A Framework for Mainstreaming Patient-Centered Communication in Community-Based Healthcare Organizations

Abstract

The Mainstreaming framework evolved from a research study with family planning centers that took place from 2009 – 2012.  The study tested the correlation between enhanced organizational management system, the provision of patient centered communication, and improved patient health outcomes. Enhanced management system was measured by ability to integrate the needs of Communication Vulnerable Patients (CVP) into an organization’s operating structure including its design, culture, data, information, and monitoring/evaluation systems. Improved patient outcomes were measured through increased testing for STD with Latina patients. The study was conducted in two phases. In phase 1, a baseline survey deepened understanding of the organizational structures. In Phase 2, six clinics were purposively selected from the pool of survey respondents to participate in the study. The 6 clinics were divided into two groups.  A delayed intervention methodology was used to allow an opportunity to use Group B as a control Group for the initial 4 months.  Site visits; interviews, action plan development, technical assistance, patient chart reviews and review of organizational records were used. Social Learning Theory51, Behavioral Ecological Model, Learning Organizational theory, system theory and gender mainstreaming concepts guided this study. With few exceptions, response to communication barriers has been reactive and non-consistent. They ignored the complexity of the organizational system and the interconnectedness of its many parts and elements.  Strategies failed to recognize the interrelated consequences of communication breakdowns, and the overall impact on organizational structure, process and health outcomes. The mainstreaming framework utilizes system thinking principles critical to catalyzing organizational learning and development. It provides guidance to integrate the needs and concerns of CVP within the organizational structure, and enables practitioners to overcome mental models that perceive serving CVP as a burden. It facilitates harnessing the business potential of capturing a larger pool of the patient market.