Patient-Centeredness in Sweden’s Health System

Two international experts, Angela Coulter and Elizabeth Docteur, developed a framework consisting of five dimensions that served as a basis for defining and assessing the degree of patient-centeredness. The framework was then applied to make a preliminary assessment of patient-centeredness in Sweden. On the basis of the conclusions drawn, they put forward six recommendations that can serve to strengthen the progress towards a more patient-centered health care system in Sweden.

A Framework for Assessment

In this study we present an analytical framework for assessment of patient centered care, which consists of the following five dimensions:

• Empowering patients through information and education
• Respecting patients’ needs, preferences and values as individuals
• Coordinating care across service providers and ensuring continuity of care
• Taking a holistic approach to patients as people with medical and nonmedical (i.e., social, emotional, and spiritual) needs
• Involving family and close friends in the health care experience, to the extent desired by the patient.

Assessment of Patient-Centeredness

The key findings of the assessment are:

• Sweden has made good recent progress in strengthening and improving legislation pertaining to patient information and education. Nevertheless, important gaps in information and education are evident, in terms of how well those efforts have paid off in patients’ understanding and satisfaction with the information and education obtained.
• Sweden’s health care system often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. Failure to meet patient expectations can have demonstrable costs to patients, the health system and the public purse.
• Inadequate coordination of care across health-care providers is an important weakness in Sweden’s health system. Such problems are likely to have a negative impact on health outcomes and costs, in addition to having a negative impact on patient experienced quality of service.
• Some problems in taking a sufficiently holistic approach to patient care are evident, with relatively little variation in performance across counties.
• While evidence regarding the patients’ experiences in involving family and close friends in their health care is relatively limited in depth and scope, available data suggests that there is room for improvement in this area. Several types of potential problems benefiting from further exploration were identified in the course of the present study.

Six steps for progress

Our policy recommendations for improving patient-centeredness in Sweden’s health care are:

• Ensure compliance with existing legal obligations to strengthen patients’ position
• Establish patients as full partners with their providers with a role in health and care decisions
• Engage and involve patients and their representatives in health policy and administrative decisions
• Sustain efforts to facilitate coordination and continuity of care
• Define a framework for assessment that reflects the priorities of Swedish patients
• Strengthen efforts to assess and track patient centeredness