The broader definition of quality being embraced by healthcare providers and policy makers worldwide also includes patient-centeredness, defined by the Institute of Medicine as “…providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions…” 
While this recognition of patient-centeredness as a dimension of quality may represent a paradigm shift in the healthcare industry, it reflects what healthcare consumers around the globe have long expressed when describing what matters most to them about their healthcare experiences. Asked to describe what went well about a recent care episode, patients’ and long-term care residents’ responses are remarkably similar in their emphasis on humanity, partnership and relationship-building:
“I can hear shift handover…they tell exactly what they have seen and heard that day. The physicians and the liver team came and told me things without my even asking.” (patient in Brazil)
“The personnel consider us as human beings and not as patients or numbers.” (patient in Québec)
“My mother is often scared at night, she’s terrified…The staff comfort her at night. They take the time.” (Family member of long-term care resident in The Netherlands)
“You can tell the nurses here care about you as a person.” (patient in the U.S.)
From Conceptual to Operational
These comments demonstrate that the fundamental concepts of patient-centered care resonate globally—despite differences in culture, demographics and healthcare financing models.
Nonetheless, translating these concepts into concrete action and tangible change continues to stymie healthcare providers. Many are discovering that good intentions and a philosophical commitment to patient-centered care alone will not yield a person-centered culture that stands the test of time, competing priorities and a reluctance to change that pervades our industry. This leaves many providers questioning how best to operationalize the concepts of patient engagement, activation and partnership as part of their care delivery model.
In August 2005, Planetree Inc. (www.planetree.org) embarked on a project to establish a comprehensive framework for the implementation of patient-centered care. A growing international organization with more than three decades of experience incorporating the patient and family perspective into healthcare delivery systems, Planetree was uniquely qualified to develop this framework. To do so, the organization turned to the true authorities on patient-centered excellence—healthcare consumers and providers themselves.
Qualitative data from focus groups with patients and long-term care residents delineated what matters most to them about their healthcare experience. Discussion with leaders from organizations with well-established patient-centered cultures ascertained the essential practices and processes that were the linchpins for their organizations’ cultural transformations. The concepts that originated from these experiential data conform to the current literature supporting person-centered care, further establishing them as valid indicators of patient-centered excellence. 
A Practical Framework for Excellence
These findings were constructed into a blueprint for patient-centered excellence, and today are the foundation of the Planetree International Designation Program, which is guiding healthcare organizations around the world in person-centered quality improvement efforts. Recognition as a Planetree Designated organization is external validation that the facility is one where providers genuinely partner with patients, residents and families, and where patient comfort, dignity and well-being are prioritized.
The criteria for the award include opportunities for care recipients to participate in decisions regarding their care, non-restrictive visiting practices, formal mechanisms for staff and patients to influence how care is provided, healthy and flexible meal options, accommodations to meet patients’ spiritual needs, and a physical environment that promotes privacy, open communication and partnerships with caregivers.
The criteria also challenge providers to consider how best to balance patient empowerment with important safety considerations, to ensure that transparency and partnership remain priorities even when something unexpected occurs, and how to apply patient-centered approaches to administrative processes and transitions from one healthcare setting to another. Recognizing that ultimately the patient or resident experience originates with those providing their care, several other criteria focus on nurturing a workplace culture that is supportive of employees, both professionally and personally.
To achieve Planetree Designation, a multi-method assessment process validates that practices are in place and that they are effectively meeting the expressed needs of those served. The validation process includes a written self-assessment of current patient-centered activities, focus groups with key stakeholders, and a review of available outcomes measures. This integration of qualitative and quantitative data reinforces patient-centeredness as a determinant for healthcare quality—not an adjunct to it. As a group, acute care hospitals in the United States that have been awarded Planetree Designation consistently outperform national averages on standardized measures of clinical quality and patient experience. 
Raising the Bar Across the Continuum and Around the World
In pilot designation efforts in healthcare organizations in The Netherlands and Québec, the concepts behind the program’s criteria have proven to be portable across cultural divides as well as across the continuum of care. How those concepts are realized within a specific setting or country, however, varies based on cultural norms.
In considering the need for flexibility, however, the designation program guards against reliance on cultural norms as justification for resisting a more patient-centered approach. At times, healthcare consumers’ priorities may challenge a culture’s closely guarded healthcare conventions. In a patient-centered culture, the patient perspective trumps conventionality and tradition.
This tension is perhaps best illustrated in the journeys a number of hospitals worldwide have taken to invite patients to read—and even comment on—their personal medical record. In many cultures, the medical record has traditionally been the exclusive realm of healthcare professionals where they document what they need to know about the patient. Patient-centered hospitals recognize that if it is important for the healthcare team to know something about a patient, it is equally important for the patient to know. In all Planetree Designated Patient-Centered Hospitals, patients are invited to review their medical records and discuss the information with their care team. Data has demonstrated that making this option available to patients improves patient satisfaction, regardless of whether they actually review their chart. 
Planetree Designation Today
Early international designation efforts have underscored the importance of flexibility and collaboration in expanding the program globally. An International Designation Advisory Council was convened in 2009 to oversee the effort. The Council addressed language considerations, differing cultural mores related to family involvement, access to information and privacy, and the challenge of how to apply a consistent standard for quality and patient experience measures when systems for data collection and reporting can vary substantially from country to country.
 Frampton S.B., Horowitz, S, Stumpo, B.J., “Open Medical Records.” AJN, American Journal of Nursing, August 2009, 109(8):59-63.