Patient-centered innovation in health care organizations: A conceptual framework and case study application

Susan E. Hernandez, MPA, is PhD Student, Department of Health Services, School of Public Health, University of Washington, Seattle. E-mail: . Douglas A. Conrad, PhD, MBA, MHA, is Professor, Department of Health Services, School of Public Health, University of Washington, Seattle. E-mail: . Miriam S. Marcus-Smith, RN, MHA, is Research Manager, Patient-Centered Care Project, Department of Health Services, University of Washington, Seattle. E-mail: . Peter Reed, MPH, is MD Student, School of Medicine, Duke University, Durham, North Carolina. E-mail: . Carolyn Watts, PhD, is Professor and Chair, Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond. E-mail: .
Health care management review (Impact Factor: 1.3). 06/2012; 38(2). DOI: 10.1097/HMR.0b013e31825e718a
Source: PubMed


BACKGROUND:: Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors. PURPOSE:: We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article. METHODS:: We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation. FINDINGS:: The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation. PRACTICE IMPLICATIONS:: Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.

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    • "Leading studies in this stream suggest the following organizational facilitators of PCC: a strongly committed leadership that can forge structural changes (Luxford et al, 2011; Shaller, 2007); the improvement of the built environment to provide a supportive and nurturing space for patients and their families (Arneill and Frasca-Beaulieu, 2003; Frampton and Goodrich, 2014; Frampton, 2008); a supportive information technology that engages patients and families directly in the process of care as well as the use of systematic measurement of patient feedback to support continuous learning (Hernandez et al., 2013; Luxford et al., 2011). In fact, encouraging patients and caregivers' inputs to innovate healthcare services as well as ensuring providers' commitment with patient centered values are considered crucial elements of compassionate care (Frampton & Goodrich, 2014). "
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    ABSTRACT: Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and benefits of our approach through a hospital case study.
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    ABSTRACT: The increasing availability of medical information and the rising relevance of patient communities drive the active role of health consumers in health care processes. Patients become experts on their disease and provide valuable stimuli for novel care solutions. Medical encounters evolve toward a more collaborative health care service process, where patients are accepted as equal partners. However, the patient's active role depends on the interaction with the involved health care professionals. The aim of this article is to examine whether the service orientation of health care professionals and their proactive and adaptive work behavior and the extent of shared goals within the necessary interdisciplinary health professional team influence patients' innovative behavior. We address six rare diseases and use interview and survey data to test theoretically derived hypotheses. The sample consists of 86 patients and their 160 health care professionals. Sixty patients provided additional information via interviews. Patients' innovative behavior is reflected by the number of generated ideas as well as the variety of ideas. The service orientation of work teams plays an important role in the innovation process of patients. As hypothesized, the extent of shared goals within the health care teams has a direct effect on patients' idea generation. Work adaptivity and proactivity and shared goals both reinforce the positive effect of service orientation. Furthermore, significant associations between the three independent variables and the second outcome variable of patient's idea variety are confirmed. The study underlines (1) the important role of patients within health care service innovation processes, (2) the necessity of a service-oriented working climate to foster the development of innovative care solutions for rare diseases, and (3) the need for an efficient cooperation and open mindset of health care professionals to motivate and support patient innovation.
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    ABSTRACT: Nowadays, National Healthcare Systems are confronted with an increased demand for high quality and patient centred services worldwide, but the limits of resources challenge their sustainability. The mandate to " do more with less " encourages policy makers, healthcare managers, and professionals to look for innovative ways to redesign healthcare services in order to meet the challenges of the new social and economic trends. In this scenario, healthcare researchers and policy makers increasingly acknowledge patient engagement as a pivotal lever to improve the effectiveness and efficiency of healthcare provision. The chapter presents a frame of the current trends and challenges related to the development of sustainable innovation in healthcare by specifically focusing on the hospital change from the perspective of both new hospital positioning in the wider healthcare ecosystem and organizational reengineering. Hospital innovation is discussed in terms of its connection with the concept of engagement, which is articulated both at multiple levels and across multiple stakeholders composing the health-care ecosystem. The work is grounded on the analysis of the recent theoretical perspectives in healthcare innovation and on some illustrations and examples from relevant organizational case studies.
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