Determining requirements for patient-centred care: a participatory concept mapping study

Abstract

Background: Recognition of a need for patient-centred care is not new, however making patient-centred care a reality remains a challenge to organisations. We need empirical studies to extend current understandings, create new representations of the complexity of patient-centred care, and guide collective action toward patient-centred health care. To achieve these ends, the research aim was to empirically determine what organisational actions are required for patient-centred care to be achieved.

Methods: We used an established participatory concept mapping methodology. Cross-sector stakeholders contributed to the development of statements for patient-centred care requirements, sorting statements into groupings according to similarity, and rating each statement according to importance, feasibility, and achievement. The resultant data were analysed to produce a visual concept map representing participants' conceptualisation of patient-centred care requirements. Analysis included the development of a similarity matrix, multidimensional scaling, hierarchical cluster analysis, selection of the number of clusters and their labels, identifying overarching domains and quantitative representation of rating data.

Results: The outcome was the development of a conceptual map for the Requirements of Patient-Centred Care Systems (ROPCCS). ROPCCS incorporates 123 statements sorted into 13 clusters. Cluster labels were: shared responsibility for personalised health literacy; patient provider dynamic for care partnership; collaboration; shared power and responsibility; resources for coordination of care; recognition of humanity - skills and attributes; knowing and valuing the patient; relationship building; system review evaluation and new models; commitment to supportive structures and processes; elements to facilitate change; professional identity and capability development; and explicit education and learning. The clusters were grouped into three overarching domains, representing a cross-sectoral approach: humanity and partnership; career spanning education and training; and health systems, policy and management. Rating of statements allowed the generation of go-zone maps for further interrogation of the relative importance, feasibility, and achievement of each patient-centred care requirement and cluster.

Conclusion: The study has empirically determined requirements for patient-centred care through the development of ROPCCS. The unique map emphasises collaborative responsibility of stakeholders to ensure that patient-centred care is comprehensively progressed. ROPCCS allows the complex requirements for patient-centred care to be understood, implemented, evaluated, measured, and shown to be occurring.

Keywords: Concept mapping; Health care systems; Implementation; Patient-centred care; Research.

Fig. 1

Conceptual map for Requirements of Patient-Centred Care Systems

Fig. 2

Go-zone for cluster 9: system review, evaluation and new models: Importance vs Feasibility. Scale limits represent lowest (importance = 3.04 and feasibility = 2.71) and highest (importance = 4.71 and feasibility = 4.49) average rating (on a 1–5 scale) for all statements. Cross section value relates to median for that cluster. Statement numbers relate to the order they were presented to participants

Fig. 3

Go-zone for cluster 9: system review, evaluation and new models: Importance vs How Well Achieved. Scale limits represent lowest (importance = 3.04 and how well achieved = 1.71) and highest (importance = 4.71 and how well achieved = 3.69) average rating (on a 1–5 scale) for all statements. Cross section value relates to median for that cluster. Statement numbers relate to the order they were presented to participants