Transferring Knowledge on Patient-Centered Care through the Establishment of an International Network

Abstract

Background

Patient-centered care (PCC) is a key principle of high-quality health care and is becoming increasingly relevant in many countries. In 2006, Chile declared PCC as a fundamental pillar of its health care system. However, PCC implementation in the Chilean healthcare system is still lagging. Some factors contributing to this are 1) the complexity of the concept, 2) the interdependence between healthcare activities and policy regulations, and 3) the need for a cultural change in health politics and care. This paper shares experiences of how we have tried to address some of these challenges by establishing an international network for PCC.

Methods

As part of a collaborative project between researchers and clinicians based in Chile and Germany, have established the International Network for Patient-Centered Care (PCC NET) that enables knowledge exchange and trainings through different means.

Results

A website was developed and launchedas a platform to share knowledge. Furthermore, a series of online seminars on PCC was organized, each conducted by an international expert in the field. In January 2023, several face-to-face were held in Chile attended by 51 participants, comprising health care professionals responsible for implementing PCC in the country, those working for the Ministry of Health or those in primary care in Chile. Workshops were evaluated by assessing the participants' reactions via surveys, and the participants rated the workshops positively. In January 2024, the first Latin American Conference on Patient-Centered Care was implemented in Santiago de Chile. There were four keynotes, two roundtables, five workshops, 31 oral and 19 poster presentations from both research and clinical practice during the two conference days with 196 participants on location.

Conclusion

Establishing the PCC NET has facilitated international collaboration, knowledge exchange, and capacity-building for PCC implementation in Chile. Through different communication strategies, such as workshops, seminars and a conference, it was possible to enhance awareness and practical knowledge among healthcare professionals and policymakers. These initiatives represent significant steps toward advancing PCC in Chile, although continued efforts are needed to address remaining challenges and sustain momentum in policy and practice.

Keywords

patient-centered care - shared decision-making - network - transfer of knowledge - evaluation

Schlüsselwörter

Partizipative Entscheidungsfindung - Netzwerk - Wissenstransfer - Evaluation - patientenorientierte Versorgung

Background

Patient-centered care (PCC) is a key principle of high-quality health care [1]. It is associated with higher patient satisfaction, improved health status, increased health behaviors and further desirable outcomes [2] [3] [4]. In recent years, PCC has become increasingly relevant in health policies and health care delivery in many countries across the globe [5].

Patient-centered care promotes equality, equity, and respect in patient care [6] [7], which are central aims of the Pan-American Health Organization [8]. Therefore, implementation of PCC is a goal for Latin American countries. However, diverse degrees of PCC implementation can be observed within these countries [9] [10] [11] [12]. Chile is a pioneer in fostering PCC. Since 2006, it has stimulated the implementation of PCC by declaring PCC one of the fundamental principles of the Chilean health care system [13]. Nevertheless, the implementation of PCC in routine care has been found to be challenging [14] and lags behind in Chile [15]. Some of the factors contributing to this are

1. the complexity of the concept [6] [16],

2. the interdependence between health care activities and policy regulations, and

3. the need for a cultural change in health politics and care.

We will describe these three factors in more detail in the following. In consideration of these complex factors, the implementation of PCC is a long and challenging process.

Challenges in Implementing PCC

PCC is a complex concept covering multiple dimensions [6] [16]. A core dimension of PCC is shared decision-making (SDM), which means the active involvement of both patients and health care professionals in a joint decision-making process [17]. PCC implementation can be fostered through different means and at different levels, e. g., beliefs and self-efficacy of individuals being targeted on the individual level, structural characteristics of hospitals being targeted within the inner setting, and external policies being targeted within the outer setting [18].

Health policy regulations are context variables that shape the behavior of health care professionals, e. g., the amount of time a health care professional can spend with a patient. Recently, a new policy regulation in Chile determined that all patients with multiple chronic conditions can have 45-minute consultations with a pair of health professionals. This is to ensure that they are properly assessed and their care plan is collaboratively built. Likely, re-regulating the amount of time a physician can spend with a patient (i. e., increasing the time from approximately seven minutes to 45 minutes) will change the kind and depth of physician-patient-conversation during the consultation. This shows that political regulations have the potential to influence the behavior of health care professionals.

An important prerequisite for the PCC implementation in routine healthcare is a cultural change. In Germany, physicians have sometimes been referred to as “half-gods in white”, in Chile, a similar description “God-tors” (Diostor) exists [19]. Likely, one would not argue with half-gods about anything, including one’s own health. In line with this argument, Bravo and colleagues have pointed out that the relatively passive role of patients that preferred to delegate health decisions to health care professionals rather than actively participate in the decision-making process are major barriers to implementing PCC in Chile [15]. If the aim is to implement PCC, the culture needs to change towards a perception of people being experts of their own health and lives, while physicians are experts of medical care. Following the ideas of PCC and SDM, the best medical care can only be provided, when both the patient and the doctor contribute their knowledge to form a joint decision.

In our project, we have tried to overcome some of the mentioned challenges by establishing a network that offers knowledge exchange and training. This article describes the milestones of establishing a research network alongside several main experiences in this collaborative binational project.

Methods

Establishment of the International Network for Patient-Centered Care

A collaborative project has been conducted between researchers and clinicians based in Chile and Germany, funded by the German Federal Ministry of Education and Research (FKZ 01DN20005, period 2020–2024). The project aimed to develop and extend long-term collaborative and international research structures with excellent research institutions between Germany (University of Hamburg and University Medical Center Hamburg-Eppendorf) and Chile (Universidad Católica, Santiago de Chile) that promote patient-centered care (PCC) and shared decision-making (SDM) for people living with chronic conditions. The main objectives of this project were to

1. establish a network, including a webpage that provides relevant information to both German and Chilean health care researchers or researchers in the field of PCC and SDM from various disciplines (e. g., medicine, nursing, psychology, health and social sciences);

2. understand the needs for PCC, including barriers and facilitators, and adapt the PCC model [see 6, 16] to the Latin American health care context;

3. develop and implement a workshop program on PCC research, education and clinical practice in Chile; and

4. facilitate international exchange of young researchers between Germany and Chile.

Furthermore, the aim was to support Chile through knowledge transfer in the following areas: research on PCC, education of PCC and clinical patient-centred work. Beyond the exchange between Chile and Germany, PCC NET’s mission is to promote exchanging experiences and collaboration on research, clinical, and teaching practices related to PCC and SDM to foster knowledge translation in this field across the globe [20]. PCC NET is using different means to reach those aims, which have evolved over time, i. e., website and newsletter, online seminar series, workshops, and a scientific conference.

Results

The bi-national group of academics from this collaborative project has created the International Network for Patient-Centered Care (PCC NET; https://www.pcc-network.org), which consists of 63 members plus another 69 interested individuals in 2024, mainly from Chile and Germany, but also from other countries, e. g., Argentina. PCC NET has successfully established a stable and permanent collaboration between researchers from Chile and Germany and facilitates knowledge exchange on PCC and SDM through different means.

The first step was the development and launch of a specific website that serves as a platform to share knowledge. We included information on the concept of PCC [6] [16], previous and upcoming events; and short biographies of the members of PCC NET. Later on, we developed a regular newsletter, which was sent out to the members and created a communication platform for the members of PCC NET, fostering exchange among the members. Gradually, we have moved towards offering all content on the website and the newsletter in English and Spanish as well as partly in German in order to diminish the language barrier. The webpage gave us the opportunity to offer accessible information in multiple languages.

In addition, we organized a series of online seminars, each seminar being conducted by an international expert on the field and taking 60 to 90 minutes. On average, three online seminars per year took place between 2021 and 2024 with parti-cipants mainly from Chile and Germany. At the beginning, online seminars were offered to invited guests only; later, the seminars could be joined by anyone interested in the topic. So far, twelve online seminars took place. The first six seminars focused on PCC research, whereas the last six seminars focused on the implementation of PCC and SDM ([Table 1]).

Table 1 Content of the online seminar series.

Focus	Topic	Date
Research	Risk communication during health crisis	June 2021
Research	Development, evaluation and implementation of patient-centered communication skills training for nurses	September 2021
Research	Development and refinement of the Integrative Model for Patient-Centeredness	November 2021
Research	Guideline for good practice in risk communication during a health crisis	January 2022
Research	Benefits and risks of patient participation in multidisciplinary tumor conferences – findings of the mixed methods PINTU study	May 2022
Research	Researching patient-centered care in Latin America	September 2022
Implementation	The Patient University to enhance health literacy and empowerment	December 2022
Implementation	Health information and decision aids by the Institute for Quality and Efficiency in Health Care (IQWiG)	January 2023
Implementation	A new educational concept for SDM in primarycare training	July 2023
Implementation	Achieving shared decision making in routine practice: Tools, challenges and solutions	September 2023
Implementation	Health literacy, shared decision making and health inequalities: What do we know and what can we do better?	January 2024
Implementation	Scaling up of shared decision-making through a novel collaborative platform	March 2024

It became clear, that online seminars which focus on the practical implementation of PCC were a lot more interesting to professionals from Chile, as compared to research-focused online seminars. Thus, we changed the focus of our online seminars from research to implementation. On average, between 20 and 30 interested researchers or clinicians participated in the seminars. However, a large increase in participants was observed from summer 2023 onwards, with 100 participants, 255 participants, and 390 participants for three different seminars. For those three seminars, simultaneous translation to Spanish was offered, while before, seminars have only been offered in English. Most likely, offering simultaneous translation to Spanish for high quality content by international experts has fueled the interest in the seminars and led to the very high numbers of attendance.

As part of PCC NET, several workshops were developed and held in Chile in January 2023. A workshop is defined as “a usually brief intensive educational program for a relatively small group of people that focuses especially on techniques and skills in a particular field” [21]. The format of workshops was chosen as it corresponds with the implementation strategy of conducting educational meetings as described by Powell and colleagues [22] and at the same time allows to incorporate additional implementation strategies such as building a coalition and distributing educational materials. The workshops happened on the 30^th and 31^st of January 2023 in Santiago de Chile. Workshops took place over two days of four hours each. The facilitators of the workshops were internationally re-known experts on PCC and SDM from Germany and Chile. Simultaneous translation from English to Spanish was offered for all workshops. The workshops combined different teaching techniques, such as presentations, group work for discussion, and role-playing.

Workshop participants were invited to the workshops by the Chilean Ministry of Health. About 200 people from the Ministry wanted to register for the workshops, however due to capacity, we limited the workshops to 50 participants. The selection was done by the Ministry in order to have representatives of most health services regions throughout the country. In total, 51 participants attended the workshops (76.5% female). They were either health professionals responsible for the implementation of PCC in the country or were working for the Ministry of Health or in primary care in Chile. Representatives of 23 out of 29 health service regions that exist in Chile were present at the workshops. Some participants were currently active in both clinical practice and health policy.

The scope of the workshops was defined with the group in charge of implementing PCC in Chile at the Ministry of Health, i. e., the Chilean Division of Primary Care. This allowed us to build on their knowledge and consider the progress the country has already made, making the workshops sensitive to the real needs of clinicians and stakeholders from Chile. This led to a high number of people who wanted to attend the workshops in 2023 (about 200) and lots of questions and discussions during the workshops. The aim was to introduce the topic to the stakeholders. The workshops’ educational curriculum and delivery included four main topics and one exercise:

1. concepts and practices of PCC and SDM,

2. clinician-patient communication,

3. assessment of PCC and SDM, and

4. implementation and adoption of SDM.

They were complemented by a practical exercise of patient-clinician role-plays.

The concept and practices of patient-centred care were explained using the Integrative Model of Patient-Centeredness, which contains 16 dimensions [6] [16] and was shown to generally match the conceptualization of PCC in Latin America [23]. Shared Decision-Making was introduced according to the definition proposed by Elwyn and colleagues [24]. In terms of clinician-patient communication, general advice was shared on what can transform communication between clinicians and patients towards more patient-centeredness, e. g., with techniques like active listening [25]. Furthermore, a typical structure of a patient-centered communication was introduced according to the Enhanced Calgary Cambridge Guide [26] and the Three-Talk Model for SDM [27] [28]. One workshop stressed the importance of valid and reliable assessments of PCC and SDM [29]. Furthermore, tools to assess PCC (e. g., the Experienced Patient-Centeredness Questionnaire (EPAT; [30]) and SDM (e. g., the SDM-Q-9 [31] were presented. The Consolidated Framework for Implementation Research (CFIR) was introduced as a theoretical basis for implementing health care change [18]. How aspects of CFIR can be used for the implementation of SDM into practice has been exemplified by sharing experiences from the German PREPARED trial [32]. The role-play exercises were undertaken in small groups of approx. 10 participants. In each group, one participant was given a short role description to play a clinician during a medical encounter; a second participant played a patient with high blood pressure. The remaining participants were asked to observe and evaluate the SDM process according to the Three-Talk Model [27] [28]. This practical exercise of simulated patient-clinician encounters aimed to practice a patient-centered consultation with a shared decision between patient and clinician.

According to Kirkpatrick’s four-level model, we evaluated the workshops by assessing the first level of evaluation, i. e., the reactions of participants [33]. At the end of the second day, a questionnaire (in Spanish) to evaluate the workshops was handed out to all participants on paper and was filled out by 46 participants. The questionnaire included 16 questions, which were rated on a 4-point rating scale (ranging from 1=“disagree very much” to 4=“agree very much”) and covered topics like satisfaction with the workshops, aspects of PCC and SDM, comprehension, and statements related to specific sessions.

Results of the evaluation are displayed in [Table 2]. The questionnaire also included three open questions: “What did you like in particular?”; “What can we do better next time?” and “Other comments”. The first two open questions were analyzed by qualitative content analysis using inductive coding and results are displayed in [Fig. 1]. If a participant gave multiple comments to one question, all comments were counted and categorized individually. To ensure anonymity of the participants, we did not ask for age and gender in the questionnaire.

Fig. 1 Summary of answers to a) “What did you like in particular?” and b) “What can we do better next time?”. Note: Within each category, the order of the comments is in accordance to frequency, thus the most frequent comments are reported first. PCC=patient-centered care; SDM=shared decision-making

Table 2 Results of workshop evaluation.

Items	n	M	SD
Overall, I was satisfied with the workshop.	45	3.8	0.37
My interest in patient-centered care is high.	46	4.0	0.00
My interest in shared decision-making is high.	46	3.9	0.28
The main topic „patient-centered care” is relevant for my work.	46	4.0	0.15
The main topic „shared decision-making” is relevant for my work.	46	3.9	0.28
I learned new things from the input on the concepts of patient-centered care and shared decision-making.	46	3.8	0.38
I learned new things about how to measure patient-centered care.	46	3.7	0.50
I have an idea of what steps/actions facilitate the implementation and adoption of shared decision-making.	46	3.5	0.55
Overall, I was satisfied with the interactive part based on the role play.	45	3.5	0.63
The role play has increased my skills on shared decision-making.	45	3.2	0.71
I could follow the presentations easily.	45	3.8	0.39
At times, I did not understand what the speakers were saying.	46	1.3	0.57
The simultaneous translation helped me a lot to understand the content of the presentations.	43	3.9	0.52
Overall, my expectations of the workshops were met.	46	3.8	0.38

Note: Values range from 1=disagree very much to 4=agree very much.

Overall, the participants of the workshops rated the workshops positively. The participants rated both concepts, PCC and SDM, as relevant to their work. Participants particularly appreciated the theoretical clarification of the concepts and the specific tools introduced during the workshops (e. g., measurement tools, SDM tools, implementation tools). They would have liked more practical examples, more time to review topics or exercises, and clearer instructions for the role-plays.

In January 2024, as part of PCC NET, the 1 ^st Latin American Conference on Patient-Centred Care (1º Congreso Latinoamericano sobre el Cuidado Centrado en las Personas, 23.-24.01.2024, Universidad Católica, Santiago de Chile) was facilitated by experts from Germany, Chile, the United States and Argentina. During two days, four keynotes, two roundtables, five workshops, 31 oral and 19 poster presentations from both research and clinical practice took place. In total, 196 people have attended the conference personally, representing many parts from Chile but also other Latin American countries. Furthermore, another 1,000 people have virtually visited the conference by following the live streaming of the event. This conference has pushed knowledge transfer of PCC by making information of PCC accessible to many people and creating space for discussions on the topic.

We have evaluated the conference by assessing the reactions of participants, i. e., the first level of evaluation according to Kirkpatrick’s four-level model [33], via an online survey, which was published at the end of the conference and could be filled out for four weeks in either Spanish or English.

In total, 113 people (81% female) have participated in the survey. On average, the survey participants were 41 years old (SD=10.9). The majority (n=107) indicated their nationality as Chilean. About half of the survey participants have indicated their profession as clinician (49%) and about one third as technical referent (36%). Few people stated their profession was scientist (11%) or in health policy (8%). Multiple answers could have been selected. Twenty-one people indicated to have a different profession, e. g., teacher (n=7). Survey participants indicated to be currently active in clinical practice (34%), policy (31%), teaching (31%) or research (19%), multiple answers possible.

The questionnaire included questions, which were rated on a 5-point rating scale (ranging from 1=“totally disagree” to 3=“neither” to 5=“totally agree”). The survey participants stated that their interest in SDM and PCC was high (M=5.0, SD=0.2; n=109) and that the topics were relevant for their work (M=4.9, SD=0.3; n=109). In general, the participants felt that the conference had improved their understanding of PCC and SDM (M=4.7, SD=0.6; n=109) and that they know some of the challenges of implementing PCC (M=4.6, SD=0.6; n=108). Overall, they were satisfied with the conference (M=4.8, SD=0.5; n=108) and the simultaneous translation has helped them to understand the content of the presentations (M=4.8, SD=0.4; n=92; not applicable=16).

From the results of this survey it can be anticipated, that a diverse group of people with different professions and currently active in different settings, has participated in the 1^st Latin American Conference on PCC, and that overall the participants were satisfied with the conference, which has covered a topic of high importance and relevance to the Chilean audience.

Discussion

The International Network for Patient-Centered Care (PCC NET) aims to promote knowledge transfer and the exchange of experiences related to PCC and SDM to foster knowledge translation in this field. As part of PCC NET, different formats were conducted to transfer knowledge between countries from different continents and cultures, i. e., a webpage, a series of online seminars, workshops, and a conference. Those formats facilitated knowledge transfer between countries and gave room for exchange, which addressed the challenges of implementing PCC.

The complexity of patient-centred care demands a multifaceted approach for implementation. PCC NET has met this demand by offering activities addressing different stakeholders at different levels, e. g., health professionals and representatives of the Ministry of Health.

The interdependence between health care and policy underlines the need to involve political stakeholders. PCC NET has met this demand by developing the content of its activities in close relation with the Chilean Ministry of Health, which is responsible for the implementation of PCC in Chile and by directly addressing representatives of the Ministry of Health with its activities. First successes have already been recorded, e. g., training for SDM became mandatory in Chile [34].

Cultural change is a process that needs a long time. However, we believe that this process can be pushed forward when people from different countries and different cultures come together and are given the opportunity to exchange views and perspectives systematically. PCC NET has promoted this exchange through different means, e. g., roundtables at the conference and discussion time at the online seminars.

Best Practice Advice

Experiences collected during the establishment of PCC NET have enriched our understanding of what can foster the implementation of PCC in Chile and presumably other countries. From our experiences, we have derived some best practice advice.

Visit each other in the collaborating countries Exchanging thoughts and opinions during personal meetings in both Germany and Chile has greatly improved the understanding of needs and potential barriers when it comes to knowledge transfer regarding PCC.

Tailor Offers By developing the scope of the workshops in 2023 and also the scope of the conference in 2024 in close collaboration with the Chilean Division of Primary Care, which is responsible for the implementation of PCC in Chile, the contents were tailored to the needs and interests of the target group, which presumably led to high interest in the workshops and the conference.

Be Aware of Language as a Barrier It can be challenging to engage people in international trainings when a second language is not really common in a country. However, offering simultaneous translation to Spanish of the workshops, the conference, and some of the online seminars has diminished the language barrier and made the different offers more accessible to the Chilean representatives.

In line with this notion, become aware of cultural differences which may play a role and get a local facilitator to help you understand these differences. Elaborating the (health care) systems of both countries may also foster achieving a common ground. As PCC is a complex concept, which has so far predominantly been described in literature originating from North America and Europe [6], the question of how PCC is conceptualized in the Latin American countries and if this needs to be specifically addressed arises. A recent scoping review [23] has revealed, that in general, the conceptualization of PCC in Latin America matches the Integrative Model of Patient-Centeredness [6], which is based primarily on literature from North America and Europe. However, the differentiation between patient-centered and family-centered care seems to be more pronounced in Latin American countries [23]. This underlines the importance of clarifying concepts in international exchange, also for less complex concepts and terms.

Limitations

The majority of workshop participants were females. Likely, this does not reflect a gender-biased acceptance of patient-centred care, but rather reflects the gender distribution in the health system as most health professionals in Chile are women, e. g., nurses. Furthermore, in accordance with Kirkpatrick’s four-level model, we have only evaluated the first level, i. e., reactions [33]. Thus, no statements can be made about the extent to which the workshops may have also led to changes on the other three levels by Kirkpatrick, i. e., learning, behavior, and results. A more extensive evaluation with multiple measurement points would be needed to be able to do so. However, after the workshops, our Chilean team members have been invited to comment on the new policy on patient-centred care and shared decision-making in Chile and also, trainings on SDM became mandatory. Thus, we rate the workshops as useful and successful steps in transferring knowledge and fostering the implementation of PCC. This has strengthened a community of practice that continues in the country with PCC and SDM as the main topics of discussion and training. Another indicator of the workshops’ success is the conference on PCC in Chile in 2024.

Conclusion

To conclude, PCC NET is an effective network to enhance knowledge transfer on PCC and SDM in a Latin American country. The inclusion of local key stakeholders and the co-design of activities (including a website, workshops and a conference) were essential to make the network culturally appropriate, by considering the needs and work progress of Chile in this matter. These initiatives represent significant steps toward advancing PCC in Chile, although continued efforts are needed to address remaining challenges and sustain momentum in policy and practice.

Funding Information

Chilean Fund for Scientific and Technological Development, FONDECYT — 1221731. Bundesministerium für Bildung und Forschung — http://dx.doi.org/10.13039/501100002347; 01DN20005

This article is part of the DNVF Special Issue “Health Care Research and Implementation”

Conflict of Interest

NL, CQ, SZ and AD declare that they have no competing interests. IS, PH, PB and MH declare that they currently are (PB) or have been (PH, MH, IS) members of the executive board of the International Shared Decision-Making Society, which has the mission to foster the implementation of shared decision-making and patient-centered care. NL, CQ, SZ und AD erklären, dass sie keine Interessenkonflikte haben. IS, PH, PB und MH erklären, dass sie derzeit (PB) oder in der Vergangenheit (PH, MH, IS) dem Vorstand der International Shared Decision-Making Society angehören bzw. angehört haben, deren Aufgabe es ist, die Umsetzung der partizipativen Entscheidungsfindung und der patientenzentrierten Versorgung zu fördern.

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Publication History

Received: 30 March 2025

Accepted: 24 June 2025

Accepted Manuscript online:
31 July 2025

Article published online:
09 October 2025