Clarifying the Concept of Patient-Centered Care Using the Method of Statement Derivation

Tuesday, July 12, 2011: 10:30 AM

Beverly Waller, MS, RN
School of Nursing, University of Michigan, Ann Arbor, MI
Huey-Ming Tzeng, PhD, RN
Department of Nursing, School of Health Professions and, University of Michigan - Flint, Flint, MI

Learning Objective 1: Increased understanding of the attributes of patient-centered care in terms consistent with the needs of patients, satisfaction, nurse-patient collaboration and the quality of care delivered.

Learning Objective 2: The participant will be able to identify areas for improvement in patient-centered care as identified by the concluded gaps.

Aim. The method of statement derivation was used to clarify the concept of patient-centered care. 

Background. Patient-centered care refers to the therapeutic relationship, between health care providers and receivers of health care services, that emphasizes meeting the needs of individual patients. Though this term has been widely used, it remains a poorly defined and conceptualized phenomenon.

Methods .  The findings are summarized using the method of statement derivation, as described by Walker and Avant, to clarify the concept of patient-centered care. The Gap Model of Service Quality developed by Parasuraman, Zeithaml and Leonard in 1985 is used to guide statement derivation.

Discussion. The statement derivation results in four statements related to four gaps: 1) customer expectation vs. management perception gap; 2) management perceptions vs. service standards gap; 3) service standards vs. service delivery gap; and 4) expected service vs. perceived service gap. The next step in theory building is testing of the derived statements.

Conclusion s. Four patient-centered care service quality gaps were concluded: 1) patient expectation vs. nurse perception gap; 2) nurse and nursing administration perceptions vs. patient-centered care standards gap; 3) patient-centered care standards vs. delivery of patient-centered care gap; and 4) patient expectation of health care service vs. patient perception of actual health care service received gap. Use of the derived statements may help further define patient-centered care in nursing from the patient perspective focusing on individual needs, patient satisfaction, collaboration and quality.

Relevance to Clinical Practice. The nurse administrator could use the identified gaps between patient perceptions and service provided on planning and prioritizing patient-centered care quality improvement initiatives. These gaps may help on allocating limited health care resource to system-level, management-level, staff-level, or patient-level interventions addressing selected patient characteristics. Nurse administrators may also use these gaps to identify and develop appropriate outcome measures.