Transcript What is person-centred health care: Research review and

National Ageing Research Institute
What is person-centred health care:
Research review and practice
perspectives
Overview of presentation
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Definitions of person-centred health
care (PCHC);
What is PCHC?
Does PCHC work?
Models of PCHC
Service user perspectives
Facilitators of PCHC
Barriers to PCHC
Some definitions
Client-centred care is an approach
to service “which embraces a
philosophy of respect for, and a
partnership with people receiving
services” (Law, Baptiste and Mills,
1995).
Some definitions (continued…)
“A collaborative effort consisting
of patients, patients’ families,
friends, the doctors and other
health professionals …” (Lutz and
Bowers, 2000).
Some definitions (continued…)
“Treatment and care
provided by health
services [that] places
the person at the
centre of their own care
and considers the
needs of the older
person’s carers” (DHS,
2003).
Features drawn from definitions
Respect
(for older persons, for their values, needs and
preferences)
Partnership
and collaboration
(between the older person (and their family)
and the professional care team)
Patient/person/client
being at the centre
(health services revolving around the service
user rather than around funders and/or
professionals)
What is PCHC?

Person-centred care is about a collaborative
and respectful partnership between the service
provider and the service user:
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5)
Getting to know the service user as a person
Sharing of power and responsibility between the
service user and service provider
Accessibility and flexibility of both the service
provider as a person and of the services provided
Coordination and integration of care for the service
user
Having an environment that is conducive to personcentred care both for service providers and service
users.
Does PCHC work?
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Evidence suggests:
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Communication between physician and patient
(asking questions about the patient’s understanding,
expectations and feelings and showing support and
empathy) can make a positive difference to patient
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health outcomes.
Person-centred education for both staff and patients
has been found to be beneficial.
Person-centred care can lead to:
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Improved
Improved
Improved
Improved
client and carer satisfaction
pain management
adherence to intervention recommendations
sense of professional worth.
Models of PCHC described in the
literature
Many models identified in the literature:
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Medical (Patient-centred medicine)
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Nursing (Person-centred care)
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Occupational Therapy (Client-centred care)
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Psychology (Client-centred counselling)
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Health and business management (Customerfocussed service)
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Service user perspectives (mostly mental
health)
Medical (1)
Mead et al (2000) proposed 5 dimensions
to person-centred health care (based on
criticisms of the bio-medical model):
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Bio-psycho-social perspective
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Patient as a person
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Sharing power and responsibility
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Therapeutic alliance
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Doctor as a person
Medical (2)
An overriding principle of this model
is the importance of both the doctor
and the patient in the patient’s care.
Nursing
McCormack and colleagues (2001) identified the
following values related to person-centred health
care:
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Assumption that human freedom/autonomy can be
retained in the presence of debilitating illness and
disability through partnership with nurses
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Partnership is obtained via:
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getting “close to the person”;
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providing care that is consistent with the person’s values;
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biographical approach to assessment; and
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focus on ability rather than dependency.
Occupational Therapy (1)
Law et al (1995) outlined 7 key
concepts to client-centred practice
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Autonomy and Choice
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Partnership & Responsibility
Enablement
Contextual Congruence
Accessibility
Flexibility
Respect for diversity
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Occupational Therapy (2)
Autonomy and Choice:
Assumes clients’ opinions will be
sought, values respected and dignity
maintained. It refers to a client
having the right to receive
information in a manner they can
understand so they can make choices
about their care.
Occupational Therapy (3)
Partnership and Responsibility:
Recognises that:
 each person in the partnership brings
with them expert knowledge and skills;
and
 all parties in the partnership have
responsibilities.
Occupational Therapy (4)
Enablement:
Incorporates the change in focus
from illness to wellness, the change
in outcome measures from acute
care outcomes to function and life
satisfaction and the consideration of
client’s capabilities versus
deficiencies.
Occupational Therapy (5)
Contextual Congruence:
The importance of understanding the
client’s roles, values, interests and
the environment and culture in which
they live as central to the process of
providing client-centred care.
Occupational Therapy (6)
Accessibility and Flexibility:
Advocates for equitable service
provision that is provided in a timely
and accessible manner to meet the
needs of the client.
Occupational Therapy (7)
Respect for diversity:
The need to respect differences in
values and beliefs, and being aware
of the balance of power within the
relationship.
Health and Business management
(1)
10 principles were identified from the
hospitality industry that may be applicable to
health services (Ford & Fottler, 2000):
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Service quality and value are always defined by the
customer;
Customer participation adds value and quality to their
service experience;
3.
Everyone must believe that the consumer matters
and act that way (customer-focused culture);
4.
Find, hire and train competent and caring employees;
Health and Business management
(2)
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Customers expect employees who are not only well
trained but have good interpersonal skills;
Customers expect the service experience to be
seamless;
Avoid making your customers wait for the service;
Create the setting (environment) the customer
expects;
Measure all aspects of the service experience - ‘what
gets measured gets managed’. Ask customers about
their experience at the time the service is being
delivered; and
Commit to continuous quality improvement.
Client
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Limited literature on client
perspective.
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Discrepancies exist
between clients’ and
professionals’ opinions and
perspectives concerning
elements of health service
practice (Sullivan &
Yudelowitz, 1996).
Corring and Cook study (1999)
A qualitative research study to gain
participants’ perspectives about what
client-centred care should be - based on
their own experiences with health services.
Corring and Cook study
Results: Service providers should:
 value and appreciate the life experience of their
clients - recognise the client's expert knowledge;
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respect different opinions;
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‘get close’, ‘be welcoming’;
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take the time to listen, get to know the person;
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be person versus paper focused;
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develop a common ground/common respect;
Corring and Cook study
Results (continued): Service providers should:
 relinquish control and power, facilitate an active
client role;
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learn from their clients (client role in education);
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advocate for the client;
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be flexible; and
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consider not just the health condition but the
whole person.
Common features of models
reported in the literature
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Partnerships (focus on the relationship);
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Respect for patient/client as a person (holistic approach
as well as individual approach);
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Sharing of power and responsibility (patient/client as
expert in their own health, sharing of decision making,
information, idea of common ground);
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Accessibility and flexibility (of service provider as a
person and of the service/s provided); and
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Co-ordination and integration (consideration of the
whole experience from the point of view of the service
user).
Service User perspectives (1)
(drawn from focus groups – NARI, 2007)
What is important in health care?
 The quality of treatment, including having excellent
surgical, medical, nursing and allied health care
provided in hospital and in outpatient facilities;
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Non-patronising attitudes of staff, including:
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Older service users not being called “darling” or “dear” by
“people you have never met before”;
Not assuming that older service users are “demented” or
deaf;
Older service users being taken seriously (being given
information and/or having their opinion taken seriously);
Older service users having their symptoms taken seriously –
not seen as “just old age”;
Service User perspectives (2)
(drawn from focus groups – NARI, 2007)
What is important in health care? (continued)
 Continuity of care (without this it is difficult for staff to
get to know the service user and vice versa);
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Good discharge planning – including consultation with
family/carers;
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The need for the older service user to be assertive, to
find out about their own health condition and to speak
up about their preferences and concerns; and
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Adequate parking and public transport access to public
hospitals.
What is PCHC (service user
perspectives)?
(drawn from focus groups – NARI, 2007)
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Respect for service user as an individual
with unique needs, preferences and
values;
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Recognition of the service user’s ability
to contribute to their own care;
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(Equal) Partnership between service user
and service provider;
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Ability to communicate/assertively
request the above.
Facilitators of PCHC (1)
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Having skilled, knowledgeable and enthusiastic
staff, especially with good communication
skills;
Opportunities for involving service user,
carers, family and community (e.g.
volunteers) in health care;
Providing the opportunity for staff to reflect on
their own values and beliefs and express their
concerns;
Opportunities for staff training and education,
including feedback from service users;
Facilitators of PCHC (2)
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Organisational support for this approach to
practice;
Working in an environment of mutual respect
and trust;
Physically and emotionally enriched care
environments; and
Being in the client’s home.
Barriers to PCHC (1)
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Time – various studies have stated that
person-centred approaches to care take more
time;
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Dissolution of professional power (staff
experiencing loss of professional status and
decision making power);
Barriers to PCHC (2)
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Staff lacking the autonomy to practice in this
way;
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Lack of clarity about what constitutes personcentred care;
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Communication difficulties between client and
staff;
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Constraining nature of institutions.
Summary

Person-centred care
is about placing the
patient, client or
person (including
their family and
carer/s) at the centre
of their health care,
with their needs and
wishes as paramount.
For more information…
For more information about person-centred
health care please see the following website:
www.nari.unimelb.edu.au/pchc
References (1)
Corring, D., & Cook, J. (1999). Client-centred care means that I am a
valued human being. Canadian Journal of Occupational Therapy, 66(2),
71-82.
Department of Human Services, V. (2003). Improving care for older
people: a policy for health services. Melbourne: DHS.
Ford, R. C., & Fottler, M. D. (2000). Creating customer-focused health
care organizations. Health Care Management Review, 25(4), 18-33.
Ford, P., & McCormack, B. (2000). Keeping the person in the centre of
nursing. Nursing Standard, 14(46), 40-44.
Law, M., Baptiste, S., & Mills, J. (1995). Client-centred practice: what
does it mean and does it make a difference? Canadian Journal of
Occupational Therapy, 62(5), 250-257.
References (2)
Lutz, B. J., & Bowers, B. J. (2000). Patient-centered care: understanding
its interpretation and implementation in health care. Scholarly Inquiry for
Nursing Practice, 14(2), 165-183.
McCormack, B., & Ford, P. (1999). The contribution of expert
gerontological nursing. Nursing Standard, 13(25), 42-45.
McCormack, B. (2001). Autonomy and the relationship between nurses
and older people. Ageing and Society, 21, 417-446.
Mead, N., & Bower, P. (2000). Patient-centredness: a conceptual
framework and review of the empirical literature. Social Science and
Medicine, 51(7), 1087-1110.
References (3)
NARI. (2007). Best practice in person-centred health care for older
Victorians: Report of Phase 1. Report to the Victorian Department of
Human Services
Sullivan, C. W., & Yudelowitz, I. S. (1996). Goals of treatment: Staff and
client perceptions. Perspectives in Psychiatric Care, 32(1), 4-6.