Publicatie datum

Person-centredness in healthcare policy, practice and research.

McCormack, B., Dulmen, S. van, Eide, H., Skovdalh, K., Eide, T. Person-centredness in healthcare policy, practice and research. In: B. McCormack, S. van Dulmen, H. Eide, K.I. Skovahl, T. Eide. Person-Centred Healthcare Research. Tom Eide (Eds). Hoboken, NJ: Wiley Blackwell, 2017. 3-17
Twentieth century (western) societies are increasingly individualised. This is not only reflected
in general politics, opinions and lifestyles but also in healthcare. Partly this is a result of an
increased knowledge about the human genome, allowing for more individualised treatment
plans (‘personalised or precision medicine’), and partly because of scarce healthcare resources resulting in increased self‐management and more patient responsibility for their own health.
A welcome side effect of this individualisation is an increased attention to the person behind
the patient and, related to this, more attention to individual needs and preferences in treatment
and care. This person‐centred movement is not new, but has so far been captured through
discourses of patient‐centredness (in contrast to doctor‐ or disease‐centredness) and patients’ rights, which already represent important paradigm shifts in healthcare. Person‐centredness has, however, continued to develop and also incorporates concepts like positive health, wellbeing and individualised care planning as well as the inclusion of the person of the healthcare provider. Person‐centredness can thus be summarised as promoting care of the person (of the totality of the person’s health, including its ill and positive aspects), for the person (promoting the fulfilment of the person’s life project), by the person (with clinicians extending themselves as full human beings with high ethical aspirations) and with the person (working respectfully, in collaboration and in an empowering manner) (Mezzich et al., 2009). Person‐centredness implies recognition of the broad biological, social, psychological, cultural and spiritual dimensions of each person, their families and communities. The person‐centred approach is closely linked to Carl Rogers’ humanistic psychology and person‐centred therapy (Rogers, 1961) with a focus on the fulfilment of personal potentials including sociability, the need to be with other human beings and a desire to know and be known by other people (the origins of personcentredness will be further explored in Chapter 2). It also includes being open to experience, being trusting and trustworthy, being curious about the world, being creative and compassionate.

This perspective has been particularly influential in the field of dementia care.
Person‐centredness has permeated all fields in healthcare. For example, person‐centred nursing has been defined as an approach to practice that is established through the formation and fostering of healthful relationships between all care providers, patients/clients/families and significant others McCormack and McCance, 2017). It is underpinned by values of respect for persons, individual right to self‐determination, and mutual respect and understanding. Person‐centred nursing practice is about developing, coordinating and providing healthcare services that respect the uniqueness of individuals by focusing on their beliefs, values, desires and wishes, independent of age, gender, social status, economy, faith, ethnicity and cultural background and in a context that includes collaborative and inclusive practices.
In addition, person‐centred nursing practice aims to plan and deliver care that takes account of the person’s context including their social context, community networks, cultural norms and material supports. Person‐centred medicine is anchored in a broad and holistic approach that is critical of the modern development of medicine, which has been dominated by reductionism, attention to disease, super‐specialisation, commoditisation and commercialism (Mezzich et al., 2009). These authors argue that this has resulted in less attention being paid to ‘whole‐person needs’ and reduced focus on the ethical imperatives connected to promoting the autonomy, responsibility and dignity of every person involved.
Changes in the delivery of healthcare services have been significant over the past 25 years. The increasing demands on emergency services, reduction in the number of available hospital beds, shorter lengths of stay, increased throughput and the erosion of Health Services’ commitment to the provision of continuing healthcare have all impacted on the way healthcare services are provided and the practice of healthcare professionals. In addition, the prevailing culture of consumerism has enabled a shift away from society’s collective responsibility for the provision of an equitable and just healthcare system to one that is based on individual responsibility, increasingly more complex models of insurance‐based services and a growth in healthcare as a private for‐profit business.
The combined effects of these strategic changes to healthcare globally, major changes to the organisation of services, a dominant focus on standardisation and risk reduction with associated limits on the potential for creative practice have all had an impact on the ability of healthcare practitioners to develop person‐centred approaches. McCormack (2001) suggested that there was a need for ‘a cultural shift in philosophical values’ in healthcare if authentic person‐centred healthcare is to be realised for all persons.

The following quote from one of the participants in McCormack’s research highlighted the need for this shift:
People need to be able to take on a different view of things and able to see a different kind of potential when the whole system is kind of set up in a particular way and how do you change it?
Because you’ve got teachers and educators and you’ve got role models and supervisors and people in clinical settings who have all been socialised in this system and what I think it needs is actually a complete culture shift, a shift in philosophical values, to see people as people who have responsibility for their own health and come into a system that should not totally remove
that, that kind of ownership.
Since then there have been significant developments globally in advancing person‐centred healthcare within a dominant philosophy of people as persons who have responsibility for their own health. (aut. ref.)