Systems theory provides the framework to support the idea that groups interact and interrelate with each other around certain experiences or activities. Typically, in a system, there are many parts that work together to achieve a common goal.  In a well-functioning system, the parts work to improve the system in order to achieve the best possible outcome. The system should never by stagnant and should evolve and become more efficient, as its parts change and gain experience.

We should view the American health-care system the same way – as an evolving system. It has many parts that work to achieve the common goal of patient care.  In a perfect world, the system starts with the patient, who presents to the clinic with the desire to have a health concern addressed. This patient registers with the medical receptionist. Then the patient waits and the system starts to turn on its engine. The medical assistant performs vital signs on the patient and elicits a chief complaint.  The system is on.

The patient waits and the system builds momentum. The provider reviews the patient’s chart and the system is ready. The provider greets the patient and elicits the history of present illness and the system moves closer to its destination.  The provider performs a focused physical exam, and the system gains speed. The provider makes a diagnosis and develops a treatment plan. The patient understands and agrees to the plan, and the system achieves its goals.

To improve the primary health-care system and ensure its efficiency, many professional health organizations support adopting the patient-centered medical home (PCMH) in ambulatory care.  The American College of Physicians and the American Academy of Family Physicians define PCMH as a team based health-care delivery model that provides comprehensive medical care to maximize health outcomes.  In short, the PCHM is a well functioning system whose goal is improved health.  

There are a number of components to maintain an effective patient-centered medical home, but at its core is the idea of delivering quality patient-centered care.  The patient is the most important entity within this system, because without them the system does not exist.  

The patient should be an active participant in their own health, and decisions about treatments and plans should be shared between the provider and the patient. The provider must be committed to a culture of improvement to ensure that the patient receives the best possible care.  This entails maintaining up-to-date medical records and addressing the patient’s active medical problems and medications at each visit. 

To make health-care readily available to patients, clinics should offer extended and weekend hours. Furthermore, care should be culturally competent. The community and the patient’s family should be included as vital members of the system, and care should be comprehensive and coordinated between all members.

As the health-care system in America evolves, the PCMH will likely become the standard-of-care in hopes of improving the health of Americans.  Many patients desire a model of care that is promised in the idea of the PCMH, and many providers allow these principles to guide their practice. There is hope for an American health-care system that functions efficiently and effectively, if its parts work together.

Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.