title: Exploring the practice of patient centered care: The role of ethnography and reflexivity.
abstract: Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and benefits of our approach through a hospital case study.
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy. Electronic address: elisagiulia.liberati@unicatt.it.
authors.forename: Elisa Giulia
authors.initials: EG
authors.lastname: Liberati
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Gorli
authors.affiliation: Department of Biomedical Science for Health, Università degli Studi di Milano, Via Carlo Pascal, 36 20133 Milan, Italy; Clinical Epidemiology Unit, IRCCS Galeazzi Orthopedic Institute, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Galuppo
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Ripamonti
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaratti
mesh_terms: D000884:Anthropology, Cultural; D003695:Delivery of Health Care / Q000458:organization & administration; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*
keywords: Actionable knowledge; Ethnography; Healthcare innovation; Healthcare organizations; Patient centered care; Practice theories; Practice-based; Reflexivity