We spoke to Andrew Phillips, Director of Therapies and Health Science at Abertawe Bro Morgannwg University Health Board in South Wales, about the benefits of person-centred care for health organisations and their patients.
Why does healthcare need to be more person-centred?
Patients can experience traditional medical models of care as paternalistic: arranged for the convenience of the provider, aligned around specific disease conditions, with rigid pathways and siloed behaviour.
I believe this disempowers people. It can lead to lack of compassion and failure to see a person, rather than a list of tasks or a specific condition. This approach also leads to a lack of systems thinking by providers, resulting in inefficient services with poor patient outcomes and poor patient experience.
If services are centred around people they ask the person to set the agenda, say what they would like to achieve, give them support to make behaviour changes and, ultimately, take responsibility for their own health and wellbeing. This is good for patients and good for the NHS.
What makes you so passionate about person-centred care?
Personally, I would like to be supported to make informed choices about my own health and wellbeing, so there’s an element of self interest.
Professionally, I’ve found that providing person-centred care is a very successful way of working for provider organisations, resulting in better patient outcomes, better experience and lower costs. It’s not only the ‘right thing to do’, but through release of resources also helps providers deliver the best care and keep up with the latest innovations.
How is person-centred care different from what the NHS does now?
What the NHS routinely does now is to deliver provider-centred services that do not address an individual’s health or wellbeing issues, largely ignoring the capabilities and expertise that people, their families and communities have.
Look at how we care for older people, for example. Older patients are largely confined to their beds and it’s assumed they have no ability to care for themselves. Anyone who has tried to make themselves a cup of tea or a slice of toast on a ward will understand what I mean. The current system takes older people who have been living independently at home and turns them into a set of needs and deficits.
What needs to happen in order to make NHS care more person-centred?
It’s a big change. We need to transform how staff, patients and politicians understand their personal responsibilities and the role of the NHS.
If staff are to recognise and work with the expertise and autonomy of patients, they need to give up some of these themselves, and this is no small thing.
They need support from regulatory and professional bodies so that they don’t worry about the medico-legal consequences of patients exercising their options. They also need better access to health records and sources of expertise held electronically.
Then there is the pace-complexity issue. How can staff consider the ‘whole person’ when they have so little time for each individual interaction and the demand keeps growing year on year?
In my work, I’ve found that supporting patients to set the agenda and make preference-sensitive choices has been highly successful in managing demand and reducing time pressures. Another example of this is in elective operations, where evidence shows that when clinicians support patients to make informed choices it reduces the operative rate by around one third.
The social care sector has been talking about person-centred care for decades, why are health services only just starting to think in this way?
Health services are ‘late adopters’ in many ways. You only need to consider the sort of IT infrastructure that your local supermarket has compared with the NHS. This is due to many reasons: inertia, the autonomy that practitioners have in the NHS, the inclination for management to try and reduce healthcare to a simple linear system...all these things can work against the introduction of person-centred care.
People often say that providing great care isn’t rocket science. Of course it isn’t – it’s far more complex than that. We can’t think of managing care as being a simple system, there isn’t always a straightforward recipe you can follow to get consistent results. Providing person-centred care is complex, but allows us to adapt care to the needs of each individual. The most important characteristic of working in complex adaptive systems is agility.
The social care and third sectors have been more agile than the NHS. The good news is the NHS can learn from these organisations. There are some advantages in being a late adopter.
What are you doing to make care more person-centred in your organisation?
I am working with others to embed a Co-creating Health framework for supporting interaction between patients and clinicians. In particular, I am working to engage clinicians in routinely delivering relationship-centred care.
We have partnered with the Health Foundation in delivering training for a wide range of clinicians in supporting patients with chronic conditions to improve their self-management skills. We’ve trained over 250 clinicians to date, although we have over 16,000 staff in the Health Board. More recently, we have started to develop an e-learning package to spread this training more widely. We’ve tried a number of approaches, including training entire clinical teams and entire specific therapy professions.
The most important thing is to spread the thinking. The aim is to change the internal model of behaviour of staff from being provider-centred to person-centred.