Article Text

Original research
Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations
  1. Carmen Leidner1,
  2. Vera Vennedey2,
  3. Hendrik Hillen3,
  4. Lena Ansmann4,
  5. Stephanie Stock2,
  6. Ludwig Kuntz3,
  7. Holger Pfaff5,
  8. Kira Isabel Hower5
  9. On behalf of the CoRe‑Net Co‑applicants
    1. 1University of Cologne, Cologne, Germany
    2. 2Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
    3. 3Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
    4. 4Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany, University of Oldenburg, Oldenburg, Germany
    5. 5Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculties of Human Sciences and Medicine, University of Cologne, Cologne, Germany
    1. Correspondence to Kira Isabel Hower; kira.hower{at}


    Objectives The healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).

    Design A qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach.

    Setting and participants Interviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling.

    Results This study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles.

    Conclusion The results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.

    Trial registration number


    • qualitative research
    • health policy
    • quality in health care
    • change management

    Data availability statement

    Data are available upon reasonable request. No additional data are available.

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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    Data availability statement

    Data are available upon reasonable request. No additional data are available.

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    • Twitter @PfaffHolger

    • Collaborators The CoRe‑Net Co‑applicants are Christian Albus, Lena Ansmann, Frank Jessen, Ute Karbach, Ludwig Kuntz, Holger Pfaff, Christian Rietz, Ingrid Schubert, Frank Schulz-Nieswandt, Stephanie Stock, Julia Strupp and Raymond Voltz.

    • Contributors LA, SS, LK and HP conceived the study. KIH, VV and HH specified the methods. KIH, VV and HH conducted the interviews. KIH, VV, HH and CL analysed the interviews. CL drafted and revised the manuscript in cooperation with KIH and VV. All authors critically read, revised and approved the final manuscript. CL is the guarantor of the study.

    • Funding This work was supported by the German Federal Ministry of Education and Research (grant number 01GY1606).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.