Patient Centered Care in Hospitals

Many different forces have combined to produce a paradigm shift in patient care processes in hospitals. The new model, called patient-centered (or patient-focused), is intended as an economically sound, care-driven approach to the patient as an individual. In traditional hospital care, institutions have, for the most part, "been designed following an industrial, reductionist model, with little or no attention to the difference between dealing with an inanimate object or treating patients" (Gage, 1994, p. 26). This task-centered model was unsatisfactory, for many reasons, to patients, care providers, and hospital administrators. Growing concerns of professionals in all health care fields have produced extensive use of patient-centered care in many hospitals. The literature on patient-centered care falls into thee general categories which can be roughly classified as competitive concerns, caregivers' concerns, and management concerns.

Three fairly recent changes in the health care industry have led to the new focus on the individual patient. First, the competition among hospitals has meant, as Tanne (1993) points out, that the hospital in which patients have the most pleasant stay is the one that will have the competitive edge. A second impetus toward the new paradigm has been the nursing profession's reemphasis on caring as a significant dimension of nurses' "hidden work" that is often unrecognized and seriously undervalued--as a contribution to patient welfare and a

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that patients could travel several miles within the hospital in order to have access to all the services they needed, identified between 7 and 9 layers of management responsibility between caregivers in contact with patients and the top administrators, found that RNs spent less than 60 percent of their time on direct patient care, and identified over a quarter of the institutions' budget as designated for the management of work schedules, supervision, and coordination of the efforts of workers. Yet with all this expenditure of time and money, patients remained unhappy. The concept of patient-centered care was first developed as a response to patient concerns. As Lathrop noted, it was simple economic and organizational sense to place the patient-consumer's needs first rather than those of the providers (1991, p. 76). Researchers also found that patients who felt in control, received adequate management of pain, and whose questions were answered not only showed greater satisfaction with care facilities but did better medically as well (Tanne, 1993, p. 50). Studies also showed that "trust issues and patient education" were significant factors in patient satisfaction and that, since nurses were patients' primary personal contac

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