Defining Relationship-Centered Care

From 1995-2005, the Fetzer Institute sponsored the Relationship-Centered Care Network. With the end of that initiative, the Institute has generously provided CaringMatters with the enclosed resources on Relationship-Centered Care.

Defining Relationship-Centered Care

Relationship-centered care is healthcare that values and attends to the relationships that form the context of care, including those among and between

	practitioners and patients;
	patients as they care for themselves and one another;
	practitioners and the communities in which they practice;
	healthcare practitioners across various professions; and
	administrators and managers as they set the environment and resources for care.

Attention to the following are essential to relationship-centered healthcare. Each involves a unique set of tasks and responsibilities.

The Patient-Practitioner Relationship

The work of the practitioner within this relationship includes

	organizing information about the patient and his or her care; providing comprehensive biomedical care;
	critically reflecting on his or her practice to increase self-awareness;
	practicing from a caring, healing ethic and perspective that seeks to preserve the dignity and integrity of the patient and the patient's family; listening and communicating openly and effectively;
	seeking to eliminate abuses arising from power inequalities with regard to race, sex, education, occupation, and socioeconomic status;
	encouraging the active collaboration of the patient and family in decision-making, care, and treatment; and
	promoting health and preventing illness in the individual and family.

The Community-Practitioner Relationship

It is important that practitioners and healthcare organizations understand their work and mission in relationship with the health of the community as a whole. The community is a central context for health and human development that has both the potential to injure or to heal. Individuals belong to multiple communities formed by families, neighborhoods, cultures, work groups, or circumstances.

Practitioners also need to affirm the relevance to healthcare of all determinants of health and affirm the value of health policy in community education, public safety, transportation, and so on. The ability to assess community and environmental health using multiple approaches is important to developing effective working relationships with communities. Such approaches include using public health indicators, self-assessment strategies, quality of life measures, cultural measures, and indicators of environmental factors. Practitioners must be able to identify factors that improve or maintain health as well as those that are harmful. Also important are recognizing and assessing the efficacy of both formal and informal care-giving and assessing community policies that affect health.

Relationships Among Healthcare Practitioners

Effective, empathic care requires a community of practitioners who commit themselves to working together to serve the complex matrix of individuals' needs in health and illness. Relationships among practitioners include those within or across disciplines, and those between practitioners and practitioners-in-training. These relationships require teamwork, shared values, learning from and making use of the expertise of others, helping others learn and develop, integrating services at individual and systems levels, and setting aside issues of specialization, hierarchy, and privilege. Such relationships serve the needs of practitioners as well as patients: building communities enables healthcare providers to care for one another and give and receive the support and encouragement that produces personal and professional maturation and more effective patient care.

Relationships Among Patients

Relationships among patients, from casual friendships to more formal support and self-help groups, can allow patients to have instant identity with each other and truly understand the feelings and difficulties of having cancer, coping with the death of a spouse or child, struggling with an addiction, or dealing with the stigma of mental illness. In a patient-to-patient relationship one can share feelings and discuss issues that can be uncomfortable for the closest of family and friends. Patients also become important role models for each other as they both give and receive support and offer new ways to think about specific situations in which normal coping mechanisms do not work. Beyond the social support, patient-to-patient relationships can educate and empower people to better deal with their situation and the professionals attempting to help them.

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