice.In the end they recommend that patient centered care and cultural competence remain distinct but aligned efforts to both elevate and balance the quality of health care for all patients.

references:

1) Balint E. The possibilities of patient-centred medicine. J R Coll Gen Pract 1969; 17:269-
276.
2) Lipkin M, Jr., Quill TE, Napodano RJ. The medical interview: a core curriculum for
residencies in internal medicine. Ann Intern Med 1984; 100(2):277-284.
3) Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the
empirical literature. Soc Sci Med 2000; 51(7):1087-1110.
4) American Medical Association. Cultural Competence Compendium. Chicago: American
Medical Association; 1999.