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The Case for Relationship-Centered Care and How to Achieve It

Margaret Kirkegaard, MD
Jeff Ring, PhD

American healthcare has entered a period of unprecedented debate regarding our healthcare delivery system. Adjectives such as affordable, accountable, integrated, and coordinated care routinely used to describe healthcare, but in the midst of reorganizing healthcare, have we lost the critical element of healthcare?—namely, “care” itself?  This element of true caring within the healthcare debate is often relegated to the realm of patient or consumer satisfaction. The concept of authentic caring in healthcare, as opposed to healthcare as a transaction for acquiring health care services, is best embodied in the paradigm of relationship-centered care. Beach et al developed a conceptual framework for defining relationship-centered care that is founded upon four principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable.[1]

While Beach posits that relationship in healthcare deserve attention because they are morally valuable, we sought to examine whether relationship-centered care can actually help achieve the Triple Aim —lower costs, better health outcomes, and better experience of care. We examine the value of relationships in healthcare within four domains:

  • social connectedness or supportive interpersonal relationships outside of healthcare,
  • therapeutic relationships between patients and their healthcare team,
  • relationships within the healthcare team, and
  • relationships between the healthcare team and the community.

Assembling the available research, we developed a framework for primary care practices to assess their ability to foster therapeutic relationships and harness the power of relationships to improve health outcomes.

[1] M.C. Beach, T. Inui, et al, “Relationship-centered Care, A Constructive Reframing,” J Gen Intern Med 21 (2006): S3–8.