Why we need research to address the problems associated with persons being respected in healthcare settings

Person-centred care has a long association with healthcare, and at a level of principle is well understood as that which is concerned with treating people as individuals; respecting their rights as a person; building mutual trust and understanding, and developing therapeutic relationships. As healthcare workers, we have an expectation that people should receive a standard of care that reflects these principles.

The inherent good of providing care within a philosophy of person-centredness is irrefutable, but it has been recognised that translating the core concepts into every day practice is challenging. The reasons for this come in many forms and are often indicative of the context in which care is being delivered, and the fact that we are living in times of constant change, particularly within health and social care.

The promotion of ‘person-centredness’ is consistent with international policy developments and is reflected in approaches to the delivery of healthcare. The drive, however, within the health service to demonstrate effectiveness and efficiency through performance management processes has never been greater.

This has resulted in a range of quality and clinical indicators, many of which pay little attention to how patients, clients, their families, nor indeed staff, experience care.

Developing models of practice that enable person-centred principles to be realised across all services is a key issue in health and social care reform with the focus being on the transformation of healthcare systems, structures and the redesign of clinical services.

The Person-centred Practice Framework (PCPF), a mid-range theory was developed from empirical research published between 2000–2010. Despite revisions over time, the fundamental building blocks of the framework (the domains), and the key elements (the constructs), have remained stable over time. Refinements have reflected increased engagement with person-centred theory, its implementation in a variety of contexts and contribution of this theory to a broad agenda of person-centred policy, education, practice and research.

The PCPF is the most adopted framework for informing the development of person-centred practices and systems among multidisciplinary and inter-professional teams globally. It has been translated into 11 languages and tested in multiple healthcare contexts in 27 countries. The framework and associated tools appeal to a wide range of stakeholders.

Influential participatory research and development undertaken with international partners in the United Kingdom, Sweden, Norway, Finland, The Netherlands, Spain, Portugal, The Republic of Ireland, Australia, South Africa, USA and Canada has resulted in the development of six evaluation instruments (The Person-centred Nursing Index; The Context Assessment Index; the Person-centred Practice Inventory (PCPI) [with versions for staff, service users and healthcare students]) and one observation tool (The Workplace Culture Critical Analysis Tool). Through various implementation studies that combine the use of the PCPF with these measurement tools, we have identified key outcomes from the implementation of person-centred practice.

Our collaborative research and development projects in nursing home settings have resulted in improvements to the care environment, greater resident satisfaction, improved staff well-being, reduction in falls and reduced use of psychotropic medications.

In acute care settings, we have produced peer-reviewed evidence of better engagement between staff and patients as well as improved retention of staff, greater job satisfaction and staff wellbeing.

In palliative care, our systematic evaluations of practice development programmes have shown improvements in regulator quality indicators, as well as improvements to the quality of the care environment, better and more effective staff communication, increased staff development, and better retention of staff.

An international programme of work leading to the development and testing of eight person-centred nursing key performance indicators (KPIs) and associated measurement tools have been tested through a series of international implementation studies in a range of clinical settings.

Findings from these studies confirm that using the eight KPIs generates evidence of patient experience that facilitates engagement of nurses to develop person-centred practice, contributing to an enhanced care experience.

Our ongoing research has led to the development of the first ever Indicators for Person-centred Healthcare Curricula that are being tested in an Erasmus+ pan-European curriculum development project.

Enhanced Practice Experience for Service Users and Staff:

In the Republic of Ireland, a national programme of development was commissioned by the Health Service Executive (HSE) across the Irish health system (2017-2020) focusing on the creation of person-centred cultures.

Two-hundred facilitators are embedded in the health system facilitating practice change. Impacts include changes in behaviours among participants towards more person-centred practices (e.g. changes to language used in practice, better staff relationships); more effective communication in and between teams; innovations in practice such as new services and improved quality assessments from regulation authorities.

As a result of this work a ‘practical’ set of Person-centred Principles were developed and these, along with the PCPF have been integrated into the Health Service Executive’s ‘Health Services Change Guide’.

Workplace Culture Change:

Further impact from our research can be demonstrated through the international adoption of the PCPF to facilitate culture change in healthcare settings. In NSW Australia the State Health Department’s ‘Essentials of Care’ Programme uses the Framework to develop person-centred cultures and systematically change practices, policies and systems.

Outcomes include improved patient outcomes, increased person-centred care, more effective partnerships with service users, increased resource efficiency, improved professionalism among nurses as evidenced through the systematic evaluation of the work in one tertiary healthcare setting. Also, a programme of research and development focusing on the implementation of a set of 8 person-centred Nursing Key Performance Indicators (KPIs) by nursing teams has been implemented in the UK, Denmark, Australia and Canada.

The person-centred KPIs are derived from the PCPF and it is the combination of the KPIs as a mechanism for evaluating person-centred care and the use of the theory of person-centredness to drive forward improvements in practice that maximises impact. Outcomes from this work include increased staff engagement in person-centred care, a greater focus on improving practice, an increased ability of nurses and midwives to articulate and demonstrate the positive contribution of nursing and midwifery in different settings.

Quality Improvements:

In Austria, the framework has been used to design a model of nursing home accreditation – the first of its kind in Austria. The accreditation model incorporates the PCPF and the implementation of the model is evaluated using the associated instruments and tools.

The framework provides a basis for all care and support processes as well as for organizational, strategic and structural measures at the state level. It also provides the theoretical framework for evaluation.

As a result of our ongoing research, Health Improvement Scotland (HIS), in its national ‘Specialist Dementia Unit’ improvement programme has adopted the Workplace Culture Critical Analysis Tool (WCCAT) to guide observations of practice and a participatory approach to the making of quality improvements.

One such example is that of Balmore Ward, NHS Greater Glasgow and Clyde’. The work, guided by our person-centred research has resulted in outcomes including, changes in day-to-day practices and relationships with residents, better engagement with carers and implementation of meaningful activities for residents. The WCCAT is now integrated into the Scotland-wide ‘Specialist Dementia Unit Improvement Programme.

Transformative Learning and Development:

The PCPF forms the core theoretical basis of ‘the Leadership Development Programme in Nursing Development Units (NDUs)’ in Germany.

One of the outcomes from implementing the Framework has been the development of a new nursing organisational system to support and help embed person-centredness in the units.

The Framework has been translated into German and a guidance book has been developed for use across the health system in the Deggendorf region of Germany. Nurses use this guidance book to reflect on their everyday practice, mapping situations to the framework and keeping notes: this forms the basis of reflection rounds with the team. Changes to practice include better ‘knowing’ of the patient and their family, more effective patient handover reports, implementation of a new nursing organisation system and a focus on continuous quality improvement.

The processes and outcomes from this work have been integrated into bachelor of nursing education programmes in Deggendorf Institute of Technology (academic partner for the programme) and collaboration extended to Switzerland and Austria.

Academics involved in leading/contributing to this research:

Brendan McCormack, Head of Division and Associate Director, Centre for Person-centred Practice Research.

Jan Dewing, Director, Centre for Person-centred Practice Research.

Caroline Dickson, Senior Lecturer, Division of Nursing and Paramedic Science

Research and Knowledge Exchange Development Unit

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Research and Knowledge Exchange Development Unit

Kim Stuart Head of Research and Knowledge Exchange Development Unit 0131 474 0000
RKE - Vivian Rutherford Research and Knowledge Exchange Officer 0131 474 0000

QMU Academics Involved