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Opinion

Patient-centred care: all in this together

3rd Apr 2019

We hear from patient and Bevan Advocate, Barbara Chidgey, on what ‘patient-centred care’ means to her as an inadvertent ‘mystery shopper’ at University Hospital of Wales with a range of complex needs. 

Whatever our professional roles are in life, we are all united by the fact that every one of us have been or will be patients at one time or another - irrespective of whether we also work within the NHS or one of the related services.

Being a patient is what we all have in common. Therefore, we all have a role to play in ensuring patient-centred care is being delivered by the NHS and works for every single one of us. I want to reflect on what patient-centred care means to me.

Caring for the patient - and person

First and foremost, being a patient is an experience, one which we experience not just physiologically but also emotionally. In fairness, it is often one we would much rather forgo but one over which we (mostly) have little choice. Therefore, to me, patient-centred care means that the health and care professionals with whom I engage as a patient really do demonstrate that they care about me as a patient and a person.

Carl Rogers, the psychotherapist, shifted his perspective on patient or client care during the course of his career. He moved from focusing on how he could treat, cure or change a client, to focusing on how he could build a relationship within which the patient could learn and develop.

He was convinced that it was within such a co-created, trusted relationship that change and personal development happens. This relationship is led by the patient, with very clear core conditions of authenticity, unconditional positive regard and empathetic understanding. Those three conditions are the foundations of patient-centred care: ensuring the care is focused on my needs as a patient and not the needs of the service or about managing risk.

I have inadvertently gained a lot of experience of being a patient. Over 2016 I became something of a ‘mystery shopper’ in the NHS with complex health and care needs across a range of specialisms.

So, I write the following with huge appreciation of all the expertise, care and kindness from which I have benefited and continue to benefit.

What does exceptional patient-centred care look and feel like?

I have been fortunate to have experienced some examples of outstanding patient-centred care that have been instrumental in me surviving life-threatening crises. Such care has also, most importantly, helped in enabling me to manage my health a great deal better. I am therefore less reliant on NHS resources.

These experiences have enabled me to describe what exceptional patient-centred care is like i.e. feeling genuinely cared for, together with being expertly treated. These professionals provide not only their medical expertise but also a quality patient experience, even when some of the medical information is not all “good news”.

The health professionals who demonstrate exceptional patient-centred care:

  • Are fully present, with their attention and energy focused on me and what I am saying for the duration of our short appointment, consultation or ward-based discussion.
  • Have read through my background notes, looked up any recent test results and ensured they have tried to understand enough of my medical context and conditions before we have our conversation.
  • Really look at me, not just at their PC or tablet.
  • Really listen to me. Give me the space to explain what I want to say, even if I am saying it a bit badly (because I am a bit distressed maybe). Gently prompt me to help me articulate clearly what I need to say.
  • Demonstrate genuine empathy with me and my scenario.
  • Engage in a dialogue with me about the way forward, explaining possibilities that we can choose to pursue together.
  • Is directive, if appropriate – because sometimes as a patient I just need to hear: “This is what I recommend ….”
  • Puts my needs as a patient at the heart of our conversation
  • Together with me, co-creates our trusted professional relationship, which offers me a safe place when feeling so vulnerable. I can communicate with them, if needed, between appointments.
  • Treats me as a unique individual, not just a set of medical conditions.

As Maya Angelou said, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” This wonderful quote articulates what patient-centred care feels like.

NHS Wales has a number of laudable patient-centred initiatives, including ‘The Listening Organisation’ and an organisation-wide commitment to patient-centred care.

May I suggest that a patient-reported outcome measurement (PROM) about what patient-centred care feels like for a patient? This could help NHS Wales professionals understand if they are actually delivering on this promise.

Barbara Chidgey is a Bevan Advocate, patient, Executive Chair of the Leading Wales Awards and a former secondary school head teacher.

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