Organization

In order to succeed in managed care, many healthcare organizations need to shift from an inward-directed orientation to an outward, patient/client-focused orientation. A patient/client-centered approach requires the application of three critical elements of quality management: learning, training and education. “An adequate system for communication of clinical information always exists, but internal communication is usually meager,” writes A. Douglas Bender, Ph.D., in the Quality Management in Health Care, Summer, 1995 issue. The first step in the process toward patient/client-centered care is for healthcare organizations to become “learning centers” (Peter Senge, The Fifth Discipline) that encourage and support individual growth and development. Quality, as applied to medical practice, ahs three important dimensions: technical care, interpersonal care and practice productivity. The interpersonal care issue focuses on the physician/patient relationship and linking patient satisfaction to clinical outcomes. For example, Smith and Hoppe (Annals of Internal Medicine, 115 (1991): 470-77) note that physicians must incorporate patient-centered interviewing in order to deliver optimal patient care.