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When it comes to person-centred care, do we need measurement or feedback? Part 1

Darshan Patel
Darshan Patel
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The tendency to want to measure things has existed for as long as humans have walked the earth. More specifically, in the case of health and healthcare, recorded efforts to systematically measure care quality can be traced back almost three centuries.

Yet despite measurement being something we all understand, it remains a challenge in healthcare. Something as seemly straightforward as counting the number of infections in an intensive care unit is not as straightforward as it first seems.

The reality is that measurement in healthcare is highly complex and subject to a range of human factors that, in some instances, can render measures so inconsistent as to undermine the value and improvement that they were designed to bring about.

In healthcare, measuring things can also evoke considerable anxiety and frustration among all concerned: those who are being measured, those who are doing the measuring, and those who are seeking the data for a variety of purposes. However, despite the difficulties and the emotions associated, measuring performance is a fundamental function of modern healthcare, essential to ensuring accountability and monitoring patient safety.

So how do you start to measure something as contextually sensitive and elusive as person-centeredness? Person-centred care means many different things to many different people; it has no universal definition, is not something you can touch or feel, and is often easier to pinpoint or identify when it isn’t happening rather than when it is.    

A natural starting place, it would seem to me, is to ask what has been done in this area before, and where better to start than what’s been said in the empirical literature?

This is exactly what our new publication Helping measure person-centred care does. This rapid evidence review searched five bibliographic databases for studies (published since 1 January 2000) that explore how any aspect of person-centred care has been measured in healthcare.

The researchers found that there are a large number of tools and approaches being used to measure person-centred care; some are concerned with capturing a holistic concept of person-centeredness, some focus on a specific sub-component of person-centeredness, such as empathy or communication. Accompanying the review is a spreadsheet detailing 160 of the most commonly researched measurement tools – something that should be a useful, evidence-based starting point for those entrusted with measuring the person-centeredness of care.

But as useful as these resources are, there continues to be a lack of agreement about which tools are most worthwhile, let alone there being a ‘silver bullet’ or best measure that has the sensitivity and specificity to cover all aspects of person-centred care. For now, is combining a range of methods and tools to get a ‘feel’ for how ‘person-centred’ care is the best that we can do?

Given how multi-dimensional and context-sensitive person-centeredness is, is it realistic to think that in the not too distant future one simple, cost-effective measure will be unearthed? My sense is not. However, the use of ‘big data’ thinking – such as recording consultations on smartphones and linking this to patient record information – may unleash the potential to significantly upgrade the existing suite of tools and approaches being used to measure person-centeredness.

Perhaps a more pressing need is for some sort of coherent framework for gauging the person-centeredness of care. But what features would we wish to see? In part 2 of this blog, I’ll be looking at what features this framework might have in more detail and whether or not measurement is indeed the primary goal for such a framework. Stay tuned…

Update: Read part 2 of this blog

Darshan is a Research Manager at the Health Foundation.





 
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Comments
Thanks Darshan - looking forward to part 2!
Darshan - thank you.
i apologise for the length of my response, but ihave four points to make.

When I started writing my paper for University, I thought I knew all about person centred care. I had lived and breathed it for 18 years, after all!

My University learning allowed me to see that, despite the various tools which may exist, there was nothing quite so stark as a written submission.
I asked a Council Carer to write her account of a day with a severely disabled client, whom I knew personally. I then compared this to it to the contribution from a Personal Assistant, who was working totally towards the wishes of his disabled employer.

1. Anyone reading these could not doubt that person centred care was being delivered in one case and the bare minimum provided in the other. Reading it, the service provided by the Council felt both unsafe and uncomfortable. Person centred care was empowerment . What was provided by the Council was clearly highlighted as disempowerment.
With Council Care, every day was the same: with Personal Assistance, every day was an adventure.

2. It is all about quality if life- and the quality of life toolkit should be able to assist.
http://www.innervate.co.uk/educationproducts2.asp
After all, when it comes to quality of life, only the PATIENT knows!

3.Thinking over these years, i realised that the NHS is 64years old:

The first ventilated patient went home 32 YEARS ago in 1982.. She had person centred care and lived alone successfully into her eighties.
This is the first instance of person centred care that I am aware of - and although it has been around for half the life of the NHS, we still debate it - still doubt - still want to measure it.

4.Lastly, I believe we are our own worst enemies.
I believe that no matter how much we call for change, we really don't want it, and won't do it,This is highlighted by Jessica Olien's article on "Creativity is rejected"
http://www.slate.com/articles/health_and_science/science/2013/12/creativity_is_rejected_teachers_and_bosses_don_t_value_out_of_the_box_thinking.html
Hi Linda

Thank you for your comment – but firstly can I say that you had no reason to apologise for its length :-)

Personally I find it hard to disagree with any of the points you raise, especially the central importance of a person’s quality of life in providing person-centred care. Thank you also for signposting further reading and resources.

I also think (and hope) that much of what you say resonates with what you will read in part 2 of this blog .....
I am searching on the "child’s growth and weight".
Darshan Patel? Is there anything useful for me on this platform?

<a href="http://www.healthscamreviewed.co.uk/">Women's Health</a>
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