Table 1.
Clinician Knowledge, Attitudes, Behaviors, and Anticipated Outcomes of Relationship-Centered Care*,†
| Clinician-Patient Relationship | Clinician-Clinician/Hierarchichal Relationship | Clinician-Community Relationship | |
|---|---|---|---|
| Knowledge | Each patient is a unique individual Psychosocial, emotional, and lifestyle issues are integral to medical care Patients differ in their values, preferences, and expectations for care Patients' perspective, culture, and personality are relevant to the process of care | Power inequities across health disciplines Power of understanding the other's perspective Healing approaches of various health disciplines Team-building dynamics and approaches to shared leadership | Diverse constructs/models of community Community perceptions of healthcare (including myths and misperceptions) Local community dynamics—demographic, economic, political, history of land-use, migration, occupation Local environments (social, political, economic, occupational, physical, educational, public safety) and their impact on health History of practitioner-community relationships Isolation of the health care community from the community at large Relationship of formal and informal healthcare |
| Each relationship is unique and is a product of the work of each participant The manner in which a clinician participates in an encounter fundamentally affects the course, direction, and outcomes of care both episodically and longitudinally | |||
| Approach, Philosophy, and Attitudes | Value partnership with patients View patients as experts Acknowledge that patients deserve respect View the provider-patient relationship as a therapeutic vehicle | Affirm importance of self-awareness Value diversity and interdisciplinarity Appreciate importance of shared mission Is open to others' ideas Affirm importance of, mutual respect, and trust Believe in importance of sustaining capacity for recognition, reconciliation, and prevention of error | Respect for community integrity, cultural diversity, and multiple determinants of health Understand health-relevant policy Is open-minded Is honest about the limits of medical care Appreciate responsibility to contribute health expertise to public dialogue Respect for community leadership Appreciate responsibility to work for the health of the public |
| Value the achievement of mutual respect and unconditional positive regard Acknowledge that affective engagement, rather than affective neutrality or detached concern, can further the therapeutic bond and its efficacy Acknowledge that clinicians and patients are both active human participants (not just role occupants) who co-construct their relationships Acknowledge that relationships are reciprocal and involve mutual tasks, duties, and responsibilities | |||
| Behaviors | Show respect to patients Find out about patient's values, expectations, preferences, and background Tailor approach to the patient based on knowledge of patient Help patient get story across, listen well (nonjudgmentally)Respond to patient's emotions, show empathy Seek common ground as a point of departure for formulating therapeutic plans | Reflect on self and personal/professional needs Continually learn from personal experience and that of others Learn cooperatively Derive personal meaning from the work of others Communicate effectively to other members of the team Listen actively to understand and engage other members of the team Work collaboratively, share responsibility Recognize and work to resolve conflicts Provide space in meetings for new thoughts, ideas Employ appreciative inquiry to imagine improvements Continuously examine whether the organizational values are reflected in day-to-day work | Participate in community dialogue and development Participate in activities intended to ascertain the relationship between health care providers and community health, community health status, and the impact of health care delivery systems on community health Participate in the development of health-enhancing community policy Communicate actively in matters of relevance to community health—listening openly, empowering others, contributing health expertise, facilitating the learning of others Participate actively in the implementation of community health strategies, health teams, and health care organizations |
| Attend to/monitor one's own behavior as an influence on the other(s) Be aware of and acknowledge own feelings and biases (emotional self-awareness) Acknowledge the importance of relationships to the therapeutic process and outcome for both partners Acknowledge need to take both participants' values, attitudes, and personality into account Acknowledge areas of agreement and disagreement on values, expectations, etc. Monitor the state of the relationship Acknowledge the importance of the relationship to one's own well-being | |||
| Outcomes | Patient feels honored, respected, attended to, etc. Patient likes and is satisfied with provider Patient has lower anxiety Patient has trust in provider Patient adheres to treatment Patient remembers information, advice Patient is more actively engaged | Productive resolution of disagreements Minimal staff turnover Improved ease of staff recruitment Colleagues reach personal and professional goals regularly Team members report being treated fairly and respectfully Enhanced capacity for working across a broad array of challenges Enhanced patient safety and quality of care | Enhanced collaboration between formal and informal health care “systems” within the local community Greater depth of understanding of the community's health care resources, as well as vulnerabilities Greater prevalence of organizational policies that promote community health Greater participation of health care organizational personnel in civic service Enhanced community health |
| Mutual attunement and harmony Informed decision making Added depth and vitality to interactions Clinician becomes a source of social and emotional support for the patient Patient becomes a source of professional reward/gratification for the clinician Protection against professional burnout Greater agreement on treatment plans |
*
Shaded areas indicate features of care that we consider part of both patient-centered and relationship-centered care.
†
Categories (knowledge, approach, behaviors, and outcomes) are evolving and interactive.