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leadership, management ethics, organizational ethics, patient-centered care



  1. Nelson, William A. PhD
  2. Forcino, Rachel C. MSc
  3. Elwyn, Glyn MD, PhD, MSc, FRCGP


Health care organizations have embraced the concept of patient-centered care, but there is concern that the mere inclusion of those words in mission and value statements does not equate to implementation at the health care delivery level. Despite initiatives to align the patient-clinician encounter with broader patient-centered values, there have been mixed results, often creating a gap between practice and the organization's stated position. This preliminary study aims to assess the extent to which patient-centered values are reflected in actual patient care. The survey was sent electronically to Dartmouth's Masters in Health Care Delivery Science alumni, leaders in health care management. A majority of 49 survey respondents acknowledged the importance of patient-centered values to their organizations. However, 90% of respondents identified a gap between patient-centered values and day-to-day patient care. Thematic analysis of respondent comments showed a misalignment of organizational incentives with patient-centered care, a lack of leadership priority given to patient-centered values, and a failure to clearly define patient-centered values. Quantitative and qualitative data indicated that patient-centered statements represented rhetoric rather than the reality of patient care. Consistently achieving patient-centered care will require leaders to adopt a systematic approach to move beyond rhetoric.