Implications for teaching and learning

Person-centered care

Authors: Tim Swanwick and Clare Morris

Date: 30th September 2016

We do not have an affiliation (financial or otherwise) with a

pharmaceutical, medical device or communications organization.

Je n’ai aucune affiliation (financière ou autre) avec une

entreprise pharmaceutique, un fabricant d’appareils

médicaux ou un cabinet de communication.

Person-centred care:

Implications for teaching and learning

Tim Swanwick, Senior Clinical Adviser, Health Education England

Clare Morris, Reader in Medical Education, Research &

Development, Queen Mary University of London

Person-centred care

‘Person-centred care’ is an approach that sees patients

as equal partners in the planning, development and

delivery of care, and active participants in the

management of their health and wellbeing

Activity 1 – a patient perspective

PAIRS

• Introduce yourselves to your neighbour.

• Consider a situation when you’ve been on the

receiving end of healthcare.

– In what way(s) was it ‘person-centred’?

– What would have made it more so?

@NHS_HealthEdEng

What is person-centred care?

@NHS_HealthEdEng

@NHS_HealthEdEng

‘we will do more to support people to

manage their own health -staying healthy,

making informed choices of treatment,

managing conditions and avoiding

complications. With the help of voluntary

sector partners, we will invest significantly

in evidence-based approaches such as

group-based education for people with

specific conditions and self-management

educational courses, as well as

encouraging independent peer-to-peer

communities to emerge.’ (p12)

http://www.nationalvoices.org.uk/principles-integrated-care

• GOSH -‘Me First’

• Heart Support Groups for Patients and Carers

• Barts Health - older persons care improvement

• *Coaching for Health

• *End of life care education programmes

• ‘Breaking Down the Barriers’ education programme

• *Dementia awareness training programme

• *Care navigation programme development

Examples of workforce initiatives

@NHS_HealthEdEng

Activity 2 – a clinician perspective

TABLES

• What does person-centred care mean in your area(s)

of clinical practice?

– Why does it matter?

– What examples can you offer from your own

organisation /context?

@NHS_HealthEdEng

But where is person-centred care in the

(medical) curriculum?

• Are you talkin’ to me?

• Pathways not pathologies

• Rediscovering compassion

• Whose care is it anyway?

• Partners in production

@NHS_HealthEdEng

I. Are you talkin’ to me?

@NHS_HealthEdEng

Interpreters,

advocatesRela

tives,

carers

Intra-

professionalInter-

professional

Communication

impairment

Age Specific

Handling

Emotions

Specific

clinical

contexts

Cultural

& Social

diversity

Sensitive

issues

Specific

application of explanation

Dealing with

uncertainty

Handling

mistakes

and

complaints

Ethical and legal Ethical and legal

principlesprinciplesProfessionalismProfessionalism

ReflectiveReflective

practicepracticeEvidence based Evidence based

practicepractice

ClosureClosure

Explanation

& planning

Explanation

& planning

StructuringStructuring

Information

gathering

&

history

taking

Information

gathering

&

history

taking

InitiationInitiation

Relationship

building

Relationship

building

Tasks of clinical

communication

Specific issues

Media

Communicating beyond the patient

Theory and

evidence

Respect for

others

Written

Presentations

Co

mp

ute

rs

Face-to-face

Tel

ephone

Communication

in the healthcare

curriculum

@NHS_HealthEdEng

@NHS_HealthEdEng

II. Pathways not pathologies

Comparable assessment outcomes for knowledge and clinical skills

Students felt better prepared to:

- work in ambulatory care settings

- understand how the health system works

- be competent practitioners

- know strengths and limitations

- deal with ambiguity

- engage in self reflection

Enhanced patient-centredness scores

Longitudinal integrated clerkships

A pause for thought

• We have offered examples of curriculum

design that emphasise a pathway approach

• What examples can you offer other from your

own experience/contexts?

@NHS_HealthEdEng

@NHS_HealthEdEng

III. Rediscovering compassion

‘Patients, carers and members

of the public will increasingly

feel like they are being treated

as vital and equal partners in the

design and assessment of their

local NHS. They should also be

confident that their feedback is

being listened to and see how

this is impacting on their own

care and the care of others.’

Stories of care

‘

‘Patients make two types of journey –

disease journeys and healthcare journeys.

The disease journey progresses through

diagnosis to treatment which leads to cure

or lifelong co-existence. The healthcare

journey is punctuated by events like

consultations, operations and

prescriptions, and each journey is unique.’

Muir Gray (2002) The Resourceful Patient

There’s a phrase that’s very fashionable at

the moment, I think, in health care which is

talking about ‘the patient journey’ and all

too often, I think, when a healthcare team

sits down to, as they say ‘map the patient

journey’, all they’re doing is listing the

encounters that the patient has with the

healthcare system.’

Ian Kramer, patient and storyteller (2004)

@NHS_HealthEdEng

A pause for thought

• What might we learn from patient narratives of care?

– How do we ensure they are heard?

– How might we act upon them as educators?

@NHS_HealthEdEng

@NHS_HealthEdEng

IV. Whose care is it anyway?

‘Many patients expect to play an active role in managing

their own health care…In order to be fully engaged,

patients require help from clinicians who recognise and

actively support their contribution and are willing to work

with them as healthcare partners…Patient partnership is

now on the agenda in medical education. Its importance is

emphasised in codes and statements of principle, it

appears in some of the new curricula, and methods of

assessing the relevant competences have begun to be

developed. Despite promising developments in some

medical schools and certain postgraduate training

programmes, particularly in general practice, we found a

general lack of awareness of needs and skill gaps and

few examples of good practice.’

@NHS_HealthEdEng

@NHS_HealthEdEng

V. Partners in production

Levels of engagement in care

• Curriculum design and development

• Selection of students and trainees

• Teaching, learning and assessment

• Quality assurance

Levels of engagement in (medical) education

Examples of patient and public involvement

• Patient and Public Forum

• End of Year review

• Patient mentor for Selected Study Component (Yr2)

• Commenting on teaching and learning materials

Thanks to Prof Anne Cushing

@NHS_HealthEdEng

Activity 3 – patients as partners

TABLES

• How do you currently involve patients in education

and training?

– What else might you easily do?

– What would you do if resources were available?

@NHS_HealthEdEng

• Are you talkin’ to me?

• Pathways not pathologies

• Rediscovering compassion

• Whose care is it anyway?

• Partners in production

@NHS_HealthEdEng

What makes us

healthy?

No decision

about me

without me

What matters

to you?

HEALTH

CARE SOCIAL

CARE

COMMUNITY

DEVELOPMENT

From

person-centred

care to healthy

communities

@NHS_HealthEdEng

@NHS_HealthEdEng

Principles of

person-centred care

@NHS_HealthEdEng

Activity 4

• Design an educational intervention for residents that

will promote an understanding of person-centred care

• Identify any challenges and how these will be

overcome

• Prepare a poster to ‘sell’ your programme to

colleagues in the room

@NHS_HealthEdEng

• Download the ICRE App,

• Visit the evaluation area in the Main Lobby, near Registration, or

• Go to: http://www.royalcollege.ca/icre-evaluations to complete the session evaluation.

Help us improve. Your input matters.

• Téléchargez l’application de la CIFR

• Visitez la zone d’évaluation dans le hall principal, près du comptoir d’inscription, ou

• Visitez le http://www.collegeroyal.ca/evaluations-

cifr afin de remplir une évaluation de la séance.

Aidez-nous à nous améliorer. Votre opinion compte!

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