Real World Definitions

Paradigm, not Pill: The New Role of Patient-Centered Care

In the years since the Institute of Medicine (IOM) pronounced patient-centered care one of six core aims of a high-value system, its definition has broadened and become more prescriptive. The 2001 IOM report spoke loftily of “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”1 In contrast, a February 2013 IOM workshop called for “strategies and policies for activities to be undertaken at multiple levels to advance patients, in partnership with providers, as leaders and drivers of care delivery improvement through the protected use of clinical data, informed, shared decisions and value improvement.”2

The difference in tone reflects a substantive shift in the role of patient-centeredness in health system reform. What began as an adjuration to physicians about values has progressed to a prescriptive guide incorporating activities and objectives that reverberate well beyond the individual clinical encounter. As the 2013 IOM meeting put it: “Prepared, engaged patients are a fundamental precursor to high-quality care, lower costs and better health.”

In this essay, I explore the sometimes conflicting roles that have become part of the real-world definition of patient-centered care, describe evidence of the concept’s economic and clinical impact, and examine the opportunities and barriers involved in making patient-centeredness an integral part of U.S. health care.

Click here to read the balance of Michael Millenson’s piece, which is part of the Expert Voices series on the National Institute of Health Care Management (NIHCM) Foundation’s site.


Michael L. Millenson, President, Health Quality Advisors LLC Michael L. Millenson, president of Health Quality Advisors LLC, Highland Park, IL, is a nationally recognized expert on quality of care improvement, patient-centered care and web-based health. He is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and he is adjunct associate professor of medicine in the Department of Medicine at Northwestern University's Feinberg School of Medicine. National Public Radio called him “in the vanguard of the movement” to measure and improve American medicine. Prior to starting his own firm, Millenson was a principal in the health-care practice of a major human resources consulting firm. Before that, he was a healthcare reporter for the Chicago Tribune, where he was nominated three times for a Pulitzer Prize. He serves on the boards of the American Journal of Medical Quality and Project Patient Care.

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1 Comment

  • With the paradigm shift to patient-centered care, inevitable difficulties, disruption and discomfort can be initially mitigated using “‘rules of engagement’ that explicitly set out respective responsibilities.15”

    As turbulence due to the shift abates (or at least becomes more readily navigated), those “rules” can be modified to acommodate changing workflows (e.g. greater use of mHealth and telehealth/medicine), changing patient education / literacy and changing financial practices.

    “Rules of engagement” should include recommendations on

    –health apps
    –sources credible health information
    –patient and disease-specific online communities and
    –using a PHR

    that eliminate uncertainly on “how to discuss economic concerns or how to use health information technology for effective collaboration.” This reader-friendly

    –(12-point or larger
    –no jargon
    –lots of white space
    –block diagrams
    –structured writing/presentation)

    print and online booklet would have FAQ-like elements for highest ease-of-understanding of responsibilities and immediate usability.

    As demand for physician, nurse and other health professional time swells, “rules of engagement” should be SOP for every encounter.

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