People-Centred Healthcare Accreditation

One of CAPCH’s four key programs focuses on establishing consistent national people-centred healthcare standards.

The role of Accreditation Canada in setting and maintaining healthcare standards of excellence for the provision of care in Canada’s healthcare organizations places them as a world leader. We admire the Accreditation Canada team for all their work: they set the bar on enabling quality care for those who rely on healthcare.

At the same time, as CAPCH started developing collaboratives among health care providers, industries and academics, we also began receiving requests from most of them for a program that might result in a “People-Centred Seal of Approval”. At CAPCH it is now our goal, in consultation with Accreditation Canada experts, to develop an assessment process in the form of a type of accreditation program which will ultimately assist these individuals, providers, industries and organizations – including medical schools and healthcare training centres – to be formally acknowledged as people-centred practitioners backed by people-centred philosophies.

Take a narrative journey inside a people-centred Initial Physical Examination process. Begin to challenge the way you look at care – how it’s delivered – and how anyone can start a personal Journey to Wellness. Imagine you are the patient…

Example of a People-Centred New Client Examination

This description of a visit to a people-centred new client examination is adapted from CAPCH founder Vaughan Glover’s book Journey to Wellness. It is based on Dr. Glover’s extensive research including 30 years’ experience in a People-Centred dentistry practice founded on the team approach to empowering clients.

The point of people-centred health practice is to provide expertise while helping you follow your personal wellness goals - not to dictate how you do should do that. In people-centred care, a gram of healthy living is worth a kilogram of medical intervention. And the patient holds the reins.

But read on. Imagine you are the patient…

This example highlights four aspects of a typical client examination. The example doesn’t involve an emergency, which would follow different procedures, but a garden-variety visit to a doctor’s office. The participants are:

• You, the patient
• Renee, the receptionist
• Cate, the coach, and
• Dr. Well, the physician

You recently turned 50 and haven’t seen a doctor for two years. You don’t have any specific serious problems, but feel ‘off’ in general, and want to get back on track to feeling better.

1. The phone interview
You phone for an examination.  Renee, the receptionist, completes a screening interview to assess your needs and set up an examination. She explains several examination options including convenient times. Even at the initial phone call you have choices. Not all patients are the same, so why would one exam procedure fit everyone? Emergencies are dealt with immediately and are very focused, but for someone such as you, Renee would suggest a comprehensive examination. Renee doesn’t go into great detail, but attempts to find out enough about your personal history and your health concerns to arrange an examination process which meets your concerns. Renee is also trying to determine who might be the most appropriate team member to become your initial Client Coach.

2. The personal interview
On the day of the examination, Cate, a coach, greets you and escorts you to a consultation room for a personal interview. The coach, also called a client co-ordinator, could be a nurse practitioner, a nurse, or a trained greeter, but rarely the doctor. You get to know one another and share personal and health-related facts. It’s at this time that together you design a personally-relevant examination. Typically this takes 20–30 minutes for a trained team member, and is critical to the long-term provider/patient relationship. During this time the coach invites you to share past and present concerns and experiences, so that the coach can appreciate you as a real person. You sense genuine concern and feel listened to – the first step in establishing a trusting relationship.

3. The examination
Cate calls in Dr. Well, introduces you and brings the doctor up to date on your conversation so far. This is preferably done in front of you and in a consultation room (not the examination room) for two reasons: to reassure you that the coach was listening, and to give you a chance to hear and confirm your history and concerns. Dr. Well then asks pertinent questions and goes into detail about any concerns you have regarding your health history. He explains that the purpose of the examination is to gather as much information about your health as possible, share the information with you, discuss options and make recommendations for future care.

Dr. Well, Cate and yourself move to an examination room and together you complete the examination. As well as the usual medical procedures, the physical examination involves many listening and communication skills: for example, the doctor dictates all information aloud for the coach to record so that you are aware of everything being recorded. At the end of the physical examination, Dr. Well asks you what you think of the information you heard. This is a crucial step because it ensures that you haven’t been left behind by any healthcare or physician ‘jargon’, and allows doctor and coach to focus on what’s important and relevant to your own needs and values. This may also be the first time that you have been invited to participate directly, and proves that your opinion matters. Often you have a primary concern that differs from the doctor’s. As long as this is not an emergency, you are always right. Your feedback also begins to reinforce the concept that you have ownership of, and freedom with, your own healthcare.

4. Treatment consultation
Dr. Well summarizes all the findings and outlines to you and the coach the options for proceeding. At this time, the options for treatment may or may not be clearly defined, and there may be several ways to proceed in gathering more information. The important thing is that there are always options and you are invited to share in the decisions about where to go next. Depending on the health situation and your decisions, Dr. Well answers any questions and explains that Cate will go through things in detail. The doctor leaves, and you and your coach review the options and make decisions about how to proceed. If at any time the doctor’s opinion is needed, Cate will call in Dr. Well. Your patient-centred examination usually takes 30–40 minutes for the doctor and 1½–2 hours for the coach. Serious health problems may require the doctor to be present at all times, but for most health concerns the doctor and coach discuss the options, and the coach and patient discuss the how, when, where, and why of treatment. By the time the exam is completed, typically you and your coach—and, we hope, the doctor—have made the first steps to establishing a trusting relationship. You have developed confidence that you can share information and that your coach will act in your best interests. When you’re comfortable that you have all the information you need, with Renee you make any necessary appointments for tests and/or treatment: the next step of your health journey.

Re: treatment options
In this example it’s essential to understand that none of the procedures or options was determined by what a third-party insurance company or a government health program deems ‘good enough’. In CAPCH’s view it’s unethical for a third party to dictate the relationship between a patient and his or her healthcare provider. The care options were determined by the findings of the clinical examination.The treatment plan was determined by what you and the doctor or coach agreed is the best way in which to fulfill your health goals.The examination procedure, the options available, and your own treatment-plan decisions must remain the same no matter the funding model. Otherwise the insurer is dictating treatment.

Conclusion
In our imaginary case, the steps in your initial examination may seem somewhat lengthy. But each step of the examination is important to meet the goal of a well-informed and empowered patient. Ultimately this initial time investment will save time and money later by avoiding more expensive health needs caused by cursory doctor visits or visits that don’t actively empower individual wellness. In the examination, you usually need time to talk, be listened to, and to get clarification. It makes sense that someone be present throughout who has that time plus the listening and communication skills. This allows the doctor to focus on what s/he does best and what legally s/he must be the one to do: make a diagnosis and define treatment options.
You have the power to choose which option is most appropriate at various times during the process: from the first phone call to the completion of the exam and the final consultation. You feel valued and listened to, and appreciate that your input is essential. You have started a relationship based on trust, and probably feel very comfortable with a doctor who’s open and willing to trust the other team members.

(based on Glover, V., Journey to Wellness, Chapt. 10: “How A People-Centred Model Works”)