Although much of the focus of competencies revolves around clinical abilities of physicians, there are other competencies to consider with other stakeholders in healthcare.
"Patients need competencies too," Dr. Eric Holmboe, chief medical officer of the American Board of Internal Medicine (ABIM), said Tuesday at the ECRI Institute's 18th Annual Conference at the FDA in Silver Spring, Md.
"All too often, we don't include patients," he said. What's more, "systems also needs competencies," Holmboe added. Physicians should help patients to manage their own care, and the system should help them improve their health literacy and empower them to advocate for themselves.
Teaching patient-centered care
In certifying physicians, the ABIM looks at the six Accreditation Council for Graduate Medical Education/American Board of Medical Specialties core competencies to evaluate the skills of those clinicians: patient care, medical knowledge, practice-based learning, systems-based practice, professionalism, and interpersonal skills and communication. Where does patient-centered care fit in? Holmboe explained that patient-centeredness plays a role throughout all six competencies.
With that in mind, teaching patient-centeredness to future generations of doctors plays an increasingly important role in healthcare.
"We have to re-think the way we train medical professionals," Holmboe said.
As American College of Surgeons Executive Director Dr. David Hoyt noted, today's physician leaders, notably the ones teaching young physicians, didn't have that patient-centered, dedicated curriculum and mounting measures. "We are learning this together," Hoyt said.
Measuring patient-centered care
How does an organization evaluate patient-centered care? Many organizations use the industry standards of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Press Ganey, or other similar patient surveys.
However, Holmboe cautioned that there is a difference between patient satisfaction and patient experience.
"Surveys should target patient experience and outcomes, not just satisfaction," he said.
Studies have shown experience correlates to quality performance, although there is little correlation between satisfaction and outcomes, according to Holmboe. For example, patients who report their providers' communication as good have better outcomes. Patients who experienced higher ratings of performance (access to care, waiting time, general communication, communication about illness, care coordination, and office staff interaction) showed to have better blood pressure control, indicating a link between communication and care outcomes.
Key to medical education and health reform is practice redesign that is conducive to patient-centered care, said Dr. Malcolm Cox, chief academic affiliations officer of the Veterans Health Administration. "Patients have a right to personalized, patient-centered care that is safe, effective, and efficient," he said.