Person-centred Care Made Simple What Everyone Should Know .
Quick guideJanuary 2016Person-centred caremade simpleWhat everyoneshould know aboutperson-centred care
Contents1Introduction22What is person-centred care?53Why is person-centred care so important?104How has person-centred care developed?145Putting person-centred care into practice186Frequently asked questions287Where can I find out more?37References42Person-centred care made simpleis published by the Health Foundation,90 Long Acre, London WC2E 9RAISBN 978-1-906461-56-0 2016 The Health Foundation 1
IntroductionThe challenges facing the NHS are well understood.There are growing numbers of older people andpeople living with long-term conditions anddisabilities. At the same time, health and social carebudgets are under increasing pressure. If we are toprovide high quality care that affords people thebest possible quality of life, we need to rethink therelationship between people and the services thatprovide their care.1In person-centred care, health and social careprofessionals work collaboratively with people whouse services. Person-centred care supports people todevelop the knowledge, skills and confidence theyneed to more effectively manage and make informeddecisions about their own health and health care.It is coordinated and tailored to the needs of theindividual. And, crucially, it ensures that people arealways treated with dignity, compassion and respect.This might seem a common sense vision for any formof health care, but it is not standard practice. Often,health care does ‘to’ or ‘for’ people rather than ‘with’them, finds it difficult to include people in decisions,and views people’s goals only in terms of particularclinical outcomes.Introduction3
Adopting person-centred care as ‘business as usual’requires fundamental changes to how servicesare delivered and to roles – not only those ofhealth care professionals, but of patients too – andthe relationships between patients, health careprofessionals and teams. Despite the challenges inmaking this shift, person-centred care does exist,in a modest but growing number of services, withpositive outcomes. It requires effort, but it certainlyis possible.What isperson-centred care?This guide seeks to provide a quick overviewof person-centred care. It is written for anyoneinterested in health and health care, including healthcare professionals and those who use the NHS.4Person-centred care made simple2
2. Offering coordinated care, support or treatment.3. Offering personalised care, support or treatment.4. Supporting people to recognise and developtheir own strengths and abilities to enable themto live an independent and fulfilling life.*6For more information about these principles, see Dr AlfCollins’ thought paper for the Health Foundation, Measuringwhat really matters. Available from: ly-mattersPerson-centred care made simpledre s p e c tn,iossaAffording people dignity, compassion and respect.teCare is.coordinatedCare is.enablingt re1.Care is.personalisedisInstead of offering a concise but inevitably limiteddefinition, the Health Foundation has identified aframework that comprises four principles ofperson-centred care:*Figure 1: The four principles ofperson-centred carePe rs o nThe term ‘person-centred care’ is used to refer tomany different principles and activities, and thereis no single agreed definition of the concept. Thisis partly because person-centred care is still anemerging and evolving area. It is also because, if careis to be person centred, then what it looks like willdepend on the needs, circumstances and preferencesof the individual receiving care. What is important toone person in their health care may be unnecessary,or even undesirable, to another. It may also changeover time, as the individual’s needs change.wit h .o. d i g n it y, cmpaWhatever the specific care or interventions a personreceives, it should be done with these principles inmind. Any example of person-centred care, withinany health care experience, will involve acombination of these principles.If the person is highly dependent – for example, ifthey are unconscious or otherwise lack capacity –Introduction7
there is likely to be more emphasis on the principlesof dignity, compassion and respect, coordinationand personalisation. However, even in these cases itis usually possible to practise all four principles tosome extent.Health care professionals, health and care workers,peer support workers and others, have a role insupporting people to develop the knowledge,skills and confidence they need to fully participatein this partnership.A new relationshipTerminologyThe principle of being enabling is rather differentfrom the others. A health care provider couldfeasibly uphold the other three principles withoutthe person’s input. They could work on behalf ofthe population they serve to ensure that people aretreated with dignity and receive services that arebetter coordinated and personalised to fit aroundtheir needs.Because the concept of person-centred care is newand developing, you may have come across a rangeof other terms also used to refer to similar principlesand activities. Examples include patient-centred care,personalisation, relationship-centred care and, inScotland, mutuality.But for care to be enabling, the relationship betweenhealth care professionals and patients needs to bea partnership rather than the professional beingthe expert while the patient simply follows theirinstructions. It is a relationship in which health careprofessionals and patients work together to: understand what is important to the person make decisions about their care and treatment identify and achieve their goals.8Person-centred care made simpleIn this guide, we refer to ‘person-centred care’throughout. We use the word ‘person’ in orderto emphasise a holistic approach to care, that takesinto account the whole person – not a narrowfocus on their condition or symptoms but alsotheir preferences, wellbeing and wider social andcultural background.Introduction9
Why is person-centredcare so important?3Given the current focus on safety and financialtargets, some might ask whether person-centred careis a ‘nice to have’ rather than an essential – or at leasta lower priority. However, if we turn this thinkingaround then, according to the four principles (seepage 6), are we saying it is acceptable for healthcare to: fail to offer people dignity, compassion orrespect? be poorly coordinated? treat patients as a set of diagnoses or symptoms,without taking into account their wideremotional, social and practical needs or those oftheir carers? maintain dependency, so that patients failto recognise and develop their own strengthsand abilities and live an independent andfulfilling life?Obviously, most people would answer ‘no’ to thesequestions. However, in addition to the clear ethicalrationale, there are also some very practical reasonsfor adopting person-centred care. Many peoplewant to play a more active role in their health care,and there is growing evidence that approaches toperson-centred care such as shared decision makingand self-management support can improve a range ofWhy is person-centred care so important11
factors, including patient experience, care quality andhealth outcomes. Examples include the following: Supporting patients with long-term conditionsto manage their health and care can improveclinical outcomes.1 When people play a morecollaborative role in managing their healthand care, they are less likely to use emergencyhospital services.2 They are also more likely tostick to their treatment plans3 and take theirmedicine correctly.4 Patients who have the opportunity andsupport to make decisions about their careand treatment in partnership with healthprofessionals are more satisfied with their care,5are more likely to choose treatments based ontheir values and preferences rather than those oftheir clinician,6 and tend to choose less invasiveand costly treatments.7 Individuals who have more knowledge, skillsand confidence to manage their health and healthcare are more likely to engage in positive healthbehaviours and to have better health outcomes.8 Person-centred care is good for health careprofessionals too. As patient engagementincreases, staff performance and morale see acorresponding increase.912Person-centred care made simpleCare that is person-centred should also representbetter value for money because it ensures thatservices are built on the needs and preferencesof the people who use them, rather than on theconvenience of providers.Person-centred care and, in particular, approachessuch as collaborative care and support planningand self-management support (see Section 5)can also help services respond to the needs ofthe growing number of people living withlong-term conditions.Introduction13
How hasperson-centredcare developed?In the early 1960s, psychologist Carl Rogers was thefirst to use the term ‘person-centred’, in relationto psychotherapy (and had used ‘client-centred’ asearly as the 1950s). Although different in many waysfrom today’s meaning of ‘person-centred care’, a keyelement that both approaches share is empathy – theprofessional’s willingness to suspend judgementand appreciate the service user’s perspective. Rogerstermed this ‘unconditional positive regard’.In the late 1970s, American psychiatrist GeorgeEngel promoted the move from a medical to abiopsychosocial model of health – a model that isnow commonly used to explain the shift required todeliver person-centred care.4These ideas began to become aligned within healthcare in the 1990s in the US, when the ChronicCare Model was developed to address perceiveddeficiencies in how people with long-termconditions were supported. And in 2001, thehighly influential Institute of Medicine included‘patient-centredness’ as one of its six aims of healthcare quality.10Over the following decade, ideas of personcentredness began appearing with increasingregularity in UK health policy. The 2000 NHSPlan highlighted the need for personalisation andHow has person-centred care developed15
coordination,11 while in 2002 the Wanless reportfocused on enablement and empowerment, withpatients as partners in care.12In 2008, Lord Darzi’s report High quality care for alldescribed changing public expectations of services,including the importance of people being involved indecisions about their care.13The following year, the first NHS Constitution inEngland set out what people could expect the NHS todeliver, pulling together all of these policy statementsof intent into a rights framework. It stated that ‘NHSservices must reflect the needs and preferences ofpatients, their families and their carers. Patients,with their families and carers where appropriate,will be involved in and consulted on all decisionsabout their care and treatment.’ This has been furtherstrengthened in subsequent versions.14Since 2010, the Francis inquiries into failings in careat Mid Staffordshire NHS Foundation Trust between2005 and 2009 have propelled person-centredcare back into the spotlight, focusing on dignity,compassion and respect.15 And in 2013, the BerwickAdvisory Group argued for ‘greater involvement ofpatients and their carers at every level of the healthservice in order to deliver safe, meaningful andappropriate health care’.1616Person-centred care made simpleToday, person-centred care is also central to thepolicies of the four UK countries. The Health andSocial Care Act 2012 imposes a legal duty forNHS England and clinical commissioning groups(CCGs) to involve patients in their care.17 Vision2020 for Scotland has a focus on supported selfmanagement.18 Northern Ireland’s 2020 qualitystrategy cites ‘patient and client focus’ as one of itsthree main areas of focus,19 while the Welsh WhitePaper The listening organisation focuses exclusivelyon ‘ensuring care is person-centred in NHS Wales’.20More informationOur interactive timeline provides a visual guide throughthe key events that have contributed to the movetowards a more person-centred health service over thepast 50 years. Find the timeline at: www.health.org.uk/pcctimelineIntroduction17
Puttingperson-centredcare into practiceIn order to make health care more person-centred,services and practitioners need to be open to a widerange of approaches and initiatives. This sectionpresents some examples of work that is being done,with the aim of providing inspiration and helpingthose who are looking to put person-centred careinto practice.The section includes a combination of broadapproaches, specific initiatives and qualityimprovement approaches. Some of these seek toimprove the care or experience of individual patientswhile others focus on making care more personcentred at an organisational or wider level.5Collaborative care and support planningA way of supporting people with long-termconditions and disabilities to work together withtheir health care professionals to plan their care.The process involves exploring what matters to theperson; identifying the best treatment, care andsupport; and supporting them to set goals and thinkabout actions they can take to reach them.The charity National Voices has developed aninteractive guide to four stages of the approach:Putting person-centred care into practice19
preparing for a discussionHello, my name is. having the discussion (with the care andsupport partner) writing down the main points fromthe discussion review.A national campaign founded by Kate Granger, adoctor living with terminal cancer, to encourage allstaff to introduce themselves by name and professionwhen meeting a new patient. Kate says, ‘In my mindit is the first rung on the ladder to providingcompassionate care.’Find out rt-planningFind out more:www.hellomynameis.org.ukExperience-based co-designHouse of CareA method for improving people’s experience ofhealth care that involves gathering experiences ofpatients and staff and then bringing them together todevelop service improvements. This evidence-basedmethod was developed by academics at King’sCollege London and has been tested at sitesinternationally.A model that draws on international evidenceand best practice to show that effective careplanning relies on four key elements in thelocal health care system: The approach helps staff to re-frame what they do, tosee things from patients’ perspectives, and to workwith patients to identify often small changes thatmake a big difference to patients’ experience of care.Patients feeling engaged in decisions abouttheir treatment and care and able to act onthese decisions. Professionals being committed to working inpartnership with patients. Systems being in place to organise resourceseffectively. Having a whole-system approach tocommissioning health and care services.Find out more:www.kingsfund.org.uk/ebcd20Person-centred care made simplePutting person-centred care into practice21
The House of Care illustrates the importance andinterdependence of each element: if one element isweak or missing, the structure is not fit for purpose.The model can act as:studies, guidance on each step and improvementtools to use through the process.Find out more: a checklist – highlighting what needs to bein ntred-care a metaphor – emphasising that care and supportplanning is complex and that all the componentsneed to be in place to make it a successPersonal health budgets/individual budgets a flexible framework – guiding each localcommunity to build a stable house designedround the needs of local people.Find out ouse-of-carePerson and family-centred careA quality improvement process that focuses on twoparallel aspects of health care: care processes (the waycare is organised) and staff interactions with patientsand their families (human interactions).This evidence-based approach incorporates‘shadowing’ patients, developing a shared vision forthe ideal patient experience, and working throughindividual improvements. A toolkit provides case22Person-centred care made simpleA system that enables people to manage their care inthe way that suits them best. They are used in NorthAmerica, Australasia, Scandinavia and much ofWestern Europe. The individual designs and agrees aplan with their health care team that helps them meettheir goals. They then receive a ‘budget’ to spend ontheir care. Some receive this directly, while for others,it takes the form of a nominal budget or is managedby a third party.People may choose to spend their budget on thingsthat enhance their health and wellbeing but are nottraditionally considered health care, such as gymmembership or a companion to allow them to goon outings.Find out more:www.personalhealthbudgets.england.nhs.uk; our-ownsupportIntroduction23
Schwartz RoundsSelf-management supportAn approach designed to help providers of healthand social care develop their organisational cultureand support staff by allowing time for staff reflectionand sharing insights.A whole-system approach to enabling people withlong-term conditions to manage their health on aday-to-day basis. Every day, anyone living withlong-term conditions will make decisions, takeactions and manage a broad range of factors thatcontribute to their health. Self-management supportacknowledges this, and supports people to developthe knowledge, skills and confidence they need.The ‘rounds’ bring together professionals to sharelunch and then explore a workplace event, such as anincident involving a particular patient, or a theme,such as ‘when things don’t go to plan’. These oftenfocus on non-clinical aspects of care. One team givesa short presentation on their experience and thentheir colleagues share thoughts and similarexperiences, moderated by trained facilitators.A range of benefits have been documented, includingstaff becoming more empathetic, more confident inhandling sensitive issues and non-clinical aspects ofcare, and more open to expressing thoughts,questions and feelings.Find out ndsFor people with long-term conditions, selfmanagement support may include structured groupeducation programmes, health coaching ormotivational interviewing. Health care professionalsalso need to develop the skills, knowledge andconfidence to support patients – for example,through training in agenda setting, goal setting andgoal follow-up. Services also need to be organiseddifferently to make sure that people really do receivethe support they need – for example, changing ITsystems to enable people to receive their test resultsbefore their appointment.Find out ed care made simpleIntroduction25
Shared decision making‘What matters to me’ boardsA collaborative process through which a health careprofessional supports a patient to reach a decisionabout a specific course of action, such as decidingon a strategy to manage the pain from knee arthritis.An information board placed above beds to makesure everyone can see what is most important to eachpatient. The magnetic boards are used to write downpatients’ preferences and priorities, such as whetherthey want friends and family close by, or preferencesabout pain relief, sleep or treatment options. Theboards help share information that may not always beincluded at handover and act as a talking point to helpstaff get to know patients better.The conversation brings together the health careprofessional’s expertise – such as the treatmentoptions, risks and benefits – with the areas that thepatient knows best: their preferences, personalcircumstances, social circumstances, goals, valuesand beliefs.This approach can be useful whenever a decision i
Why is person-centred care so important 11. factors, including patient experience, care quality and health outcomes. Examples include the following: Supporting patients with long-term conditions to manage their health and care can improve clinical outcomes.1 When people play a more
inability to be person-centred. This guide offers clear and concise advice on how to go about bridging this gap. Too often, person-centred support gets put to the back of the queue behind the perceived necessity to meet targets and deadlines. This guide does an excellent job of focusing attention on the importance of being person-centred.
The emphasis is upon person centred, rather than service led, outcomes. Person centred planning tools are used to capture information that feeds in to the care and support or educational plan for a person. There are many different tools that can be used i.e. the relationship circle, communication chart. These tools allow for person centred
f and 10 (1)). We believe that person centred planning can help to achieve this objective. Person centred planning is a way of discovering how a person wants to live their life and what is required to make that possible. Person centred planning has its roots in the normalization and independent living movements. It is grounded in a social model of
Person Centred Working (day-to-day) is informed by person centred thinking. Every aspect of your day-to-day support work is carried out in a way that is respectful of the individual's wishes and dignity. In everything you do, you strive to support the individual to take control. Person Centred Planning (for future change) is the name given to a
Fund, 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 person-centred care. London: The Health Foundation 2014. 17 Coulter A, Fitzpatrick R, Cornwell J. The Point of Care.
Patient and Family Centred Care (or person/people centred care) is the philosophy of care, Patient Engagement is an approach to Patient and Family Centred Care and Patient Experience is an outcome. Patient engagement is the act of involving the patient and their family in decision-making, design, planning,
Transitioning from paediatric to adult care settings can present issues for young people, their parents and health care professionals. Key theories and concepts explored in this chapter are child-centred care, family-centred care, children participating in their care and transitioning between services. Case study 1.1: Mikael Setting the scene
2.3 Gresham’s Law 2.4 Money and near money 2.5 Role of money in Capitalist, Socialist and mixed Economy 3. Money Supply and Banks (14) 3.1 Narrow and broad definition of money 3.2 Alternative measures of money supply in India and their components 3.3 Concept of High Powered Money 3.4 Definition of Bank – Functions of bank 3.5 Multiple credit creation by bank and limitations to it. 4 .
