person-centred care - gpcc · gpcc the university of gothenburg centre for person-centred care...
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Person-centred Care
”A patient is a person
who is more than their disease”
GPCCThe University of Gothenburg Centre for Person-centred care (GPCC) was established in 2010 with support from the Swedish government as a strategic research area. Around 130 national and internatio-nal researchers from a range of disciplines collaborate on research at the centre. The overall aim of GPCC is to combine research, innovation and education to faci-litate an evidence based sustainable change in health care.
Uniquely GPCC has evaluated the effects of person-centred care carried out in a structured manner. Among the effects are a high level of patients´ satisfaction with care and the extensive cost savings from reduced lengths of stay in hospital; person-centred care has been shown to have a positive effect as the patient’s per-sonal resources are utilized in an entirely new way.
Person-centred Care – a paradigm shiftGPCC wants health care professionals to widen their remit whereby the patient’s experience of illness and health are central instead of focusing entirely on disease. Person-centred care means that the patient and health care professionals enter into a partnership, where all decisions regarding care, treatment and rehabilitation are taken collaboratively and a personal health-plan is mutually developed and agreed on.
Person-centred care is applicable to all forms of health care including rehabilitation and health promotion.
What is Person-centred
Care?
En persons resurser innebär mänskliga och mellanmänskliga tillgångar som glädje, mo-tivation och mänskliga kontakter. Exempel-vis kan vilja vara en resurs hos en person. En persons vilja kan mobiliseras i olika mål; det kan vara att kunna gå en viss sträcka efter en operation för att kunna rasta sin hund, eller att kunna komma hem inom en viss planerad tid. Däremot innebär resurser inte nödvändigtvis fysisk eller intellektuell förmåga.
Den mest centrala delen i personcentrerad vård är partnerskapet; det handlar om en ömsesidig respekt för varandras kunskap; å ena sidan patientens kunskap om hur det är att leva med tillståndet, å andra sidan hälso- och sjukvårdspersonalens kunskap om tillståndet på en generell nivå.
Strukturerad dokumentation av patientens berättelse utförd av personalen används till att i samråd med patienten formulera en personlig hälsoplan. Detta säkerställer att vård, behandling och/eller rehabilitering genomförs såsom överenskommet.
Medverkan i den egna vården enligt per-soncentrerad vård är alltså mycket mer än egenvård: det innebär att patienten ses som en jämlik partner i vården, en person med expertis om sin egen situation och om hur hon/han hanterar sin sjukdom/hälsa. Detta innebär att man som patient ges möjlighet att, efter förmåga och vilja, vara fullt insatt i och medverka i planering av den egna vår-den, samt att ens resurser, motivation och omständigheter beaktas och tas till nytta.
The basis for person-centred care is the patient’s experience and their personal resources.
The most central component of person-centred care is the notion of partnership; it is a question of mutual respect for one another’s knowledge. On the one hand the patient’s knowledge of their own body, self, circumstances and what it is like to live with the condition, on the other hand the health care professionals’ generic knowledge of the condition. This partnership can extend to include the patient relatives and community.
Participation in care is therefore more than self-care. It means seeing the patient as an equal partner in care; as a person with expertise regarding their own situation and how they handle their illness/health. For the patient this entails being given the possibility, should they be able and willing, to be fully involved in their own care, and that their resourc-es, motivation and circumstances are taken into account and utilized.
Structured documentation of the patient’s narrative is transcribed by the health care staff and used in consultation with the patient to create a personal health plan. This is then documented in the patient´s record, and integrated and updated in the care process as an anchor for the partnership. This ensures that care, treatment and/or rehabilitation are carried out as agreed.
A person’s resources are not limited to physical or intellectual abilities, but also include human and interpersonal assets such as joy, motivation and human contacts. Willpower or agency can be one such resource. The willpower/agency of a person can be mobilized towards different goals such as being able to walk a certain distance after surgery or being able to return home within a planned time schedule.
About GPCC
Eight out of nine faculties at the University of Gothenburg are represented within GPCC, involving researchers from disci-plines such as nursing, medicine, educa-tion and health economy, amongst others. Approximately 35 different projects and 30 PhD students are linked to the centre.
The University of Gothenburg and The Sahlgrenska University Hospital have a strong tradition of clinical research, and now GPCC contributes to this tradition with inter-disciplinary research in person- centred care. In addition to the clinical research across the whole care chain, the aspects of utilization and innovation are
considered in all aspects of the centre’s activities from the start. This is to ensure that our research can be put to practical use, the end goal being to contribute to an evidence based, sustainable change in health care.
The Knowledge Triangle: research, innovation and education
To ensure such a sustainable change in health care GPCC integrates “the know-ledge triangle”, namely research, innovation and education, and transforms knowledge about person-centred care into linked acti-vities in all these areas.
The University of Gothenburg Centre for Person-centred Care (GPCC) is an interdisciplinary research centre. It was established in January 2010, with the support of the Swedish government’s strategic investment in health care research. The overall aim of GPCC is to combine research, innovation and education to facilitate an evidence based sustainable change in health care.
Research
One of the concluded studies within GPCC included patients with chronic heart failure, whose condition had deteriorated recently.
Those patients who received person- centred care during their entire hospital
stay reported feeling less uncertainty about their illness. [1] Furthermore their hospital stay was reduced by one third compared with ”usual care”.[2]
1. Dudas K, Olsson LE, Wolf A, Swedberg K, Taft C, Schaufelberger M, Ekman I: Uncertainty in illness among patients with chronic heart failure is less in person-centered care than in usual care. European Journal of Cardiovasc Nursing, 2013 Jan 9. [Epub ahead of print]
2. Ekman I, Wolf A, Olsson LE, Taft C, Dudas K, Schaufelberger M, Swedberg K: Effects of person-centered care in patients with chronic heart failure: the PCC-HF study. European Heart Journal, 2011, 32:2395–2404.
A key challenge for GPCC is to ensure that its research is effectively used to drive im-plementation and a transition in practice to person-centred care. This means design ing research projects to maximize their poten-tial for impact, driving research processes in collaboration with stakehold ers and implementers, and ensuring that the results of research activities are not only published but brought into dissemination and educa-tional activities as well as practical innovation.
GPCC works continuously with stake-hold ers in academia, industry and health care; regional and national innovation sys-tems as well as international development partners. These collaborations aim to iden-tify sustain able and scalable methods for carrying out evidence based person-centred care in order to improve care processes. By integrating research results into both practical utilization projects and the policy and education support systems needed to maintain change, GPCC has demonstrated
that the benefits of person-centred research can be sustainably implemented in both. This work has now led the EU to assign the GPCC the task of coordinating the WE CARE consortium in developing a new R&D Strategic plan and R&D Road-map on cost containment of healthcare with maintained or even improved quality, together with EU key players. (For more info, see web link on back page.)
Exemples of best practice: Person-centred care wards of the future
Examples of implementation and best practice within GPCC are the wards where professionals now work entirely in accord ance with the principles of person-centred care. These wards are part of the Department of Medicine, Geri atrics and Emergency Department at Sahlgrenska University Hospital.
GPCC innovation and education: examples of implementation
The aims of this project are to develop “the person-centred care wards of the future” as well as to constitute an open and sustainable testbed for new methods of care, services and products such as education, e-health and IT solutions. The ward staff and project partners identify, develop and integrate innovative part solutions for a change to an effective high quality health care. Project partners: amongst others (from industry) IBM, AstraZeneca and Doberman. Project fund-ers: Vinnova, the Swedish Governmen tal Agency for Innovation Systems.
Person-centred care in Practice (PCP)
A further example of GPCCs implementation of their centred care principles in practice is the develop ment of change/education programmes which can be tailor-made to the needs and particular circumstances of, in principle, any health care environment.
The goal of PCP in any given environment is to establish a sustainable person-centred approach which permeates the entire care process and rests on three fundamental pillars; Narrative, Partnership and Docu-mentation. A radical change of both culture and structure of both organisations and persons is often needed in order to be able to foster and maintain person-centred care.
The programme model combines evidence-based person-centred knowledge and change management knowledge. The aim of the programme is to have an impact on both participant and organisational levels:
IMPACT GoAlS on A PArTICIPAnT lEvEl
• Gain a greater understanding of what person-centred care entails and how it can be carried out in practice.
• Be able to develop structured working methods to plan and systematically carry out person-centred care for
patients with a variety of conditions and care needs.
• Ability to establish a partnership with the patient and draw up a person- centred health plan.
IMPACT GoAlS on An orGAnISATIonAl lEvEl
• Consensus firmly anchored in the concept of person-centred care.
• To be able to identify possibilities and barriers to implementing person-centred care within the care unit/department.
• Create a plan for continued work.
The model is structured so that the change management work is carried out at three levels simultaneously: managerial level, amongst strategic change agents and amongst all members of staff.
• Ourevidence-basedresearchintotheeffects of person-centred care, carried out in a structured way and incor po-rating key components shows very positive results.
• Wehavedirectlinkswithcare practices across the whole care chain.
• Wehavecreatedtailormadechange/educational programmes based on person-centred theory and empirical findings.
• Wehaveastrongtheoreticalfounda-tion, based on personalist philosophy.
GPCC
