FAQ's

Why did I become so interested in patient-centered care?
What was available in the medical literature to help me solve this problem?
Why is the OPN Method different from other models?
Why patient-centered care is different from "being caring"?
How do you know if you are really patient-centered?
Why is it important to have a standard communication method and measurement tool for patient-centered communication?

Why did I become so interested in patient-centered care?
Over the years, when I found myself investigating why a patient was less than satisfied with treatment more often than not, the therapist's treatment was ethically and technically sound, based on the patient's diagnoses. This was not the issue. The issue was there were unmet needs at discharge.

The complaint I heard most often when a patient was dissatisfied with the clinician was that the clinician "just wasn't listening to me," or "didn't understand how the diagnoses affected me as an individual or my lifestyle." I felt that there must be a more effective way to handle these issues. In order to combat that problem, the next step was to improve the clinician's ability to elicit information from the patient regarding concerns and expectations. As I read more about patient-centered care, I came to the conclusion that not only would it help me prevent patient complaints but will actually help improve ALL patients' quality of care.

What was available in the medical literature to help me solve this problem?
In 2000, I discovered a book titled Patient Participation in Program Planning: A Manual for Therapists¹ (1990). The title caught my attention because I was researching communication methods to improve clinician-patient communication. I then discovered the second edition, Treatment Planning for Rehabilitation: A Patient-Centered Approach ²(2000). The Ozer Payton Nelson Method (OPN), detailed in the book, provides clinicians with a flexible and easy to remember communication method to involve patients as active participants in the goal-setting and treatment-planning process.

1. Payton OD, Nelson CE, Ozer MN. Patient Participation in Program Planning: A Manual for Therapists. Philadelphia, PA: FA Davis Co.;1990.
2. Ozer MN, Payton OD, Nelson CE. Treatment Planning for Rehabilitation: A
Patient-Centered Approach. New York, NY: McGraw-Hill;2000.

Why is the OPN Method different from other models?
After researching many other communication models, I chose to study the OPN Method in my doctoral dissertation. Not only does the OPN Method facilitate patient involvement in the goal-setting process but in the evaluation of the treatment plan and outcomes as well. I also appreciated the in service outlines in the textbook and the experiential design which enables learning of the Method. The OPN Method's multidisciplinary approach to maximizing patient-centered communication was attractive because I felt that teaching the same communication model to clinicians across many disciplines would increase the benefit to the patient if everyone involved in the healthcare team understood the process in which patient information would be elicited. Additionally, the OPN Method can be used with almost any patient and his or her family. It is not a "patient or diagnosis specific" method. I feel the OPN Method engages the patient to make the patient a collaborative partner in his or her care. Discussing concerns and goals with patients speaks to the heart of patient-centered treatment planning. It gives the patient the opportunity, frankly, the right, to be involved in his or her treatment planning to the maximum extent they desire or are capable.

Why patient-centered care is different from "being caring"?
Many embrace being patient-centered just like we do caring. We can care about our patients but caring is a verb that implies action. We can conceivably care without being caring. So too is it with being patient-centered. We can embrace the idea of being patient-centered but it usually requires a change on how we traditionally practice. At the crux of being patient-centered is involving patients in the goal-setting and treatment planning processes. Giving them a role in deciding what their desired outcomes of treatment are and a say in treatment interventions is at the heart of being patient-centered.

How do you know if you are really patient-centered?
When someone or an institution says they practice patient-centered care, my question to them is, how do you know? By what means do you measure it? A few instruments are in the medical literature but one in particular has been used over the past 15 years to measure the clinician's ability to involve patients in the goal-setting process. This measurement tool started off in one study simply named the PPEF³ (Patient Participation Evaluation Form), was edited and modified in a subsequent study and aptly titled the Participation Method Assessment Instrument⁴ (PMAI). Later, in another study it was edited for the next research experiment and entitled the Adapted Participation Method Assessment Instrument⁵ (APMAI). These remain the standards that measure the ability of the clinician to involve patients in the goal-setting process. These studies and others have shown that most clinicians involve patients in the goal-setting process at far below optimum levels.

3. Northern JG, Rust DM, Nelson CE, Watts JH. Involvement of adult rehabilitation patients in setting occupational therapy goals. Am J Occup Ther. 1995;49:214-220.
4. Baker SM, Marshak HH, Rice GT, Zimmerman GJ. Patient participation in physical therapy goal setting. Phys Ther. 2001;81:1118-1126.
5. Tripicchio R, et al. Increasing patient participation: the effects of training physical and
occupational therapists to involve geriatric patients in the concerns-clarification and
goal-setting processes. J Phys Ther Educ. 2009:23(1):55-63.

Why is it important to have a standard communication method and measurement tool for patient-centered communication?
Best practices are needed for nearly all practices in medicine and this area is no exception. Best practices in patient-centered communication will help clinicians involve patients to the fullest extent possible and thereby become more patient-centered. What is needed in particular is to improve the clinician's patient-centered communication skills. For being patient-centered we will not only fulfill our ethical and regulatory requirements but most importantly we improve patient satisfaction, adherence and clinical outcomes.