My wife and I care for her father who has been called “frail” and our son who has diabetes, kidney failure and other problems. We noticed that a couple of the agencies that help us talk about ‘patient or client-centred care’ and ‘system navigation’ in their handouts. What do these terms mean?
Client or patient-centred care has been defined as an approach to care in which clients are viewed as whole persons involved with their health care decisions to whatever level they wish. The client in this definition includes individuals, families/significant others, caregivers, groups and communities. In client-centred care, the client is treated as a member of the health care team and is involved in shared decision making. The client is encouraged to be a partner in the development and monitoring of the treatment plan or plan of care and the client’s choices, rights, values, and expressed needs are respected. The client has the right to refuse care. It is the responsibility for health care providers to ensure the client receives and understands the necessary information to make an informed decision. This information should include: the nature of the treatment or plan of care, expected benefits, potential risks and side effects, options or alternatives, the possible consequences of not having the treatment, and an opportunity to discuss questions, concerns and preferences with the health care team (adapted from Registered Nurses Association of Ontario, 2006; Canadian Nurses Association, 2009)..
System navigation is a term used when there is a need for assistance to navigate the complex health care system. Formally, this navigation is the responsibility of positions such as care or case managers or patient navigators commonly employed by home care organizations and hospitals. Informally, family caregivers often act as system navigators, researching various care options on behalf of their loved ones. System navigation usually includes functions of assessment of need, providing information and education to the client, referral to needed services, providing guidance or linkage to available health and community support resources, helping to communicate and interpret to/for the client and long-term follow-up.
VON’s S.M.I.L.E. (Seniors Managing Independent Living Easily) Program is an example of client-centred care and system navigation.
The SMILE Program, with the support of its partners, makes it possible for frail seniors, who are at risk of loss of independence, to remain in their own homes. The program provides access to service for these seniors and their caregivers. Because dignity is a matter of choice, the SMILE program offers seniors options in managing their own care. Seniors can choose what services they need, when they need them and who will provide those services. Service providers and community groups become involved in the program by becoming a SMILE partner. The program partners serve as entry points to the program using standardized information and needs assessment and information is shared between partners. Seniors involved within the SMILE program can choose to select services from existing service providers or non-traditional providers. The service providers that seniors choose to use are responsible to the senior as a client and are not employed by SMILE program.
Further Reading:
Heather Menzies is an author and adjunct professor at Carleton University. Her latest book is Enter Mourning: A Memoir on Death, Dementia and Coming Home. In July, the Globe and Mail carried her article entitled Patient-centred care: It’s about relationships, describing the need to shift from receiving a set of individual services from our health care system to building patient-centred relationships. Ms. Menzies uses her personal experience to illustrate this need. Her son was diagnosed with a severe chronic mental illness 12 years ago and her mother died of dementia seven years ago. Relationships were key to the outcomes in both cases: a good death for her mother in the care of people who knew and cared for her over time, and recovery for her son.Read the story.