Implications for teaching and learning Person-centered care · Person-centered care Authors: Tim...
Transcript of Implications for teaching and learning Person-centered care · Person-centered care Authors: Tim...
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!
You could be entered to win 1 of 3 $100 gift cards.
Vous courrez la chance de gagner l’un des trois chèques-cadeaux d’une valeur de 100.
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