Response to Commentary Patient - Centered Care in the VA : A Research

patients. It means arranging health care in such a way that patients routinely participate in decisions about their own treatment. It means creating an atmosphere where staff naturally solicit patients' input and accept that input with respect. It means building a system that doesn't waste patients' time, offers easy access to care, and meets patients' needs for information , education, and preventive care. Most importantly, patient-centered care means better outcomes for patients —and rewards for staff in knowing that they provide excellent care. Patient-centered care also means hard work — otherwise, we would see more of it. At VA, patient-centered care has become increasingly important as we've shifted our focus from inpatient to outpatient care. Although we maintain a large number of robust medical centers — more than 150 — VA now operates more than 800 community-based outpatient clinics. This is all part of a strategic move to establish primary care near where our veterans live. To make this strategy work, we need a more effective approach to patient encounters, and that's where patient-centered care comes in. The Employee Education System and the Primary Care Central Office promote patient-centered care within VA through our national meetings, conference calls, and educational presentations. Advanced Clinic Access coaches support patient-centered care through a variety of meetings and their soon-to-be-released handbook. Several new initiatives support patient-centered care, including the directive on panel size released earlier this year to ensure that resources match demand. The directive sets a panel size standard and identifies quantitative adjustments based on factors such as the number of exam rooms and the number of support personnel. As described in this directive, continuity of care, enrollment to panels, and adjustments to panel size serve as a structural foundation for patient-centered care, even though these things are largely invisible to patients. Ultimately, however, patient-centered care thrives where innovative leaders and dedicated staff members join forces to care for veterans. Each time a patient calls for an appointment, contacts a nurse advice line, or visits one of our clinics, we have an opportunity to exceed that veteran's expectations. Each staff member who encounters a patient should understand and practice the fundamentals of patient-centered care. Patient-centered care is largely determined by the rules that define the health care environment. All medical facilities have rules. Rules determine what patients may or may not do, from the moment they enter the parking lot until they leave. …