The value or usefulness of models first depends on the evidence supporting the validity and reliability of their inferences, and secondly, the extent to which they offer added-value in the field. Using these criteria, evidence converged in support of the model’s inference that patient-centeredness was an underlying ability of pediatricians that influences patient family trust, confidence, and the likelihood to recommend. For example, evidence of a strong “stimulus-response effect” between patient-centeredness and family trust was apparent; when patient-centeredness increased or decreased, family trust changed almost on a 1:1 basis. As such, the model can serve the interests of pediatricians, their patients and families by illuminating examples of care behaviors that influence the quality of the transmission of care. In this study, these care behaviors included the pediatrician’s friendliness and courtesy, explanations of the patient’s condition, concern for the family’s questions and worries, efforts to include the family in decision-making, and efforts to provide medication information and follow-up instructions. The model offers a template for testing many others, of which the number and quality of patient-centered care behaviors is only limited by the imagination and creativity of the provider. Pediatricians can improve their patient-centeredness scores by increasing and improving their care behaviors that serve the interests of patients and families.
In addition to providing evidence that patient-centeredness increases pediatric family trust, the model establishes that families value the patient-centeredness of their practitioner. For providers and patients/families, the model offers the potential for improved relationships, communication, care, and outcomes. Increased patient-centeredness can lead to greater patient satisfaction - more pleasant, more comforting, more compassionate, less frightening, and less humiliating care.
Lastly, the model provides an evidence-based framework for designing future research on patient-centeredness and desired outcomes, physician-patient-family relations and communication, and quality measurement and improvement.
What are potential consequences of adhering to the model if it is wrong? For some practitioners, being more patient-centered may require change. Change can be difficult. Being more friendly and courteous and showing more concern for the family’s questions and worries may reduce the formal distance between a practitioner and the family, and require vulnerability and risk. Increased efforts to include families in the decision-making process may require giving up some hard earned control and power. Being more patient-centered may require changes in practice patterns and the amount of time providers spend with their patients and patients’ families. This could result less patient through-put and revenue. Practitioners will have to individually weigh the benefits against the potential consequences of increased patient-centeredness and family trust.
Based on the above results and supporting evidence, we conclude that patient-centeredness is a variable, measurable, and teachable latent ability of pediatricians. Moreover, increases in a pediatrician’s patient-centeredness enhance family trust, confidence, recommendations, and ratings of care behaviors. On the other hand, decreases in a pediatrician’s patient-centeredness drive these outcomes down.
Lastly, and in general, we hold that clinical competency is a necessary but insufficient condition of provider quality. The very best pediatricians will be both clinically competent and patient-centered.
All data for this investigation were accumulated with one instrument. While there is no generally accepted response rate in survey research, (Babbie, 1990
) patients who respond to surveys could be different from those who do not. A study of non-response bias concluded that minority patients could be under-represented by not being as likely to return a completed patient survey (Kaldenberg, 1998a
Directions for Future Research
Within the context of the Primary Provider Theory, the results of this study offer an evidence-based model for future research with specific implications for the measurement and improvement of pediatric patient-centeredness, family trust, confidence, the likelihood to recommend, physician-patient-family relations and communication, and quality measurement and improvement. The model should be validated in other healthcare settings (e.g., inpatient, NICU, OB/GYN) and with non-physician primary providers.