Sunday, 16 March 2014

Being Person-Centred – Are We Nearly There Yet?

Regular readers will know that Successful Diabetes is firmly founded on a person-centred philosophy, following the principles originally articulated by Carl Rogers and more recently described in diabetes care specifically, as empowerment, by Bob Anderson and Marti Funnell and their colleagues.

Our person-centred philosophy informs all SD’s activities, including the structure and format of our books and workshops. The central question in designing any of our activities is ‘how can this material be made meaningful to the individuals experiencing it?. Answering that question gives rise to the order and type of activities included for learners in a workshop, for example and to the language and style of the writing in our books. As described by Rogers himself, a person-centred approach is not something to be applied, but ‘a way of being’. In this way, work flowing from philosophy feels very natural and it also offers a ready made source of evaluation and quality assurance.

As previous SD blogs have mentioned, with such a philosophical background, it is extremely welcome to see the current emphasis on personalisation in UK health policy, with documents describing and exhorting the importance of prioritising a person’s own wishes and needs, and sharing decision making, especially for long term conditions. Evidence supports the positive impact of this on people’s health and health service use and also on cost and satisfaction with their experience of care.

The Health Foundation in particular has released a number of practical reports on the subject, including the recent review ‘Helping Measure Person-Centred Care’ which includes detailed descriptions of the measures and tools available, advice for undertaking measurements locally and several hundred references. The same organisation also recently launched a dedicated online person-centred care resource centre, which seeks to promote the approach throughout the health system.

Our own contribution to spreading the word about person-centred care is embodied, for example, in our recent ebook about person centred practice, in other books and in training for personalised care planning (PCP). The latter is a way of organising care for those with diabetes and other long term conditions to prioritise their thoughts, wishes and needs as much as those of the health professional. It contrasts with the traditional model of the health professional being the dominant force in the relationship, with their knowledge and opinion prized more than that of the person consulting with them.

The PCP approach has been born out of the changing world of health, with people no longer suffering predominantly with acute, ‘fixable’ or short term conditions, but increasingly living with incurable but long term conditions that require a multitude of their own daily decisions to be made, without the guidance of a health professional. Hence, care services must be geared towards promoting such decision-making skills for self-management.

Most recently, it was a privilege to be a co-presenter of a workshop about consultations at the Annual Professional Conference of Diabetes UK*. Our 5-strong team created an experience for the participants, which enabled them to reflect on their own struggles with consultations and consider them through the issues raised in short but ‘real life’ scenarios by the presenters. Much discussion and insight ensued, especially about the final scenario which focused on ‘why isn’t a person-centred way of consulting more prevalent in diabetes / long term conditions care, given all the encouraging documents and evidence as to its success?’

The opinions given in response included that there is a gap between the rhetoric and the hectic reality of everyday practice, that change among health professional practice takes time and that reflection on practice to plan and evaluate changes is not valued sufficiently. Most memorably, the comment that we are so busy trying to listen well, that we may forget to shout about the importance of our consultations and their style. It was also a conclusion that showing person-centred practice by example could be powerful.

While we may not be able to directly change others, we can indeed change ourselves and / or continue to be true to our principles and philosophy. In that spirit and to answer the question in the title, no, we are not yet at our destination, but the activities described in this blog and others, are one more contribution to continuing the journey.


Health Foundation Person Centred Care Website

Person Centred Practice: A Concise Guide to Success

Personalised Care Planning Workshops

*You can download the ‘take home messages’ of workshop participants from this page