How to measure star quality

By Helle Gjønnes Møller

How do you evaluate intrinsic traits such as empathy and compassion? How do you rate subtle behaviors like being respectful of other’s needs and values and asking open-ended questions? Many of the skills and qualities that characterize person-centered care (PCC) are indeed difficult to measure. Nonetheless, there is a growing incentive to do so, as PCC is now increasingly recognized as a key component of high-quality healthcare, in both the public and private arenas.

The measurement of PCC is also a key topic among the academic partners in the Person-Centered Hearing Network (PCHN). Back in 2019, the group initiated a joint project to develop resources helping educators to integrate PCC into academic curricula. As a natural next step, the group is now exploring different ways of measuring PCC and considering what designs and methods can be applied to achieve this in academia and beyond. Some initial insights and ideas were shared as the partners convened earlier this summer. But before we dive into the highlights from this conversation, let us first take a glance at the wider healthcare landscape and the work that is being done globally to help measure PCC and its impact. 

PCC measurement on a wider scale

In many countries, healthcare services are facing significant challenges as populations are increasing in size and age. And as people live longer, often with multiple conditions, health systems are under severe pressure. In response to these challenges, the ‘personalization agenda’ is making headway at a global scale. PCC is now seen as a way to improve outcomes and reduce the burden on health services. And with recognition from such authorities as The National Academy of Medicine in the US and The National Health Service in the UK, the approach has transitioned from its previous position as a nice-to-have add-on to being a fundamental part of quality care. Indeed, a multitude of tools and resources for measuring PCC have become available. According to a review by The Health Foundation based on more than 23,000 studies, the most used methods include:

•    Surveys of people using healthcare 
•    Surveys of clinicians
•    Observations of clinical encounters

According to the review, the most used tools are:

•    The Individualised Care Scale
•    The Measure of Processes of Care
•    The Person-centered Care Assessment Tool

However, there is no universally agreed or formally endorsed approach and no consensus in terms of which tools are most worthwhile. As such, The Health Foundation concludes that a combination of methods and tools is currently likely to provide the most robust measure of person-centered care. In terms of the research available, most studies have been conducted in a hospital context or in primary care, community services, and nursing homes. Less information is available on how clinical organizations measure PCC as a routine part of their clinical practice – or how PCC skills can be rated and graded in an educational context. It is this gap between theory and practice that the academic PCHN partners are aspiring to help bridge.

Star quality

As we touched on earlier, measuring the core components of PCC is not an easy task. When the academic PCHN partners met this summer, Sarah Riches, Senior Teaching Fellow at Aston University, stated eloquently: “With PCC, it’s a bit like star quality. We know when we’ve seen it, and we know that the needs of the patient have been met. But it’s difficult to pin down.” 

The topic is extremely diverse and means different things to different people. So why attempt to measure PCC at all? Cherilee Rutherford, Senior Audiologist at the Ida Institute, said, “The overarching reasons why we need to measure PCC are to assess the quality of existing service provision and to ensure that people’s needs and preferences are addressed. Not only in a student setting but also in a broader context of clinical practice.”

Solid evidence

Among the academic PCHN partners, there is broad agreement that in order to truly implement PCC and ensure its validity, we need to measure its impact. At the meeting, Patricia McCarthy, Professor of Audiology at Rush University in Chicago, shared, “We need to provide solid evidence that it is effective - to look at the positive outcomes of PCC compared to other strategies.”

Christian Brandt, Associate Professor in Audiology at the University of Southern Denmark, stated, “If we don’t measure it, how can we work with it? From the very basics of students needing to know how they are doing – to being able to research it. We need to measure it.” Talita le Roux, Senior Lecturer in the Department of Speech-Language Pathology and Audiology at the University of Pretoria, added, “Students are not going to be cognizant of something if they don’t get a mark for it. We have to measure it so that students are conscious about it.” 

An ambitious endeavor

While the initial ambition is to create a tool or resource to help measure PCC in an educational context, the group also aims for usability and validity beyond academia. The project is currently in its early stages and though there is no doubt that the endeavor is both immense and ambitious, the partners are hopeful that the outcome will help to measure PCC formally and consistently in audiology training as well as in clinical practice.