Is This Too Extreme?

For some reason, many leaders in healthcare like to equate things in their lobby to person-centered care. Player pianos. Coffee for visitors. Seating areas with plants. Leaders that were eager to tell me about how they are “doing” culture change have proudly presented each of these examples to me.


The greatest pianist, coffee or seating does not make up for the fact that most healthcare organizations deprive people of their dignity and individuality.

Extreme? Perhaps. True? Absolutely.

The idea of person-centered care is not new.  It has a long history in various levels of healthcare.

Yet, somehow, the concept of person-centered care still struggles for the respect that clinical outcomes, quality measures and financial results get.

But is what a person wants any less important than what a person needs?

Don Berwick, former CMS Administrator, describes himself as an extremist in his article on patient-centered care. It is one of the best articles I have read on the subject.

In it, Berwick addresses common objections that I often see.

One objection is, “What do we do if a person wants something crazy or foolish?” In an education session I recently conducted, a staff member asked, “Do people just get anything they want now?”

The answer is “Yes!”

On rare occasions a “No” may be necessary.  BUT we shouldn’t make blanket policies that affect everyone based on one situation.

As Berwick writes, “…rare occasions make for very bad rules for the usual occasions.” (That may be my favorite quote ever!)

Person-centered care goes beyond customer service and aesthetics. It asks, “What do you need and want?” It acts on the answer and then asks, “How could I do better?”

Berwick shares some ways you can bring person-centered care alive in your organization:

  1. Control: Give control over to patients, residents, and the loved ones they choose. Take over control rarely and only with permission.
  2. Transparency: Share outcomes, processes, and errors freely. Apologize when things go wrong.
  3. Individualization: While the environment is important, the focus of culture change should be on creating systems that are adaptable to individuals.
  4. Training: All staff should be equipped with the skills they need to support residents’ needs and wants.

If you think this is too extreme here are three resources that will change your mind.  They are so impactful, we’ll be focusing on each one of these in future blogs.

We shared these readings recently while facilitating a session on Person-Centered Care for NJACC’s Leadership Academy:

How to Live in Assisted Living by Judith Graham NY Times

Imagine your community will be featured in the NY times.  Are you excited?  Nervous?  Discover what one resident, Martin Bayne had to say about his experience living in an assisted living.

The Thin Edge of Dignity by Dick Weinman | Assisted Living Documentary

Dick Weinman, a retired professor, shares his experience about how he thinks and feels about where he lives. As he shares he is, “Walking along the thin edge of dignity in the complex world of assisted living.”

A reading from, “You Can’t Be Neutral on a Moving Train” by Howard Zin

“History is full of instances where people, against enormous odds, have come together to struggle for liberty and justice, and have won— not often enough, of course, but enough to suggest how much more is possible.”

What do YOU think? Is coffee in the lobby enough or should you say “yes” to everything a resident wants? Is the answer somewhere in the middle or is that a slippery slope back to mediocrity?

Visit DRIVE for more information + resources.

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