Table 2 Description of the elements and constructs within each cluster

Cluster 1: Shared responsibility for personalised health literacy

Encompasses patient and provider responsibilities. The cluster includes: responsibility for personalised care in context; understanding where the patient is at; what level of involvement they want; self-management responsibilities; carer involvement; understanding who the partners are in the care relationship; and, shared decision making by both parties. Fundamental to these requirements is the statement that a level of discussion is necessary to foster knowing, engaging with and collaboration with the patient.

Cluster 2: Patient-provider dynamic for care partnership

Elements in this cluster focus on care requiring a partnership approach. This requires patients and providers acknowledging uncertainty, giving and receiving individualised information and follow-up, explicit goal-setting at each point of care, and adequate time spent negotiating all these aspects.

Cluster 3: Collaboration

Enunciates roles for patient and multidisciplinary providers: trust; respectful understanding; proactive involvement of allied health; undertaking new roles within the care relationship, including a focus on prevention and wellness; and the encouragement of patients' engaging with support networks as part of their overall care plan.

Cluster 4: Shared power and responsibility

Details ideas for improving involvement in care and respecting the patient voice in this process. This includes patient access to health records, patients being health literate, respect between partners, and shared understanding of patient-centred care across sectors. The notion of shared power and responsibility towards and between each party is at the heart of this cluster.

Cluster 5: Resources for coordination of care

Partnership at all levels of the system is ideal, with sharing of patient health records according to patient preferences as a major requirement. Encompasses the need for team approaches, particularly in handover and discharge planning, which includes all members of a patient’s network and an effective advocacy system for those unable to do so for themselves. Transparency of costs and available services are also important requirements.

Cluster 6: Recognition of humanity, skills and attributes

Clinicians and other professional staff require interpersonal skills and attributes that demonstrate attentiveness to individual patients. Necessary for this requirement are excellent communication skills, kindness, listening capabilities that pick up on cues and validate information, being engaged with one another with an awareness of needing to introduce oneself, being empathic and non-judgemental, and having a generalist approach. Understanding end-of-life care and exercising flexible, adaptive capabilities in practice are necessary as well as a willingness to ‘go the extra mile’ in caring for patients.

Cluster 7: Knowing and valuing the patient

Represents elements that may be considered a patient-centred ‘bill of rights’. That is, care according to patient preferences, respecting patient choices and autonomy with consideration of their quality of life, prioritising their management needs and wishes alongside an awareness of all parties’ agendas for care outcomes, encouraging patient participation, building their confidence within the health care environment, and welcoming their lived experiences.

Cluster 8: Relationship building

These elements indicate an essence of curiosity to enable a responsiveness to patients’ values and preferences, including cultural needs, and an understanding of patients’ needs in different clinical circumstances. Having the right relationship between patient and doctor, based on honesty, is required.

Cluster 9: System review, evaluation and new models of care

These elements reflect the complexity of system requirements for patient-centred care to be achieved. This cluster includes: after-hour access; affordability; equity of health care; and adequate resourcing of support services to ensure timely delivery of care. Measurement of patient-centred outcomes and providing feedback of these to stakeholders, and system evaluation to ensure a focus on the patient. Development of new care models are necessary, such as complex care coordinators, longitudinal coordination for care and specific advocacy mechanisms. Health care and community (e.g. schools and workplaces) environments need to be welcoming and safe for patient disclosure.

Cluster 10: Commitment to supportive structures and processes

Consists of organisational mission, structures and processes which are required for patient-centred care. Elements are the removal of barriers for clinicians, organisational philosophy, evidence of compliance to patient-centred care standards in accreditation processes, and the patient voice at executive level of health and educational organisations. Included in this cluster is the requirement for systems that support new models of care.

Cluster 11: Elements to facilitate change

Elements in this cluster refer to the requirement of a best practice approach to facilitate reflection, change and actions for improvements. This means: addressing the culture across stakeholder groups; executive leadership for education and training; establishing ambassadors for change within the health system; developing staff who feel cared for and are empowered for the benefit of patients; training of patients to provide feedback; and providing better evidence for real complexities in patient care. New understandings of power imbalances between patient and health system, and of social determinants of health and their impact on health is required.

Cluster 12: Professional identity and capability development

These requirements span from student education to ongoing learning in the clinical environment. The cluster includes, at the pre-vocational level: teacher role-modelling; specific training for the necessary communication skills; students learning to share evidence and uncertainty with patients; students being positive towards learning from patients; and changing the focus of medical education from ‘doing to’ to ‘doing with.’ In the clinical environment it includes: reflective practice and professional discourse; a focus on avoiding contradictory messages between non-clinical and clinical educational environments; the ability to cope with complexity; maintaining clinical competencies; and understanding that professional development for patient-centred care is required.

Cluster 13: Explicit education and learning

Addressing explicitly the approach to education and learning for patient-centred care is necessary. Elements relate to the explicit teaching of patient-centred care and embedding it within curricula and professional development to build capacity for, and assessment of, humanistic skills. This cluster includes: creating a junior doctor culture which supports doing better for the patient; interdisciplinary learning of roles; involving patients actively in teaching, design, and development of curricula; and longitudinal patient care incorporated in medical education.