What is person-centred health care: Research review and practice perspectives

1. National Ageing Research Institute What is person-centred health care:Research review and practice perspectives

2. Overview of presentation • 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

3. 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).

4. Some definitions (continued…) “A collaborative effort consisting of patients, patients’ families, friends, the doctors and other health professionals …” (Lutz and Bowers, 2000).

5. 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).

6. 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)

7. What is PCHC? • Person-centred care is about a collaborative and respectful partnership between the service provider and the service user: • 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 person-centred care both for service providers and service users.

8. Does PCHC work? • Evidence suggests: • 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 health outcomes. • Person-centred education for both staff and patients has been found to be beneficial. • Person-centred care can lead to: • Improved client and carer satisfaction • Improved pain management • Improved adherence to intervention recommendations • Improved sense of professional worth.

9. Models of PCHC described in the literature Many models identified in the literature: • Medical (Patient-centred medicine) • Nursing (Person-centred care) • Occupational Therapy (Client-centred care) • Psychology (Client-centred counselling) • Health and business management (Customer-focussed service) • Service user perspectives (mostly mental health)

10. Medical (1) Mead et al (2000) proposed 5 dimensions to person-centred health care (based on criticisms of the bio-medical model): • Bio-psycho-social perspective • Patient as a person • Sharing power and responsibility • Therapeutic alliance • Doctor as a person

11. Medical (2) An overriding principle of this model is the importance of both the doctor and the patient in the patient’s care.

12. Nursing McCormack and colleagues (2001) identified the following values related to person-centred health care: • Assumption that human freedom/autonomy can be retained in the presence of debilitating illness and disability through partnership with nurses • Partnership is obtained via: • getting “close to the person”; • providing care that is consistent with the person’s values; • biographical approach to assessment; and • focus on ability rather than dependency.

13. Occupational Therapy (1) Law et al (1995) outlined 7 key concepts to client-centred practice • Autonomy and Choice • Partnership & Responsibility • Enablement • Contextual Congruence • Accessibility • Flexibility • Respect for diversity

14. 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.

15. 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 (3)

16. Enablement: Occupational Therapy (4) 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.

17. Contextual Congruence: Occupational Therapy (5) 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.

18. Accessibility and Flexibility: Occupational Therapy (6) Advocates for equitable service provision that is provided in a timely and accessible manner to meet the needs of the client.

19. Respect for diversity: Occupational Therapy (7) The need to respect differences in values and beliefs, and being aware of the balance of power within the relationship.

20. Health and Business management (1) 10 principles were identified from the hospitality industry that may be applicable to health services (Ford & Fottler, 2000): • Service quality and value are always defined by the customer; • Customer participation adds value and quality to their service experience; • Everyone must believe that the consumer matters and act that way (customer-focused culture); • Find, hire and train competent and caring employees;

21. Health and Business management (2) • 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.

22. Client • Limited literature on client perspective. • Discrepancies exist between clients’ and professionals’ opinions and perspectives concerning elements of health service practice (Sullivan & Yudelowitz, 1996).

23. 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 (1999)

24. Corring and Cook study Results: Service providers should: • value and appreciate the life experience of their clients - recognise the client's expert knowledge; • respect different opinions; • ‘get close’, ‘be welcoming’; • take the time to listen, get to know the person; • be person versus paper focused; • develop a common ground/common respect;

25. Corring and Cook study Results (continued): Service providers should: • relinquish control and power, facilitate an active client role; • learn from their clients (client role in education); • advocate for the client; • be flexible; and • consider not just the health condition but the whole person.

26. Common features of models reported in the literature • Partnerships (focus on the relationship); • Respect for patient/client as a person (holistic approach as well as individual approach); • Sharing of power and responsibility (patient/client as expert in their own health, sharing of decision making, information, idea of common ground); • Accessibility and flexibility (of service provider as a person and of the service/s provided); and • Co-ordination and integration (consideration of the whole experience from the point of view of the service user).

27. 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; • Non-patronising attitudes of staff, including: • 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”;

28. 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); • Good discharge planning – including consultation with family/carers; • 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 • Adequate parking and public transport access to public hospitals.

29. What is PCHC (service user perspectives)?(drawn from focus groups – NARI, 2007) • Respect for service user as an individual with unique needs, preferences and values; • Recognition of the service user’s ability to contribute to their own care; • (Equal) Partnership between service user and service provider; • Ability to communicate/assertively request the above.

30. Facilitators of PCHC (1) • 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;

31. Facilitators of PCHC (2) • 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.

32. Barriers to PCHC (1) • Time – various studies have stated that person-centred approaches to care take more time; • Dissolution of professional power (staff experiencing loss of professional status and decision making power);

33. Barriers to PCHC (2) • Staff lacking the autonomy to practice in this way; • Lack of clarity about what constitutes person-centred care; • Communication difficulties between client and staff; • Constraining nature of institutions.

34. 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.

35. For more information… For more information about person-centred health care please see the following website: www.nari.unimelb.edu.au/pchc

36. 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.

37. 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.

38. 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.