The Picker Institute Europe is a not-for-profit organisation dedicated to improving patients’ experiences of healthcare by making their views heard. The following eight ‘Picker Principles’ were developed after conducting a wide range of focus groups comprising patients, family members, caregivers and clinicians.[i]
Based on their 2019/20 Impact Report, the key principles are internationally recognised as signifiers of what matter most to all those who use care services and define the key elements that should remain in the delivery of care.
PICKER PRINCIPLES OF PERSON-CENTRED CARE:
- Clear information, communication, and support for self-care
- Continuity of care and smooth transitions
- Involvement in decisions and respect for preferences
- Attention to physical and environmental needs
- Emotional support, empathy and respect
- Involvement and support for family and carers
- Effective treatment delivered by trusted professionals
- Fast access to reliable healthcare advice
1. CLEAR INFORMATION, COMMUNICATION, AND SUPPORT FOR SELF-CARE
Patients want to be kept informed regarding their medical condition and involved in
decision-making. Patients indicate that they want hospital staff to recognise and treat
them in an atmosphere that is focused on the patient as an individual with a presenting
medical condition. This means:
- Care should be provided in an atmosphere that is respectful of the individual patient and focused on quality-of-life issues.
- Informed and shared decision-making is a central component of patient-centred care
- Providing the patient with dignity, respect and sensitivity to their cultural values.
2. CONTINUITY OF CARE AND SMOOTH TRANSITIONS
Patients, in focus groups, expressed feeling vulnerable and powerless in the face of
illness. Proper coordination of care can ease those feelings. Patients identified three
areas in which care coordination can reduce feelings of vulnerability. They are:
- Coordination and integration of clinical care
- Coordination and integration of ancillary and support services
- Coordination and integration of frontline patient care.
Patients often express considerable anxiety about their ability to care for themselves after discharge. Meeting patient needs in this area requires staff to:
- Provide understandable, detailed information regarding medications, physical
limitations, dietary needs, etc.
- Coordinate and plan ongoing treatment and services after discharge and ensure
that patients and family understand this information
- Provide information regarding access to clinical, social, physical and financial
support on a continuing basis.
3. INVOLVEMENT IN DECISIONS AND RESPECT FOR PREFERENCES
Patients often express the fear that information is being withheld from them and that they
are not being completely informed about their condition or prognosis. Based on patient
interviews, hospitals can focus on three kinds of communication to reduce these fears:
- Information on clinical status, progress and prognosis
- Information on processes of care
- Information and education to facilitate autonomy, self-care and health promotion.
4. ATTENTION TO PHYSICAL AND ENVIRONMENTAL NEEDS
From the patient’s perspective, physical care that comforts patients, especially when they are acutely ill, is one of the most elemental services that caregivers can provide. Three areas were reported as particularly important to patients:
- Assistance with activities and daily living needs
- Hospital surroundings and environment kept in focus, including ensuring that the
patient’s needs for privacy are accommodated. Patient areas are kept clean and comfortable, with appropriate accessibility for visits by family and friends.
5. EMOTIONAL SUPPORT, EMPATHY AND RESPECT
Fear and anxiety associated with illness can be as debilitating as the physical effects.
Caregivers should pay particular attention to:
- Anxiety over clinical status, treatment and prognosis
- Anxiety over the impact of the illness on themselves and family
- Anxiety over the financial impact of illness.
6. INVOLVEMENT AND SUPPORT FOR FAMILY AND CARERS
Patients continually addressed the role of family and friends in the patient experience, often expressing concern about the impact illness has on family and friends. These principles of person-centred care were identified as follows:
- Accommodation, by clinicians and caregivers, of family and friends on whom the
patient relies for social and emotional support
- Respect for and recognition of the patient “advocate’s” role in decision-making
- Support for family members as caregivers
- Recognition of the needs of family and friends.
7. EFFECTIVE TREATMENT DELIVERED BY TRUSTED PROFESSIONALS
Positive therapeutic relationships are at the heart of person-centred care. People should receive clinically appropriate and effective care that meets their needs and is respectful of their preferences. Interactions with care professionals should inspire a true sense of confidence and trust.
8. FAST ACCESS TO RELIABLE HEALTHCARE ADVICE
Patients need to know they can access care and advice when it is needed. There are a whole host of reasons why patients choose to be seen privately. These include speed of assessment and treatment, attempts to jump NHS waiting lists, the desire to see a particular consultant, bad experiences at an alternative hospital and the ability to have certain treatments not available within the NHS.[ii]
So why do some patients ‘go private’?
- Some patients prefer to choose who treats them
- Availability of appointments when needed compared to the NHS
- Accessibility specialty services when a referral is made
- It may be reassuring for patients to know that they have more direct access to their specialist following a procedure
- Many patients simply want more time with their consultant, more than is possible with the NHS
- Certain procedures, whether they be medical or cosmetic, may be unavailable on the NHS