What is Human-Centered Care?

At Anadolu Health Center, we define Human-Centered Care as ‘a care approach that views patients, their relatives, and staff as family members, addressing their expectations and needs, providing a healing environment where they feel at home, and offering transparent, compassionate, and humane care.’ In this framework, we consider each of our patients as unique, providing personalized care with compassion, empathy, and love. We also value informing patients and their relatives, making them a part of the care process. One of our core values at Anadolu Health Center is ‘Patient Focus,’ so Human-Centered Care is essentially a part of our culture.

Our work in Human-Centered Care, which began in 2013, has been awarded the highest level of certification in human-centered care excellence by the international accreditation body Planetree.

Our Human-Centered Care Practices

We have implemented many practices at Anadolu Health Center that reflect our Human-Centered Care philosophy. In this context, we have redefined patient partnership.

Our Patients Are Involved in Hospital Management

In addition to listening to the patients we serve, we position them as our consultants and progress towards becoming a ‘patient-managed hospital.’ In this regard, we have an initiative that was implemented for the first time in Turkey: the Patient and Relatives Advisory Board. We consult this board to gain the perspectives of patients and their relatives in our improvement efforts in all service areas. These improvement efforts can be physical space renovations or redesigning our processes. In other words, we work on projects together with our patients.

We Consider Patient Preferences When Planning Care

We prioritize maintaining the daily routines of all our patients as long as there are no medical constraints. Therefore, we incorporate patients' sleep habits, meal times, eating habits, and cultural preferences into their care.

Patient-Preferred 24/7 Visiting Policy

As long as there are no medical restrictions, patients can be visited 24/7 by their guests. Except for medical restrictions, only patients decide on visiting limitations.

Care Partnership Program

In line with our Human-Centered Care philosophy, we emphasize continuity of care even after patients are discharged from the hospital. We recognize that the individuals who are most helpful to our patients at home are their relatives. Therefore, we guide and train relatives on how to provide care during their stay in the hospital. This ensures better management of the patient’s home care needs.

Open/Shared Record Application

We believe that care in healthcare institutions should be transparent. Therefore, all patient records are shared with patients and their authorized relatives. One of the objectives of our Open Record application is to effectively inform our patients. We know that patients with accurate information play a more active role in managing their illnesses. Therefore, medical information is explained to patients in a manner they can understand by the relevant healthcare professionals, allowing sufficient time for explanation.

Life-Enriching Activities

We understand that spending a long time in a hospital can be difficult and boring for patients and their relatives. Therefore, we conduct activities such as marbling art, meditation, and breathing exercises with our patients. Occasionally, we also hold music performances in the clinics.

Human-Centered Care Makes a Difference

Dr. Hisham Alahdab mentioned that Planetree auditors have reported that institutions working on Human-Centered Care worldwide face challenges in embracing and internalizing this culture. However, our group truly believes in and internalizes the Human-Centered Care philosophy and works enthusiastically to spread and implement it in the field.

Dr. Alahdab highlighted the difference made by Human-Centered Care as follows: ‘As Anadolu Health Center, we are accustomed to a culture of accreditations. We have accreditations such as JCI, OECI, ESMO that ensure standardization in various fields. However, with the Planetree audit, we demonstrated our difference in another area. This audit focused on experiences rather than documents and processes. In other words, it evaluated how our Human-Centered Care practices are perceived by our patients and staff and whether they impact staff and patient satisfaction.’

Dr. Alahdab noted that the patient groups were also very positively affected by the audit: ‘Our hospitalized patients expressed their satisfaction with our practices such as Care Partner, whiteboard, bedside nurse handovers, planning care together, and integrating patient preferences into care. They particularly mentioned, ‘It feels like our home here... We really feel like we are in a family environment when we come here.’ They also said that the staff at Anadolu Health Center treated them with compassion, a smile, and helpfulness. Hearing this was a testament to us that we are indeed providing Human-Centered services.’

We Focus on Employees as Much as Patients

One of the key aspects of Human-Centered Care is focusing on employees, as emphasized by Asuman Kuşçu, Human-Centered Care Manager at Anadolu Health Center. While conducting Human-Centered Care efforts, we gather feedback from representatives of every segment of our staff. Additionally, when a project related to employee improvement is undertaken, we handle employee expectations, preferences, and needs just as we do with patient preferences. Therefore, we plan projects based on employee feedback and common requests.’

Human-Centered Care During the Pandemic

We did not compromise on one of our most important principles, Human-Centered Care, during the pandemic. We worked to make patients and their relatives feel at home by taking all necessary precautions, including masks, hygiene, and social distancing. So, what was done in terms of Human-Centered Care? Asuman Kuşçu, Human-Centered Care Manager and Specialist Nurse, explains Human-Centered Care during the pandemic.

Visitor and Companion Policies During the Pandemic

During the pandemic, healthcare organizations continued to provide the best care to their patients while protecting their staff under extremely challenging conditions.

While the importance of family presence/participation in healthcare is well-known, balancing safety, supporting patients, families, and staff has been quite important and delicate. This balance was not well-established everywhere during the COVID-19 pandemic, and many policies and practices created to address COVID-19 restricted family presence and participation. These restrictions brought about many safety, clinical, and/or emotional risks and issues. Visitor restrictions also placed significant emotional and physical burdens on patients, families, and healthcare personnel.

When determining visitor and companion policies at our hospital, we based our decisions on the rules and policies of the Ministry of Health. Additionally, we utilized guidelines from various organizations such as Planetree, CDC, JCI, and ISQUA (International Society for Quality in Health Care) and followed the guidelines of our infection control committee. Experts indicate that with a well-planned approach, safe and compassionate family presence can still be maintained during this process.

Through training and meetings with Planetree, we collaborated on creating and maintaining a safe, responsible, and compassionate family presence policy. The Patient and Relatives Advisory Board discussed the following topics and provided feedback and suggestions:

Measures Taken During the Pandemic

• Evaluated visitor and companion practices worldwide and in our country. Discussed problems and solutions experienced during the process with other hospitals.
• Frequently reviewed and updated our visitor procedures as time progressed and according to needs.
• Communicated visitor restrictions compassionately both through our website and by our reception staff at the entrance.
• Explained to our patients the importance of having a companion and that being with loved ones requires adherence to certain rules.
• Decided to manage patients in end-of-life care, childbirth, children, cognitive disorders, and intensive care units specifically during the process.
• Continued to educate and integrate accepting companions as care partners, making them part of the team.
• Focused on improving home care follow-ups for our patients and provided an option for those who did not want to be in the hospital by supporting social distancing.

Implementation of Home Care Program During the Pandemic

• Although we had preparatory work before the pandemic, our organization did not have a home care service. We had case managers and telephone follow-ups, and we obtained home care services from other institutions when needed. With the pandemic, we implemented a comprehensive home care service program.

Visits with managers were conducted to listen to staff expectations, wishes, and suggestions regarding the process. Information and support were provided on the application of visiting policies and other isolation measures.

Supporting Our Staff During the Pandemic

To understand and improve our staff’s experience, we carried out many activities during the pandemic. Asuman Kuşçu, Human-Centered Care Manager; Murat Demirer, Occupational Health and Safety Manager; and Şehnaz Zerengök, Senior Manager of Patient Services, share their experiences in this process:

Increased Communication and Support

• Regular meetings were held with staff to understand their needs, problems, and expectations.
• Focus groups and one-on-one interviews were organized to listen to their thoughts and opinions.
• We provided training and support for staff dealing with emotional challenges and stress management.
• We arranged programs to enhance their well-being, including relaxation activities, wellness initiatives, and psychological support.

Maintaining Safety and Providing Support

• Ensured that staff had the necessary personal protective equipment and support.
• Created safe working environments with regular disinfection and health checks.
• Offered additional support and recognition to staff for their hard work and dedication.

Despite the challenges posed by the pandemic, we remained committed to upholding our Human-Centered Care values and continuously sought ways to support and improve the experience for both our patients and staff.

Empathic Stance

Empathy is the ability to understand and recognize another person's perceptions and emotions, and to express this understanding to them in an acceptable manner. Expert Psychologist Selin Karabulut, who states that empathy is not something done but an empathic stance and presence, shared important information about empathic stance.

En-patheia: Greek "en- (inside)" and "-patheia" ("emotion, pain, feeling, perception")

It is essentially about entering into emotions, understanding, and feeling them. In everyday language, putting oneself in someone else's shoes; however, it is only possible with an empathic presence. Understanding, accepting, and validating form the basis of empathy. When we start to understand and feel the emotion of the other person, we can put ourselves in their place and have an idea of what they are going through. For this, one needs to recognize the "emotion," understand the difference from thought, and add to our repertoire what behavior might indicate which emotion.

Of course, it would be appropriate to start with ourselves. The more aware, descriptive, understandable, and interpretive we are about our own emotions, the better we can exhibit empathic behavior. When we see someone pinching their finger in the door, we automatically imagine our own fingers being pinched. Even if our finger doesn't start to ache, we begin to automatically understand and interpret that pain. Or when we see someone smiling, we unconsciously smile as well. Empathy is similar, though it is not always this automatic and easy. It requires understanding to feel, obtaining information to understand, and communication for acquiring information, which requires time and willingness.

Focus on the "How are you?" and "I'm fine" phrases used in everyday life. When you truly want to learn how the other person is or share how you are with them, think about what different kinds of words, different questions, and different feelings you use. Then you can see whether the emotional expressions you use are sufficient to express what you actually feel. Thus, you will understand how easy or difficult it is for you to understand others, recognize their feelings, and put yourself in their place.

• Empathic stance requires intuitive thinking skills, the ability to piece things together, the ability to read intentions, and strong verbal communication skills. Understanding body language is also important.
• Empathy ability increases with age.
• Women are generally more skilled at establishing empathy than men.
• Empathy is NEVER about pitying, feeling sorry, or comforting someone.
• In empathic stance, the right hemisphere of the brain is dominant. The right brain is responsible for emotions, solving problems based on intuitive information and the whole, interpreting facial expressions, and understanding intent. Therefore, artistic activities controlled by the right brain, such as theater, painting, and music studies, enhance empathy. (Studies claiming that empathy is innate also argue that it is a skill that can be developed.)

Benefits of Empathic Stance

• Facilitates communication
• Increases sincerity
• Reduces the likelihood of judgments and prejudices about you or them
• Problems are expressed more easily
• Solutions to problems are found more quickly
• Enables closer relationships
• Reduces the likelihood of conflict and disagreement
• Empathic Stance Process:
  - Try to understand the situation
  - Gather information
  - What are their feelings and expectations
  - Follow their bodily reactions
  - Accompany them
• In Empathic Stance:
  1. Avoid judgment
  2. Wait
  3. Slow down
  4. Ask open-ended questions
  5. Show that you understand

What Experts Say About Human-Centered Care in Clinical Practice?

How does Human-Centered Care work in a hospital environment? Our experts from Anadolu Health Center explained the basics of this concept...

Empathy (Selin Karabulut, Expert Psychologist)

Empathy is the ability to understand and recognize another person's perceptions and emotions and to express this understanding to them in an acceptable manner. Thanks to the ability of empathy, which holds an important place in human relationships, our emotional sharing with the person we are communicating with increases, sincerity is enhanced, problem-solving becomes easier, conflicts and disagreements decrease, and prejudices are eliminated.

To exhibit an empathic stance, one should be eager to communicate, establish eye contact, ask questions to gather information, and avoid judgments and suggestions, ensuring that the person's emotions are felt and understood.

It is quite important to add a bit of empathy to our attitude in the difficult times we are going through with the understanding that "everyone" is experiencing different challenges. Knowing that everyone might feel somewhat stuck, overwhelmed, anxious, fearful, and occasionally hopeless makes us feel that we are not alone, doesn't it?

Open-Ended Questions and Reflective Conversations (Murat Kaplan, Senior Manager of Patient Rights)

Asking the right question is central to effective communication and information exchange. Depending on the issue at hand, the type of questions used to obtain answers or eliminate uncertainties is closely related to the effectiveness of the question technique.

Open-ended questions are designed to avoid "yes" and "no" answers. Asking questions that encourage individuals to share their stories helps build empathy and trust, allowing them to freely express their important feelings and thoughts.

Open-ended questions encourage individuals to think more deeply about their experiences and actions and show that you value them. These conversations create a suitable environment for individuals to help themselves and manage themselves.

Involving Family and Friends (Prof. Dr. Ayşen Yücel, Algology Specialist)

We know that involving patients and their families in the patient's treatment planning and follow-up as part of a team is crucial for the patient's quality of life, patient satisfaction, and the success of the treatment. However, it is also true that there is often resistance from doctors regarding this issue. As a physician dealing with chronic pain patients for 30 years, I have found success primarily by explaining in detail what teamwork is and how it should be done. After explaining the treatment options in detail, discussing the pros and cons of each option, we reach a result that satisfies the patient.

I generally prefer to refer to the decision-making and treatment monitoring process as "homework," and I provide written documents of the treatment options or medication regimen to the patient or their family to take home. Feeling like a part of the team ensures that the treatment is taken more seriously and that the follow-up is more accurately conducted. Sometimes, patients or their families may be unwilling to cooperate and may prefer to leave decisions to the doctor, even not wanting to hear about treatment details. In such cases, instead of a harsh approach, I provide written information on the treatment options and regimen and gradually involve the patient and their family in the team during the follow-up process.

Shared Decision-Making (Assoc. Prof. Dr. Enes Murat Atasoyu, Internal Medicine and Nephrology Specialist)

With the widespread use of the internet, people now have more opportunities to obtain information about their illnesses. Consequently, there is an increasing demand for scientific evidence-based information from doctors regarding treatment options that may temporarily or permanently alter their lifestyle, eating habits, or work schedule, and for expressing their opinions.

Shared decision-making, which emerged in the early 1980s inspired by these patient needs, is a human-centered care model that allows and encourages individuals to participate in medical decisions. Scientific studies on this model have shown that it improves success rates and quality in diagnosis, treatment, and patient care, as well as increasing satisfaction among both healthcare providers and patients. In the shared decision-making process, detailed information is provided to the patient and family as allies, and planning is created considering the patient's values, priorities, needs, knowledge, fears, and anxieties.

Of course, the shared decision-making process may not be applicable in every medical situation. For instance, in cases like hip fractures, acute appendicitis, or bacterial meningitis where there is no alternative treatment, it may not apply. However, in situations such as early-stage breast or prostate cancer treatment, the use of lipid-lowering medications for coronary heart disease prevention, or genetic and cancer screening tests, patient participation in the decision-making process can add value to the process.

Integrating shared decision-making into human-centered care practices can significantly contribute to improving success and quality in healthcare services.

Understanding Needs and Preferences (Çiğdem Erbay, Expert Nurse)

Understanding the needs and preferences of patients or staff improves the care we provide to our patients meaningfully and also increases the motivation of our staff. This involves jointly planning care by considering what is important for the individual, including challenges or facilitators in their lives. It is a concept that integrates the emotional, physical, social, and cultural aspects of individuals.

Understanding patients' needs and preferences can be achieved through interviews, surveys, and feedback mechanisms. For example, regular follow-ups and interviews with patients help in understanding their expectations and experiences. Recognizing the importance of the patient's family and social environment in care and treatment is also crucial. Additionally, by understanding the needs of our staff, we can provide a more supportive and effective work environment, which in turn positively affects patient care quality.

Patient- and Family-Centered Care: Why Does It Matter? (Prof. Dr. Aydın Ünal, Internal Medicine Specialist)

Patient- and family-centered care is important for improving the quality of care. This approach involves seeing patients as partners in their own care and involving their families. The principles of patient-centered care are based on respect for patient autonomy, empathy, and shared decision-making.

Patient-centered care emphasizes understanding the patient's values, preferences, and needs. The involvement of the family in this process ensures that all aspects of care are considered, leading to more holistic and personalized care. This approach improves patient satisfaction, adherence to treatment plans, and overall outcomes.

By incorporating the perspectives and preferences of patients and their families into care planning, healthcare providers can offer care that is more aligned with the patients' goals and needs, leading to better health outcomes and more efficient use of resources.

Messages From Us

With the pandemic, many people hesitated to go to hospitals and postponed their check-ups. Patients and their relatives shared the difficulties of being a patient or a relative during the pandemic and their experiences at Anadolu Health Center.

Being a Patient's Relative During the Pandemic (Outpatient)

Being a relative of a patient is hard, especially during the pandemic. For someone who has always gone together even for something as trivial as buying a pair of socks in 40 years of marriage, sending my wife alone for treatment became an incredibly long and endless process. Waiting for my wife to return home after treatment felt like waiting for a new lover at the window. Now, going together and seeing our friends there has been very refreshing for us.

During the pandemic, the measures our hospital took to prevent infection and protect patients and staff were excellent. Even in such a challenging period, the renovations and changes made for the comfort and well-being of patients and their relatives in our hospital (I say HOSPITAL IS MINE) made us very happy. I express my deepest thanks and respect to everyone involved. We are grateful to have you.

Being a Patient During the Pandemic (Outpatient)

I am Nurhayat Yeşilmen, the wife of Mustafa Yeşilmen, one of the members of the Patient and Relatives Advisory Board. I have been receiving treatment at Anadolu Health Center since April 2012. At the beginning of my treatment, I also had radiotherapy. I have been receiving preventive chemotherapy every 21 days since then. During the pandemic, my son brought me to the hospital, but it was very difficult for me to enter alone. It made me feel as if I was experiencing my condition for the first time and coming for the first treatment. However, with the comfort of having established close friendships with all the staff there, and thanks to their close attention and smiling faces, I quickly overcame the discomfort. Now, my husband and I go to treatment together. Best regards and love...

Being a Patient's Relative During the Pandemic (Inpatient)

My mother has been receiving treatment at the Hematology Department of Anadolu Health Center Gebze since September 2015, which is 5 years now. Throughout this long and challenging process, all our healthcare team, especially our doctors, made us feel safe with their knowledge, experience, and caring approaches. We never experienced the doubt of "Is it possible to get better treatment at another hospital?"

In 2020, while the pandemic impacted everyone's lives, it brought even more risk and anxiety for patients and their relatives who were already fighting cancer. In the early days when we were hesitant to step outside the house, having to go to the hospital created anxiety among all family members. However, when we arrived at Anadolu Health Center, our concerns disappeared upon seeing the precautions taken here, the strict hygiene rules, and the conscious and reassuring approach of the staff. We continued to visit the hospital with confidence. We sincerely thank the hospital management and all the staff for providing this environment where patients and their relatives feel safe and can continue their treatment without interruption.

Being a Doctor During the Pandemic...

Dr. Esra Sönmez (Pulmonologist)

Life changed a lot after the first case

In December 2019, a new pandemic was added to the list of SARS, MERS-CoV, and Influenza that have confronted us with the reality of how deadly viruses can be over the last 20 years: COVID-19. As the COVID-19 pandemic continued to spread more each day, the number of losses increased. Life changed dramatically in our country after the first case was detected in March 2020. The pandemic, which disrupted daily life and even stopped it at times, led to lockdowns, closed borders, suspended flights, halted commercial activities, and closed schools. Social isolation measures made it impossible for us to approach even our loved ones. Fear, anxiety, panic, insecurity, and intense stress became part of our new way of life. The obligation to wear masks caused claustrophobia and a fear of not being able to breathe for many of us. Our lives changed so drastically that adapting to the new world became traumatic for all of us.

The COVID-19 pandemic was one of the biggest tests for the healthcare system. Within a short period, thousands of people fell ill, and there was an overwhelming demand exceeding the capacities of hospitals. As doctors, we were overwhelmed by the need to plan preventive measures, handle the increased patient load, and work with protective measures (N95 masks, face shields, protective gowns, gloves, etc.). We were the group most exposed to the COVID-19 virus, and as the pandemic swept the world without slowing down, doctors, nurses, and all healthcare workers risked their lives at the front lines fighting the disease. During this process, some healthcare staff became ill and lost their lives; new cases of illness are added daily, and we are deeply saddened by those we have lost. Our greatest expectation to lift our morale and support our work is to feel the respect, love, trust, and recognition for healthcare personnel.

The COVID-19 pandemic taught us all to take responsibility for public health. Adhering to basic measures to prevent the spread of the virus is crucial for saving lives. Compliance with social distancing, mask-wearing, and isolation is not optional but mandatory. If every individual in society does their part and supports healthcare professionals, we can overcome this pandemic together.

Wishing for healthy days when we can embrace our loved ones and hoping for a healthier tomorrow...

Being in Radiology...

Dr. Adnan Aras (Radiologist)

It is important for everyone to know the correct information to protect themselves, not just doctors

The pandemic is like an unstoppable wave sweeping humanity forward. In this rush, we are trying to survive more by reflex than by our knowledge. Despite being a health issue, the pandemic has also overwhelmed doctors. As a doctor, my knowledge was insufficient, and even though I had some basic knowledge, it was not enough to protect myself and those around me. Protecting oneself requires not only knowing the correct information myself but also ensuring that everyone sharing this world knows the correct information. For the first time in my life, I felt and understood that protecting oneself from a disease requires the correct information and actions of others outside of myself.

We are doctors, and people still ask us questions, but it is evident that they are not going to believe the answers we give. There are so many questions and so many different answers that my response seems like a small "variation" at best. Being correct or having scientific evidence does not seem to matter. I believe that the general contribution of doctors to this confusion should also be considered. Initially, the most accurate response we should have given when asked was "I don't know" or "I don't know yet." If we could have said "I don't know," perhaps the voices of a few knowledgeable individuals could have reached the ears, but that did not happen.

Now, I see that things are slowly falling into place. We are reading more and speaking less. We now have some truths to reach people and are trying to move forward with them. It seems like we are succeeding, or at least it feels that way to me...

Being in Emergency Medicine...

Dr. Yeşim Erçetin Özgürel (Emergency Medicine Specialist)

Anxiety about the unknown has grown

China seemed very far away. People collapsing on the streets, being beaten! We thought it would never reach us. Until March came. Anxiety about the unknown grew. Even though there were examples, what would happen to us?

As with all disasters, the crisis center was always the Emergency Department. This time, the disaster was named the Corona pandemic. Given our profession, we were at the heart of the disease. It was our job, and we had to overcome it as well. All our staff were uneasy, but our profession came first. Our anxiety was not only for ourselves but also for the risk of transmitting the virus to our loved ones. Those with chronic illnesses, older staff, and even very young and inexperienced groups had high levels of anxiety. Should we take vitamins, stock up on hydroxychloroquine, get a pneumonia vaccine? While other professions around the world retreated to protect themselves, we healthcare workers had to work more and did. Clinics almost completely stopped, and the entire hospital focused on Corona. At first, there were employees who had Corona tests and chest CTs done with a runny nose. As media coverage of healthcare workers, transmission, disease, and death spread, we realized that the most important things to cling to were personal protective equipment, social distancing, and other rules. After that, everything became routine for us.

They were guided with the information obtained. They had legitimate concerns. They stayed at home to maintain social distance. We are in a season when febrile illnesses are common. During the first wave, people preferred to stay home, but with normalization, emergency visits started to increase. Those coming to the emergency room were unsure of how to behave. Some hid their symptoms to avoid being examined in the Corona area (tent), while others fabricated complaints to get tested in the emergency room. Now, as the pandemic continues, we should stick to hygiene and distance rules. Despite everything, the "corona" word is losing its effect on people, and life is gradually returning to normal.

Being a Nurse During the Pandemic...

Funda Avcıoğlu (Nurse)

Maintaining a positive attitude and not panicking helped us

The most important thing during the pandemic was not to panic. Our primary responsibility as a nurse was to provide medical care to the patients. In addition to the usual patient care, we provided psychosocial support to the patients who were in isolation and their families. Most of the time, we tried to provide comfort by chatting and talking with the patients. All the staff, from doctors to nurses, were constantly trying to ease the anxiety and stress of the patients. I also tried to be in close contact with my friends and family during this time to stay mentally healthy. I believe that maintaining a positive attitude and not panicking helped us a lot in this process. I hope that everyone will stick to the rules and take responsibility to overcome this pandemic together.