It is hard at the minute to pick up any healthcare related literature that does not contain the term ‘Person-centred’. Interest in the concept has grown steadily over the last 20 years with policy makers, professional regulators, healthcare and academic institutions embracing the notion of person-centred care. The Institute of Medicine has listed patient- centered care as one the six aims for improvement in its 2001 report ‘Crossing the Quality Chasm’ and defines patient-centered care as care that respects and responds to the individual patient’s preferences, needs and values and ensures that clinical decision incorporates patients’ values.
Within NHS Scotland there have been a range of a policy initiatives implemented since 2001, which have attempted to support the concept in practice.
This has culminated in the publication of the Healthcare Quality Strategy (Scottish Government 2010), which has person-centredness as one of the three quality ambitions outlined in the document.
A complex landscape for clinicians
I am confident that despite some evidence to the contrary (e.g. Johnson et al 2006) the clinical practice of the vast majority of healthcare professionals is underpinned by person-centred values such as altruism, compassion and empathy. This belief is reinforced in frequent conversations I have with clinicians regarding their motives for coming in to a healthcare profession in the first place. However, these same individuals describe a complex healthcare landscape that inhibits the consistent delivery of person-centred care. The challenges encountered regularly include (not exhaustive):
- Increasing patient activity/acuity/targets
- A burden of bureaucracy that stifles enablement and innovation in the clinical setting
- An increasing number of ‘improvement’ initiatives imposed centrally
- A lack of acknowledgement of the emotional cost of caring
- The influence of professional paternalism
- Increasing levels of public scrutiny and patient expectation
Every person, every time.
As clinicians ‘fire-fight’ with the daily challenges they face, it is easy to understand why it is so difficult to remain sensitive and caring to every person, every time. The evidence suggests that clinicians only have a certain capacity to empathise (Morse et al 2006). Without an adequate coping strategy there is a danger of disengagement, depersonalisation, stress and burnout all of which negatively impact on the ability of the clinician to be person-centred (Glasberg et al 2007). I believe that ‘reflection’ is a powerful tool that can be used as a positive emotional coping strategy for clinicians.
Reflective practice can be defined as the process of making sense of events, situations and actions that occur in the workplace (Oelofsen 2012). Making time for reflection is essential for improving service quality, providing much-needed support to clinicians, and facilitating team members’ professional development.
A wide range of empirically tested models of reflective practice is available for clinicians to choose from, some of which are currently applied formally (e.g. clinical supervision) and informally (e.g. team huddle) on a limited basis within the organisation in which I work.
Further developmental work is required to develop a systematic approach to formal reflection within my organisation (This would impact positively on the ability of the organization to ‘self-study’ as described by @Craigwhitephd June15 #ayrshirehealth Blog).
What can individual clinicians do?
The three-step framework devised by Oelofsen (2012) offers a simple but effective model for individual clinicians to apply in everyday practice. Clinicians could easily apply this simple model (individually and as part of a group) as opportunities arise during the course of a busy day in any practice setting.
Reflection offers the potential to build the individual clinician’s capacity to cope and engage with the challenges encountered within clinical practice, whilst ensuring relationships with persons are consistently caring and sensitive to individual need.
‘Clear eyed’ or ‘Glassy eyed’?
The nursing leader Professor Stephen Wright often postulates that there are only two types of healthcare professional the ‘clear-eyed’ or the ‘glassy-eyed’.
Which type of clinician do you wish to be?
Glasberg, A.l., Erikksson, S and Norgerg A. (2007) Burnout and ‘stress of conscience’ among healthcare personnel. .
IOM (Institute of Medicine) (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press
Johnson, M., Haigh, C and Yates-Bolton, N. (2007) Valuing of altruism and honesty in nursing students: a two-decade replication study. Journal of Advanced Nursing V 57 N 4 pp 366-374
Morse, J.M. (2006) 30th anniversary commentary on Morse J.M., Bottorff J., Anderson G., O’Brien B. & Solberg S. (1992) Beyond empathy: Expanding expressions of caring. Journal of Advanced Nursing V 17, pp 809-821.
Oelofsen, N (2012) Using reflective practice in frontline nursing Nursing Times V 108 N 24 pp 22 – 24
Andrew Moore is Assistant Nurse Director, Patient Focus – Public Involvement in NHS Ayrshire in Arran
Next weeks blog comes from Gina Alexander @ginaalexander for @patientopinion - Going for Gold!” Patients coaching NHS to deliver top results.