Person-centered care is a strategy of providing health care that views the people using health and social services as equal partners in the entire process of planning, developing and monitoring care to ensure that the care meets their needs. The idea that health care should be focused on the person is not new. A considerable number of prior initiatives over the past decades have had a similar focus. All of them sound appealing. The very idea that health care should be about anything other than the health care needs of the individual seeking care is unacceptable.
Despite all of our attempts to change language and strategies, decision making about health care is not always centered around the person seeking care.
>Health care providers weigh in on what they think is in the best interest of the people they serve.
>Insurance companies and government funding authorities develop decision rules that are intended to balance the interests of the people served with the larger interests of all citizens or at least government agencies.
>Drug companies try to influence physician recommendations and decision-making.
>And of course, politicians, on both sides of the aisle, representing constituencies with strongly held moral or religious convictions, sometimes insert themselves into the healthcare decision-making process.
Person-centered care offers some hope of being different from the myriad of ‘patient-first’ type strategies that have been espoused in our lifetimes. There are two reasons for hope.
1. The approach is openly collaborative. Instead of naïve approaches that claim to put the person at the center of care, the person-centered approach explicitly makes them an equal partner. This collaborative stance is very consistent with what we have learned about managing complex ‘soft’ systems. Only hierarchical or collaborative solutions are possible in multiple party systems.
2. The rapid development of the information culture allows for the democratization of information, and hence empowered collaboration, in ways that were not previously possible.
But person-centered care will suffer the same fate as many other good ideas unless we figure out a way to actually embed it into the practice of care. Without a model, without social processes and strategies that place the principles of person-centered care formally into the day-to-day decisions made in the healthcare marketplace, it will simply be another nice idea left in the dustbin of history.
Transformational Collaborative Outcomes Management (TCOM) offers a pathway to take person-centered philosophy to scale. Consider the key decision points in the TCOM model. In order to take person-centered care to scale it is necessary to ensure that the people seeking care are full partners in each of these key decisions.
It is easy enough to conceive that exceptional practitioners could engage individuals as equal partners in each of these key decisions. But to ensure that this happens routinely requires the redesign of processes of care at the individual level. Even if you engage in collaborative care at the individual level, those decisions can be over-ridden at different points of the system. Many are familiar with situations where an individual practitioner’s decision with the person they are serving was vetoed by a supervisor or program manager. In fact, program and agencies policies are often written in a way that simply takes involvement in decision-making away from everyone. Government agencies and insurance companies are well known for either taking away the individual’s involvement in their health care or creating powerful incentives to directly influence this decision making. In an earlier post we have discussed this as a problem between equality and equity.
By creating and communicating a collaboratively-developed vision of the person’s story, TCOM offers the strategy whereby we can ensure that the people served are treated as partners in all decisions that are made. If the person is an equal partner in the use of a common assessment strategy (e.g. CANS, ANSA, FAST), then the aggregates (combinations) of these assessments can also be considered fully collaborative. Collaboration at the individual level is often called engagement; at the program level it is often called teaming; and at the system level it is called system integration. They are all essentially the same process – building a shared understanding of how to act toward a common purpose. By using collaboratively-created assessment strategies, we can provide people at every level of the system with person-centered information on how well we are identifying and acting on persons’ needs and strengths. Actions taken by persons at every level of the system can be rooted in continuously provided information about persons’ needs and strengths. That is the essence of TCOM and it is why this strategy offers person-centered care as an effective mechanism to go to scale with its vision of people as equal partners. The essence of TCOM is about keeping people at the center of everything we do together.
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