Executive Summary
Emphasis is being placed on implementing patient-centered care into all aspects of medical care, including family planning practices. Research indicates it improves clinical outcomes and patient satisfaction, enhances clinical adherence to treatment guidelines, and boosts healthcare delivery system efficiency.
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Patient-centered care is defined 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.”
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Family planning clinicians can look to the five key principles of quality counseling offered in the Recommendations for Providing Quality Family Planning Services (QFP), issued in 2014 by the Centers for Disease Control and Prevention and the Office of Population Affairs of the Department of Health and Human Services.
Emphasis is being placed on implementing patient-centered care into all aspects of medical care, including family planning practices. Research indicates it improves clinical outcomes and patient satisfaction, enhances clinical adherence to treatment guidelines, and boosts healthcare delivery system efficiency.1,2
With the advent of healthcare reform, new challenges and opportunities have opened up for the publicly funded family planning network. With expansion of coverage available through the federal Affordable Care Act (ACA), an estimated 10 million people have gained access to Medicaid coverage, with about 19 million expected to access other forms of health insurance.3
As previously uninsured patients gain access to insurance coverage, they have more choices about where to go for healthcare services. Publicly funded family planning health centers need to make the transition from being a provider of necessity to a provider of choice for existing and prospective patients, according to a case study report by the National Family Planning & Reproductive Health Association.
“Gaining patient loyalty through exceptional service is a critical component of business sustainability — as important as managing costs and revenues,” the case report states.4
Patient-centered care
Patients who are seeking an enhanced service experience and greater participation in their healthcare have added further pressure on medical practices to find ways to become more patient- and family-centered. The pursuit for patient perspective is fueled in part by the ACA’s quality improvement provisions and other federal financial incentives, such as the link between Medicare payments and patient satisfaction scores.
Hospitals already are seeking patient input on service delivery. Data from 2013 indicate 40% of hospitals have some type of patient council in place.5
Impact on quality
Patient-centered care is defined 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.”6
Research indicates that good patient experience has a positive relationship to other aspects of healthcare quality, including engagement with and adherence to providers’ instructions, and clinical processes and outcomes.7
Why is patient-centered care important in family planning? As family planning providers, clinicians ask patients to make preference-sensitive decisions every day, notes Justine Wu, MD, MPH, associate professor in the Departments of Family Medicine and Community Health and Obstetrics, Gynecology, and Reproductive Sciences at New Brunswick, NJ-based Rutgers Robert Wood Johnson Medical School.
These decisions include choices about such issues as childbearing, contraception, abortion, and infertility, observes Wu. Such choices must be based upon personal preferences and within the context of individual medical and psychosocial factors, she notes.
Adjust counseling
To facilitate this process, family planning providers must put the patient at the center of the process by adjusting their counseling approaches to fit the needs of the patient, states Wu. For example, some women prefer complete autonomy in their decision-making regarding contraception (“just give me the facts”), and others might want more input from their provider (“what do you think is best for me?”), she observes.
Patty Cason, RN, MS, FNP, assistant clinical professor in the School of Nursing at the University of California Los Angeles, points to the five key principles of quality counseling offered in the Recommendations for Providing Quality Family Planning Services (QFP), issued in 2014 by the Centers for Disease Control and Prevention and the Office of Population Affairs of the U.S. Department of Health and Human Services. (See “New guidance uses best evidence to direct family planning services,” Contraceptive Technology Update, August 2014)
The five principles include:
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establishing and maintaining rapport with the client;
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assessing the client’s needs;
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working with the client interactively to establish a plan;
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providing information that can be understood and retained by the client;
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confirming client understanding.8
With the implementation of the ACA, more women of reproductive age have access to insurance that covers the full spectrum of contraceptive options, including long-acting reversible contraceptives and permanent sterilization, says Wu.
“With increased access to more options, patient-centered care must be the core of family planning services such that women and men are given the counseling necessary to make personalized choices,” states Wu. “A team-based approach, such that the providers and staff together assume responsibility for the care of a patient, can facilitate this process during busy day-to-day clinical care.”
What can you do?
Family planning and women’s health providers are educating potential partners, including health plans and other provider organizations, about the scope, quality, and value of their services. Facilities that can share trend data about quality measures, costs of doing business, and patient experience with health plans and regulatory agencies will have greater contracting leverage than those who are unable to offer such types of information.9
The National Family Planning & Reproductive Health Association offers a case study of Kachemak Bay Family Planning Clinic of Homer, Alaska, to illustrate how to use patient experience data to implement service quality improvements. The case study looks at the facility’s process of survey development, implementation, data analysis, and quality improvement based on patient feedback. (Review the material at http://bit.ly/1zUqjNy.) Kachemak Bay Family Planning Clinic was selected for the case study because it has been engaged in a rigorous, structured process of information collection and use. The facility has more than a decade of experience in capturing key measures of patient experience through an ongoing survey and using the collected information to make operational improvements.
By strategically developing a survey tool to measure patient experience and a standard protocol for survey administration and data analysis, the family planning facility was able to identify and implement changes to improve patient experience and overall quality, the case study states.4
Some final tips
How can you improve the patient experience at your facility? Look at implementing the “Plan-Do-Study-Act” improvement model by:
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using patient experience survey data and other assessments to evaluate current performance and set an aim for improvement (Plan);
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developing a strategy to meet the aim and implementing the interventions (Do);
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reviewing data to monitor whether the change strategy has been effective (Study);
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gaining insight from the process to refine the approach and make it more widespread and sustained (Act).10
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Manary MP, Boulding W, Staelin R, et al. The patient experience and health outcomes. N Engl J Med 2013; 368(3):201-203.
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Charmel PA, Frampton SB. Building the business case for patient-centered care. Healthcare Financ Manage 2008; 62(3):80-85.
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Congressional Budget Office and staff of the Joint Committee on Taxation (JCT). Estimates for the Insurance Coverage Provision of the Affordable Care Act Updated for the Recent Supreme Court Decision. Accessed at http://1.usa.gov/O55VSP.
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National Family Planning & Reproductive Health Association. Improving Sustainability through a Positive Patient Experience. Accessed at http://bit.ly/1zUqjNy.
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Luthra S. Hospitals increasingly turn to patients for advice. Kaiser Health Network, April 27, 2015. Accessed at http://bit.ly/1Ovmm8m.
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Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
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Gavin L, Moskosky S, Carter M, et al. Centers for Disease Control and Prevention (CDC). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014; 63(RR-04):1-54.
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Agency for Healthcare Research and Quality. The Clinical Case for Improving Patient Experience. Accessed at http://1.usa.gov/1cETSIx.
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California Family Health Council. A New Vision for Family Planning and Women’s Health Centers. Accessed at http://bit.ly/1EtNKZk.
