Patient Centredness, Values, Equity and Sustainability: Professional, Organizational and Institutional Implications

Dear Colleagues,

The concept of “patient centeredness,” or “patient-centered care,” has been studied so far as an umbrella term covering a variety of declinations, perspectives, and practices. It has served as a convenient argument to support or criticize the actions (or lack of actions) of healthcare professionals, organizations, and systems directed to the patient, conceived as a person, citizen, and consumer around whose priorities and expectations the care system should be organized (Graffigna et al., 2017).

Patient centeredness can be conceived as a collective achievement that is negotiated between patients and multiple health providers, including social practices and relationships that are woven together through the material and immaterial resources available in organizational and relational settings and contexts (Liberati et al 2015; Gorli et al 2016). Linked to the possibility of such collective achievement, many efforts, actors, and elements might intervene. Putting the patient at the center does not mean that something other goes to the periphery, but rather that many components get a specific encircling position thus to create an interconnected service. Such service is made of “acts of care:” communication aspects, values, ethical concerns, equity of treatments, moral decisions, responsibilities, and implications that all together create the place for accomplishing healthcare in a sustainable way.

A patient centered approach to care holds promise for improving health equity by better engaging patients in their health care. On the other side, however, some scholars are raising some concerns about the possible “dark side” of greater patient centeredness risks to better engage sections of the population who already benefit from better health or care access associated with social status and opportunity, serving to increase inequalities by further marginalising those already suffering from relative exclusion. Moreover, there is a significant risk that the engagement of patients in the design and delivery of care may turn into value co-destruction (Palumbo, 2017) that may occur when the many healthcare actors (patients, the healthcare professionals, etc.) participate in co-creating health services by bringing contrasting expectations, conflicting inputs and diverging ends. These issues should be detected and handled to realize the full potential of patient-centered initiatives.

This Special Issue aims to explore and discuss the concept of sustainability in healthcare under these premises. Sustainability is here considered as being strongly linked to the values that are put in place throughout the process of “putting the patient at the center.” Such values are constituted by a combination of many levels and facets. In literature, levels have often been treated in a cleaved way: the value for patients (Barello & Graffigna, 2015; Graffigna & Barello, 2018a and 2018b), the economic value (Porter 2010), the organizational value (Minvielle et al 2008; Wicks & Clair, 2007; Hofmeyer & Marck, 2008; Galuppo et al, 2014), the values for professionals (Graber & Kilpatrick, 2008; Embertson, 2006; LIberati et al 2015). Diverse facets make the picture even more complex: values can be moral values, can be ethical, can be economic and financial, can be deontological or social.

We envisage this Special Issue becoming a cornerstone of the scientific literature, illustrating the potential of patient-centered practices and related values to make healthcare sustainable through the promotion of a more equitable and ethical care provision.  We are interested in opening up a collection of papers that dig into this field and illustrate the many possibilities, interpretations, and questions connected to the challenges of pursuing sustainable care under the orientation of patient centeredness and an aware positioning and debate around the values in play.  The invitation is open to an interdisciplinary debate, welcoming studies that are grounded on the different social sciences applied to healthcare: psychological, sociological, organizational, and management studies, as well as economic, philosophical, and anthropological views all are able to enrich such fields, and to propose new attention to navigate this intricate debate and future possibilities for healthcare, with a specific look to the professional, organizational, inter-relational, and institutional implications.

The Guest Editors would like to invite original research (both quantitative and qualitative), reviews, theoretical frameworks, methodological reflections, case studies, and protocols from all disciplines which illustrate via case studies and existing projects how patient centeredness contributes to achieving healthcare sustainability at local, regional, and national and international levels. We also welcome contributions which outline the benefits of patient centeredness in relation to patients and health care organizations and the future potential of patient centeredness and the role it can play in reaching healthcare sustainability.

The settings and situations can be diverse; for example, chronic care management, mental health, medical education, organizational interventions, patient and consumer health education, digital health, participatory research.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except for conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process.

References

Barello, S., & Graffigna, G. (2015). Engaging patients to recover life projectuality: an Italian cross-disease framework. Quality of Life Research, 24(5), 1087-1096.

Embertson, M. K. (2006). The importance of middle managers in healthcare organizations. Journal of Healthcare Management, 51(4).

Galuppo, L., Gorli, M., Scaratti, G. (2014) Building social sustainability: multi-stakeholder processes and conflict management. Social Sustainability Journal Volume 10, Issue 4, pp. 685-701

Gorli, M., Liberati, E.G., Galuppo, L, Scaratti, G. (2016) The Patient Centered Organizational Model in Italian Hospitals: Practical Challenged for Patient Engagement. In Graffigna, G. Promoting Patient Engagement and Participation for Effective Healthcare Reform. IGI-GLOBAL (pp.152-170) 

Graber, D. R., & Kilpatrick, A. O. (2008). Establishing values-based leadership and value systems in healthcare organizations. Journal of health and human services administration, 179-197.

Graffigna, G., Barello, S., Riva, G., Savarese, M., Menichetti, J., Castelnuovo, G., & Bertoni, A. (2017). Fertilizing a patient engagement ecosystem to innovate healthcare: Toward the first Italian consensus conference on patient engagement. Frontiers in psychology, 8, 812.

Graffigna, G., & Barello, S. (2018a). Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people’s meaningful engagement in their own health care. Patient preference and adherence, 12, 1261.

Graffigna, G., & Barello, S. (2018b). Patient Health Engagement (PHE) model in enhanced recovery after surgery (ERAS): monitoring patients’ engagement and psychological resilience in minimally invasive thoracic surgery. Journal of thoracic disease, 10(Suppl 4), S517.

Hofmeyer, A., & Marck, P. B. (2008). Building social capital in healthcare organizations: thinking ecologically for safer care. Nursing Outlook, 56(4), 145-e1.

Liberati, E.G., Gorli, M., Galuppo, L., Moja, L. Scaratti, G., Ripamonti, S. (2015) Exploring the practice of patient centered care: The role of ethnography and reflexivity, Social Science and Medicine, 133: 45-52

Liberati, E.G., Gorli, M., Scaratti, G. (2015) Reorganising hospitals to implement a patient-centered model of care: Effects on clinical practice and professional relationships in the Italian NHS, Journal of Health Organization and Management, Vol. 29 Issue: 7, pp.848 - 873

Minvielle, E., Sicotte, C., Champagne, F., Contandriopoulos, A. P., Jeantet, M., Préaubert, N., ... & Richard, C. (2008).

Palumbo, R. (2017). The Dark Side of Patient Empowerment. In The Bright Side and the Dark Side of Patient Empowerment (pp. 47-61). Springer, Cham.Hospital performance: Competing or shared values?. Health Policy, 87(1), 8-19.

Porter, M. E. (2010). What is value in health care. N Engl J Med, 363(26), 2477-2481.

Wicks, A. M., & St Clair, L. (2007). Competing values in healthcare: balancing the (un) balanced scorecard. Journal of Healthcare Management, 52(5).

Dr. Mara Gorli
Dr. Serena Barello
Guest Editors

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• sustainability
• equity
• values
• ethical concerns
• equity in healthcare
• participative healthcare
• patient engagement
• professional engagement
• ethic
• moral distress
• co-production
• value co-destruction