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

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What is person-centred health careResearch
review and practice perspectives
National Ageing Research Institute
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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

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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).
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Some definitions (continued)
A collaborative effort consisting of patients,
patients families, friends, the doctors and
other health professionals (Lutz and Bowers,
2000).
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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
persons carers (DHS, 2003).
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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)

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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.

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Does PCHC work?

• Evidence suggests
• Communication between physician and patient
  (asking questions about the patients
  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.

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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)

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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

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Medical (2)

• An overriding principle of this model is the
  importance of both the doctor and the patient in
  the patients care.

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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
  persons values
• biographical approach to assessment and
• focus on ability rather than dependency.

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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

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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.

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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.

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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 clients
capabilities versus deficiencies.
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Occupational Therapy (5)

• Contextual Congruence

The importance of understanding the clients
roles, values, interests and the environment and
culture in which they live as central to the
process of providing client-centred care.
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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.
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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.
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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

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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.

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Client

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

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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.

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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

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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.

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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).

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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

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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.

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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 users ability to
  contribute to their own care
• (Equal) Partnership between service user and
  service provider
• Ability to communicate/assertively request the
  above.

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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

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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 clients home.

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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)

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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.

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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.

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For more information
For more information about person-centred health
care please see the following website www.nari.un
imelb.edu.au/pchc
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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.
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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.
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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.