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Reforming and Transforming Care: Considering Person -
CentrednessProfessor Brendan McCormack
Head of the Division of Nursing, Queen Margaret University, Edinburgh
Professor II, Buskerud Vestfold University College, Drammen, Norway;Extraordinary Professor, University of Pretoria, South Africa;
Adjunct Professor of Nursing, University of Technology, Sydney; Visiting Professor, University of Aberdeen
Tradition evolves with time and place while holding strongly to certain formal, cultural, and personal principles. Nostalgia seeks the security of past forms without inherent principles” (Callthorpe, 2008)
Are our services more responsive to persons?
� ‘Person-centred moments vs ‘Person-centred cultures’� The ‘fragility’ of person-centredness – dependent on:
� Consistency of care delivery� Effectiveness of coordination� Quality of leadership (team/unit/organisational/strategic)� Knowledge, skills and expertise of care team� Existence of a person-centred culture� Systems-wide commitment to person-centredness� Existence of flexible models of care delivery
(McCance et al, 2012)
Misuse of power and lack of autonomy
Horizontal violence and oppressed behaviours
Transactional leadership
(Brown & McCormack 2010)
Psychologically Unsafe Environments: characterised by …
There is a need for organisationsto change structurally and create more positive conditions if transformational leadership is to be sustained. Otherwise, nurse leaders will become frustrated in an environment that is expanding regulatory mechanisms
(Hewison & Griffiths 2004)
“Why does one <leader> bolster our spirits, calm our nerves and nourish our soul? Why does another drain us of our vitality, leaving us feeling flat?
(Adapted from Quillien, 2008)
https://www.youtube.com/watch?v=krPt8z0okoQ
PresencingGroup & individual reflection to transform
self & will
SensingCreate space to see connection with
existent reality & transform perceptions
RealisingBringing new action to
transform context
Seeingourseeing
Embodyingthe new
(project completion)
PROTOTYPING
Letting go
Envisioning reaching clarity & connection to inner ‘knowing’
Suspending
redirecting
Letting come
CourageCommitmentFacilitative leadership
Capacities of the U movement (Brown & McCormack 20 10, adapted from Senge, Sharmer et al 2005).
)
The Fifteen Properties of Nature• Strong Centres• Levels of Scale• Boundaries• Good Shape• Positive Space• Local symmetries• Alternating Repetition• Deep interlock & ambiguity
• Contrast• Gradients• Roughness• Echoes• Voids• Simplicity & Inner Calm• Not separateness
‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander
A Strong Centre
All life tends to form multi-levelled structures of systems within systems … the different ‘nested’ levels help each other, perform different tasks, and are necessary to the functioning of the whole … (Quillien 2008)
Levels of Scale
Boundaries
A boundary
helps focus
attention on the
centre
Good Shape
Positive Space
Accomplished dancers will naturally create between and around themselves a flow of changing positive spaces. Beginners not well centred in themselves and out of sync with their partners will be less connected by the spaces in-between
Local Symmetries
Alternating Repetition
Roughness
Roughness
pertains to the
resolution of
problems when
diverse elements
come together in
three-dimensional
space
Every successful centre depends on the existence of a
still place
Simplicity and Inner-calm
Not-SeparatenessNot-seperateness is
experiencing a living
whole as being at one
with the world. Ponds,
such as this one, cannot
be sharply isolated from
their surrounds. In the
same way, old farming
villages are not separate
from their fields.
• A coaching model that promotes a sense of safety, openness, and trust.
• Use of authentic methods that support a learner-centred approach.
• Facilitation of leader autonomy, participation and collaboration.
• Engagement with activities that encourage the exploration of alternative personal perspectives, problem-posing, and critical reflection
• Communicative spaces for democratic dialogue and experimentation
“You never change things by fighting the existing reality. To change something, build a newmodel that makes the existing model obsolete
(Buckminster Fuller, cited in Quillien, 2008)