Patient-centered care: the role of healthcare leadership.

Throughout the year, we have been discussing the value of patient-centered care. The columns have focused on important aspects of this topic, such as the evolution of patient-centered care, patient satisfaction, community engagement, and technology. At the heart of all these components, however, is healthcare leadership.HEALTHCARE LEADERSHIP REVISITEDStrong leadership is critically important to organizations, regardless of the setting. Researchers have defined leadership in many different ways, but it is often associated with risk taking, dynamic, creative, change, and vision (Hughes, Ginnett, and Curphy 1999). Applying many of these same concepts, the Healthcare Leadership Alliance and American College of Healthcare Executives (2011) define healthcare leadership as "the ability to inspire individual and organizational excellence, create a shared vision and successfully manage change to attain the organization's strategic ends and successful performance. " Leaders determine, communicate, and guide the vision of any organization, and thus leadership engagement in any culture change initiative toward patient-centered care is crucial (Frampton et al. 2008). HEALTHCARE LEADERSHIP AND PATIENT-CENTERED CAREChanging the paradigm of care to a patient-centered model represents one such organizational culture change and requires the involvement of senior executives. Implementing a patient-centered model of care has profound implications for the way care is planned, delivered, and evaluated. Although most leaders in healthcare organizations today embrace the basic tenets of a patient-centered philosophy, it wasn't always that way. Prior to 2001, healthcare leaders frequently identified barriers to the widespread adoption of patient-centered practices resulting from ( 1 ) a general resistance to change, (2) the perception that implementation would cost too much time and resources, and (3) a lack of clarity on how to initiate and maintain a culture change of this magnitude (Frampton and Charmel 2009). The dynamics surrounding patient-centered care changed significantly when the Institute of Medicine (2001) identified patient-centeredness as one of six aims of improvement for the US healthcare system. Even today, however, leaders often find that moving toward a patient-centered model requires an unanticipated level of commitment and significant adjustments in organizational structures (Ponte et al. 2003). A study commissioned by The Picker Institute in 2007 explored what steps would be necessary to achieve more rapid and widespread implementation of patient-centered care in both inpatient and ambulatory healthcare settings. Its findings indicated that the single most important factor contributing to patient-centered care is "the commitment and engagement of senior leadership . the organizational transformation required to actually achieve the sustained delivery of patientcentered care will not happen without top leadership support and participation" (Shaller 2007). The Institute for Healthcare Improvement embarked on a study in 2011 to identify key factors in achieving an exceptional patient and family experience of inpatient hospital care. It, too, found that a primary driver was leadership, and the study's authors reinforced the idea that "effective leaders focus the organization's culture on the needs of patients and families (i.e., providing care that is patient-centered, rather than provider-centered), tap into innovative ideas, and have the persistence and skills to create a patient and family-centered care culture. Leaders from executives to front-line managers share a commitment to this goal, and understand that it is led by senior leaders and is part of the organization's core strategy" (Balik et al. …