Transcription

What is person-centredcare and why is itimportant?

What is person-centred care?Person-centred care is a way of thinking and doing things that sees the people usinghealth and social services as equal partners in planning, developing and monitoring care tomake sure it meets their needs. This means putting people and their families at the centre ofdecisions and seeing them as experts, working alongside professionals to get the bestoutcome.Person-centred care is not just about giving people whatever they want or providinginformation. It is about considering people’s desires, values, family situations, socialcircumstances and lifestyles; seeing the person as an individual, and working together todevelop appropriate solutions.1,2,3 Being compassionate, thinking about things from theperson’s point of view and being respectful are all important. This might be shown throughsharing decisions with patients and helping people manage their health, but person-centredcare is not just about activities. It is as much about the way professionals and patients thinkabout care and their relationships as the actual services available.In the past, people were expected to fit in with the routines and practices that health andsocial services felt were most appropriate.4 But in order to be person-centred, services needto change to be more flexible to meet people’s needs in a manner that is best for them. Thisinvolves working with people and their families to find the best way to provide their care. Thispartnership working can occur on a one-to-one basis, where individual people take part indecisions about their health and care, or on a collective group basis whereby the public orpatient groups are involved in decisions about the design and delivery of services. Theunderlying philosophy is the same: it is about doing things with people, rather than ‘to’ them.There is no one definition of person-centred care.5,6 People might also use terms such aspatient-centred, family-centred, user-centred, individualised or personalised.7,8,9,10Regardless of the terms used, a lot of research has looked into what matters to patients andhow to provide person-centred care to make sure people have a goodexperience.11,12,13,14,,15,16,17,18 There are many different aspects of person-centred care,including:19 respecting people’s values and putting people at the centre of caretaking into account people’s preferences and expressed needscoordinating and integrating careworking together to make sure there is good communication, information andeducationmaking sure people are physically comfortable and safeemotional supportinvolving family and friendsmaking sure there is continuity between and within servicesand making sure people have access to appropriate care when they need it

Why is person-centred care important?Person-centred care is a high priorityMaking sure that people are involved in and central to their care is now recognised as a keycomponent of developing high quality healthcare.20,21,22,23There is much work to be done to help health and social services be more person-centredand this has become more of a priority over the past decade.24,25 This is because it is hopedthat putting people at the centre of their care will: improve the quality of the services availablehelp people get the care they need when they need ithelp people be more active in looking after themselvesand reduce some of the pressure on health and social servicesIn the UK there is increasing demand for health services and there are limited resources.People are living longer and may often have many health conditions as they age.26,27Research has found that person-centred care can help to improve people’s health andreduce the burden on health services,28,29,30 so government policy is emphasisingstrengthening the voice of patients31,32,33,34 and moving away from a paternalistic modelwhere professionals ‘do things to’ people.35,36,37 The NHS constitution in England has personcentred care as one of its seven core principles. This philosophy is also built into NationalService Frameworks, monitoring requirements and legislation in all four countries of the UK.

Person-centred care can improve qualityResearch has found that person-centred care can have a big impact on the quality of care. Itcan:38,39 improve the experience people have of care and help them feel more satisfiedencourage people to lead a more healthy lifestyle, such as exercising or eatinghealthilyencourage people to be more involved in decisions about their care so they getservices and support that are appropriate for their needsimpact on people’s health outcomes, such as their blood pressurereduce how often people use services. This may in turn reduce the overall cost ofcare, but there is not as much evidence about thisimprove how confident and satisfied professionals themselves feel about the careprovidedReviews of research about this topic found that offering care in a more person-centred wayusually improves outcomes.40 Some of the most common ways that have been researchedto improve person-centred care include helping people learn more about their conditions,prompting people to be more engaged in health consultations and training professionals tofacilitate care that empowers people to take part.41,42Offering care in a more person-centred way can even improve outcomes for professionals. Areview of seven studies about professionals delivering person-centred care in nursing homesfound that this approach improved job satisfaction, reduced emotional exhaustion andincreased the sense of accomplishment amongst professionals.43Research has found that some components or underlying principles of person-centred caremay be most important for affecting outcomes, 57 getting to know the patient as a person and recognising their individualityseeing the patient as an expert about their own health and caresharing power and responsibilitytaking a holistic approach to assessing people’s needs and providing careincluding families where appropriatemaking sure that services are accessible, flexible and easy to navigatelooking at people’s whole experience of care to promote coordination and continuitymaking sure that the physical, cultural and psychosocial environment of healthservices supports person-centred caremaking sure that staff are supportive, well trained in communication and striving toput people at the centre of their careWhile the evidence is mounting that person-centred care can make a difference, there arenot that many studies about outcomes yet and some research has mixed findings.58, Personcentred care means different things to different people and this might be why there aremixed findings. This makes it even more important to think about how to measure and putperson-centred care into practice, so that health services can better understand the benefitsof this approach.

Towards person-centred care in South LondonIn order to be more person-centred, health services need to know what is most important topeople. Person-centred care can focus on people’s individual health needs, but it is alsoabout involving people in planning and evaluating services. Words such as ‘co-production’and ‘co-design’ have been used to describe involving people in developing services andassessing their quality.Based on all of the available evidence and feedback from patients and professionals, theHealth Innovation Network – South London believes that beginning with a person-centredapproach will lead to positive outcomes for patients and carers. Finding out what is importantto patients and carers and making improvements in these areas will improve people’sexperience of care and help them be more independent. For this reason, The HealthInnovation Network is developing ways to measure the experience of health services in oneof its key clinical priority areas: dementia. A Delphi technique is being used to get opinionsfrom people with dementia, carers, patient and carer representative organisations,professionals and other stakeholders. People will be invited to rate the importance of variousaspects of the quality of dementia care. Their responses will be summarised and circulatedfor discussion in repeated rounds until consensus is reached. This will help to make surethat the things being measured and improved upon are important to the people usingservices.This is an innovative approach because although the concept of person-centred care putspatients at the heart of their care, few approaches to measurement have been driven bypatients or build on aspects that patients and carers identify as most crucial.59 However, it isimportant not just to focus on people’s preferences because these can change over timeand people generally prioritise the things they are currently doing rather than the potentialway things could be.60 One of the challenges that the Health Innovation Network is tacklingis how to define what services are fundamentally trying to achieve, and this is beingdone in partnership with patients and carers.

References1 Sepucha K, Uzogarra B, O'Connor M. Developing instruments to measure the quality of decisions: earlyresults for a set of symptom-driven decisions. Patient Educ Counsel 2008;73(3):504-510.2 www.ihi.org/IHI/Topics/PatientCenteredCare/ PatientCenteredCareGeneral/3 Gill PS. Patient Engagement: An investigation at a primary care clinic. Int J Gen Med 2013;6:85-98.4 Redrup Publications. Introducing Person-Centred Care Approaches. Redrup Publications, undated.5 McCance T, McCormack B, Dewing J. An exploration of person-centredness in practice. Online JIssues Nurs 2011;16(2):1.6 Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? Anarrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs2013;69(1):4-15.7 McGilton KS, Heath H, Chu CH, Boström AM, Mueller C, Boscart VM, McKenzie-Green B, MoghabghabR, Bowers B. Moving the agenda forward: a person-centred framework in long-term care. Int J OlderPeople Nurs 2012;7(4):303-309.8 Nandini V, Sridhar C, Usharani M, Kumar JP, Salins N. Incorporating person centred care principles intoan ongoing comprehensive cancer management program: an experiential account. Indian J Palliat Care2011;17(Suppl):S61-67.9 Cloninger CR. Person-centred integrative care. J Eval Clin Pract 2011;17(2):371-372.10 Edvardsson D, Fetherstonhaugh D, Nay R. Promoting a continuation of self and normality: personcentred care as described by people with dementia, their family members and aged care staff. J ClinNurs 2010;19(17-18):2611-2618.11 Shaller D. Patient-Centered Care: what does it take? US: The Commonwealth Fund, 2006.12 The King’s Fund. What Matters to Patients? Developing the Evidence Base for Measuring andImproving Patient Experience. London: Kings College London and the King’s Fund.13 Coulter A, Ellins J. Patient-Focused Interventions: A Review of the Evidence. London: Picker InstituteEurope, 2006.14 The King’s Fund. Reading List. The Point of Care: improving patients’ experience. London: The King’sFund, 2012.15 de Silva D. Helping measure person-centred care. London: The Health Foundation 2014.16 Collins A. Measuring what really matters. Towards a coherent measurement system to support personcentred care. London: The Health Foundation 2014.17 Coulter A, Fitzpatrick R, Cornwell J. The Point of Care. Measures of patients’ experience in hospital:purpose, methods and uses. London: The King’s Fund, 2009.18 Cronin C. Patient-Centered Care: An Overview of Definitions and Concepts. US: National HealthCouncil, 2004.19 /20 Ashby ME, Dowding C. Hospice care and patients’ pain: communication between patients, relatives,nurses and doctors. Int J Pall Care Nurs 2001; 7(2):58.21 Dowsett SM, Saul JL, Butow PN, Dunn SM, Boyer MJ, Findlow R, Dunsmore J. Communication stylesin the cancer consultation: preferences for a patient-centred approach. Psycho-oncology 2000;9(2):147-156.22 Kwan J, Sandercock P. In hospital care pathways for stroke. Coch Database Sys Rev 2004;4.23 Simces Z. Exploring the link between public involvement/citizen engagement and quality health care. Areview and analysis of the current literature. Ottawa: Health Canada, 2003.24 Department of Health. Equity and Excellence: Liberating the NHS. London: Stationery Office, 2010.25 Coulter A, Collins A. Making shared decision-making a reality. No decision about me, without me.London: King’s Fund, 2011.26 World Health Organisation. Innovative Care for Chronic Conditions. Building Blocks for Action. Geneva:WHO, 2002.27 Department of Health. Equity and Excellence: Liberating the NHS. London: Stationery Office, 2010.28 ople-help-themselves/29 e-decision-making30 xperience/31 al-care-act-2012-fact-sheets32 Department of Health. Equity and Excellence: Liberating the NHS. London: Stationery Office, 2010.33 www.scotland.gov.uk/Resource/Doc/ 275476/0082608.pdf34 www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH 11517535 Department of Health. Equity and Excellence: Liberating the NHS. London: Stationery Office, 2010.36 Coulter A, Collins A. Making shared decision-making a reality. No decision about me, without me.London: King’s Fund, 2011.

37 Tritter JQ, Koivusalo M. Undermining patient and public engagement and limiting its impact: theconsequences of the Health and Social Care Act 2012 on collective patient and public involvement.Health Expect 2013;16(2):115-118.38 McMillan SS, Kendall E, Sav A, King MA, Whitty JA, Kelly F, Wheeler AJ. Patient-centered approachesto health care: a systematic review of randomized controlled trials. Med Care Res Rev (publ