Olağanüstü Bakım: Kavramsal Bir Tanıtım ve Türk Sağlık Sistemi Bağlamında Kısa Bir Değerlendirme

Quality in healthcare is mostly defined by external authorities focused on reducing errors and meeting minimum standards. While this approach is necessary for patient safety, it does not sufficiently reflect the human and relational dimensions of care. This situation has brought to the fore the need for a brilliant healthcare approach that exceeds expectations and focuses on care practices that are experienced as extraordinary. This approach signifies a shift in mindset, moving service delivery away from standard procedures toward a relationship management model that prioritizes human interaction and psychosocial needs.

The current literature’s heavy focus on problems, errors, and failures renders invisible the positive experiences and practices that exceed expectations already in healthcare services. The concept of brilliant care arose from the need to make these positive practices visible. This study aims to address the theoretical background, fundamental dimensions, and areas of application of this emerging approach in healthcare and to introduce the concept to the Turkish literature.

Brilliant health service management focuses on people, relationships, and value rather than technical excellence. Karimi and colleagues (2019) state that this approach is shaped around the components of teamwork, leadership, innovation, brilliant individuals, empowerment, and patient centered care.

Brilliant care can be defined as care that exceeds expectations, is relationally rich, and is often provided in an improvisational manner. It goes beyond the standard understanding of good care and emerges particularly in unexpected, human, and emotional moments. The theoretical foundations of the concept are based on the logic of care, the theory of extension and construction, emotional labor, and the ethics of care. Brilliant care does not have to be expensive; it often materializes through small but meaningful micro gestures.

Brilliant care is made possible through the four fundamental dimensions defined by Dadich (2025). It expresses a sincere alignment with the needs of the care recipient through relational orientation, empathy, active listening, and trust building, and is closely related to care ethics. Attentive engagement is the practical counterpart of this orientation; it involves full presence and mental focus during the care interaction. Working with and beyond technique refers to going beyond the necessary technical competence to adapt care to contextual needs. Embracing care as a shared responsibility transforms the care process into a collective effort among patients, caregivers, and managers, requiring role flexibility.

Brilliant care is inherently contextual and manifests in different forms across various clinical settings. In palliative care, proactive action, flexibility, and team capacity are prominent (Collier et al., 2019). In renal care, relationship centered service delivery and team cohesion are prominent (Kippist et al., 2020). In pediatric tube feeding, emotional support, normalization, and small gestures gain importance (Dadich et al., 2023a). In elderly care, getting to know the individual closely and granting autonomy to caregivers are among the fundamental elements (Dadich et al., 2023b). The common elements in all these areas are the quality of human relationships, role flexibility, proactive behavior, and collective responsibility.

 Although brilliant care can emerge through individual dedication and relational sensitivity, it cannot be considered independently of the structural and organizational context in which it develops. There are significant structural problems in the Turkish healthcare system that make it difficult for brilliant care to emerge in a sustainable and widespread manner. Ineffective referral chains and the de facto elimination of tiered healthcare services lead to high patient volumes at the second and third tiers. This situation, combined with increased workload, high patient numbers per physician, and shorter consultation times, limits relational care.

The quantity focused, performance based payment system weakens teamwork, encourages individual competition, and instrumentalizes the care relationship. Performance pressure can steer healthcare workers toward procedures that yield high points rather than medical necessity, transforming the patient healthcare worker relationship into a customer seller relationship. In addition, violence in healthcare, fear of complaints and lawsuits, increases the tendency toward defensive medicine; this situation seriously weakens the relational orientation, attentive participation, and contextual flexibility required for brilliant care. However, brilliant care is considered possible in contexts where the relational field is broader at the micro level, such as elderly care, palliative care, oncology, and family medicine.