Status of Patient-centered Care in Health System of Iran

Care is the main essence, core, and element of the health system, which facilitates the improvement of the health and well-being of patients (1). In the health system, quality is defined as safe, timely, effective, efficient, fair, and patient-centered provision of care (2). Patient-centered care is one of the six areas expressed about the quality of health system and a vital issue in development of care quality. Today, patient-centered care is recognized as a global issue (3). In addition, patient-centered care is an essential element in improving the health system and gaining public trust, which leads to decreased mean duration of hospital stay, improved patient satisfaction, reduced hospital costs, and an overall enhancement in the treatment condition, health consequences, and life quality of patients (2, 4). Despite the positive impacts reported for patient-centered care, there have been barriers to the provision of this type of care, including lack of comprehensive policies, lack of adequate training in universities and hospitals, lack of coordination in the role of different people in providing patient care, lack of focusing on all aspects of patients, improper communications between healthcare providers, and workforce shortage (4, 5).
Today, considerable attention is paid to the concept of patient-centered care in the planning stage in the educational system and the accreditation process of hospitals. While health institutions and education departments use the concept of “patient-centered” in their terms, there is little evidence on the use of this concept operationally. Moreover, unavailability of this concept in healthcare systems of the world has become a concerning issue (5, 6). In the health system, quality management system are important tools for standardization and improvement of quality of services (5). In this regard, accreditation has been considered as a requirement by the Ministry of Health for the evaluation of hospitals since 2012 (7). Accreditation is a systematic extra-organizational evaluation process carried out to improve care quality and safety. By providing standards, this process directs hospitals toward the establishment of a comprehensive and systematic management system and promotion of safe, high-quality and patient-centered culture (8).
One of the most important standards of accreditation is the patient-centered concept, which includes access to care and continuity of care, observing the rights of patients and their families, patient assessment, patient care, anesthesia care in surgery, drug use and management, and education of patients and their families (9). Therefore, proper use of accreditation is expected to lead to the observing of patient-centered principles in providing services, ensuring patient safety, and constantly improving the quality (10). Despite gaining grade 1 and 2 acceleration by hospitals, the major problems of the health system are the quality and method of provision of health-centered services (6, 8, 9). Several studies have demonstrated the relative preparedness of hospitals in implementing the accreditation standards (6, 9, 10).

Results of other studies have shown that the health system of Iran deals with some challenges in the process of accreditation, including the position of the institution responsible for accreditation, the lack of proper and accurate definition of the implementation methods for accreditation standards, and the lack of a suitable combination of institutions participating in the process of accreditation, which are recognized as a big gap in this area (11, 12).
Furthermore, there is a great emphasis on documents in the accreditation process in Iran, in a way that several developed policies may not be implemented in practice. It seems that the investment aspects in the accreditation process have deflected health cares from their primary clinical objectives (e.g., being patient-centered). All of the issues mentioned can justify the lack of a rational relationship between the accreditation grade of hospitals and quality of patient-centered services. Therefore, the following questions are raised: “to what extent does issuance of an accreditation certificate provides valid evidence on the quality of patient-centered cares?” and “are patients and families considered as care recipients in the accreditation process?”.
What is the actual status of patient-centered care in the health system of Iran with excellent accreditation grades?
The important and effective role of accreditation in improvement of quality in various dimensions is undeniable. However, it seems that the most neglected aspect in provision of high-quality services is the centeredness of patients. In other words, it could be stated that not only the concept of accreditation do not meet the major needs of patients and their companions, but also it is mostly a factor that distinguishes an organization from its competitors.
Patient centeredness has no clear, distinct, and unified status in the execution process of accreditation of hospitals. Meanwhile, patient centeredness is a strategic concept in accreditation that must be beyond reducing errors and complaints and performing periodic evaluations for earning a grade (2, 12). Therefore, the concept and culture of patient centeredness must be identified and established fundamentally so that effective steps could be taken toward providing high-quality cares and achieving patient satisfaction. Accordingly, along with the implementation of accreditation standards, it is vital to pay attention to educational, clinical, and research infrastructures, especially in the area of safety of care and centeredness of patients, so that the proper performance of healthcare providing organizations could be ensured.
In order to improve the current status of the accreditation process, it is suggested that more dynamic and accurate analysis of the existing evidence on the effectiveness of accreditation components in providing patient-centered and high-quality results be carried out before planning for evaluation of the effect of accreditation and issuance of a certificate to hospitals. Furthermore, the culture of patient centeredness must be institutionalized in a way that it would be regarded an essential concept in all hospital standards (e.g., processes and outcomes of care provided by all medical and paramedical departments) and not just areas related to nurses.