Person-centred practice

Person-centred practice puts the person at the centre of everything we do.

It recognises that every patient is a unique and complex person. It respects and responds to their needs, preferences and values and the knowledge they bring about their health and healthcare needs with the aim of delivering individualised care that is holistic.

Person-centred practice can minimise the functional decline of older people in hospital and help us tailor care to meet each person’s needs. It can result in decreased mortality, readmission rates and healthcare-acquired infections; improved functional status and increased patient and carer satisfaction.¹

For this reason person centred practice is integral to meeting many of the actions in the National Safety and Quality Health Standards, especially Comprehensive Care and Partnering with Consumers.

This topic gives an overview of person-centred practice and recommends actions that we and our organisations can take, in addition to health service policy and procedures, to provide quality person-centred care to our older patients.

Person-centred practice and functional decline

Person-centred practice is important because it can improve experiences and outcomes for our patients and improves our own satisfaction and morale.

• Person-centred practice is crucial in reducing functional decline in older people in hospital, for example:
  • if we know what types of foods and drink a patient prefers then we can look at how they access these while in our care so they are less likely to lose weight or become dehydrated in hospital
  • if we know that a patient likes to take a walk every day we should encourage them to keep active while in hospital so they can continue this when they go home
  • if we listen to the family’s concerns about a change in a patient’s level of alertness, we can investigate delirium
  • if we understand how a patient usually takes their medication, we can look to alter how we might administer them.
• Person-centred practice can mean decreased mortality, readmission rates and healthcare-acquired infections; improved functional status; a shorter length of stay in hospital; and increased patient and carer satisfaction.¹
• Person-centred practice improves the patient’s experience, reduces their anxiety and enhances trust – all important in an unfamiliar hospital environment.
• Person-centred practice leads to better outcomes through partnerships and shared decision-making.

‘When you are caring for somebody who is acutely unwell, it is hard to sometimes look at them as a person and not just as a bunch of observations’ – Luke, graduate nurse²

Implementing person-centred practice

Person-centred practice is a natural part of our day-to-day work

We can make person-centred practice a part of our work through our everyday interactions with patients and their family and carers, for example:

• smile and introduce ourselves
• wear a name tag that people can see and read
• explain your role to the patient
• ask the patient how they are feeling today - both physically and emotionally
• see the patient as a person who has a life outside hospital
• treat the patient as an equal partner
• listen to the patient and respect the knowledge they bring about their own health
• listen to their family and carers
• acknowledge that being in hospital can be a frightening and uncertain time for patients and their families
• acknowledge that feeling lonely or isolated in hospital can be a common experience
• make sure the patient has all the information they need to make informed choices.

‘ find that the families and the carers that come along to us, with the patients, have a wealth of knowledge. When the patients can’t tell us what they need, their carers often can.
- Dora, clinical resource nurse²

Person-centred practice must be embedded at an organisational level

Person-centred practice should be embedded in our organisations.³ To achieve this, ‘senior leaders need to unite them around a common sense of common purpose’.⁴

Embedding person-centred practice

The World Health Organization’s framework for creating age friendly communities urges organisations like hospitals to consult with ‘older people on ways to serve them better’ as it ‘contributes to empowering older people and fostering age-friendly respect and social inclusion’.⁴

Ask how your organisation is embedding person-centred care in day-to-day practice:

• Are there policies and procedures for involving patients and carers in their own care?
• Is training provided to staff on person-centred care?
• Do leaders explain and promote the importance of person-centred practice?
• Do we seek and use patients’ and carers’ feedback to improve our practice?
• Do we engage patients in staff education programs?
• Do we have systems to collect and report patient experience data?
• Are person-centred principles part of core business and embedded in organisational and employment documentation and performance review processes?
• Do we have a culture of reflective practice, continuous improvement and lifelong learning?

Achieving person-centred practice

Many Victorian health services are surveying their patients and families to improve their understanding of their patient’s needs and adapt their service to these needs.

As part of the Victorian Department of Health’s Improving care for older people initiative, health services across Victoria undertook to implement person-centred practice in settings involving older people. Some examples include:

• Alfred Health has a Patients Come First plan and has developed an organisation-wide patient experience survey, which has been translated into five different languages. In collaboration with the Department of Health, Alfred Health also produced a DVD resource called Best Care for older people: the patient experience
• Eastern Health implemented performance monitoring strategies including mystery shopper observations and patient interview, leadership walk-rounds, patient experience trackers which capture real-time information, and monthly patient experience surveys.
• Melbourne Health conducted a ‘Board to Bedside Consultation’ in 2012, which surveyed more than 300 staff and consumers about what matters to them when receiving healthcare. It also developed an audiovisual resource, Lola’s Story, which emphasises patient experience and has been used to open executive/board meetings. Melbourne Health also runs tailored sessions on person-centred practice.
• Peninsula Health has embedded person-centred practice principles in employment position descriptions; they are also a formal component of orientation.
• Western District Health Service has developed and implemented a Partnering with Consumers policy, and principles of person-centred care are included in orientation for new staff. Fifty staff have attended education sessions on person-centred care, and older people are represented on the Consumer Advisory Committee.
• Barwon Health has introduced electronic bedside assessments on tablets to increase the time nursing staff spend with their patients and their families when gathering information and developing care plans and facilitate shared decision making.

Measuring person centred practice

Measuring person-centred practice is helpful in assessing services, the outcomes of particular initiatives and whether or not people’s needs are being met¹. It is important in improving the patient experience and reducing the risk of functional decline, creating a culture of constant learning, keeping services accountable, encouraging cultural change and boosting morale.

However, before measuring person-centred practice, we need to know what we are measuring. Do we want to understand what person-centred care means to different people, the type of care patients expect or experience, or the impact?

The tool we choose will depend on whether we are measuring definitions, preferences, experiences or outcomes⁵.

There are three common methods used to measure person-centred practice:

• surveys and interviews with patients and carers
• surveys and interviews with health professionals
• observation of practice.⁵

Other methods include focus groups and reviewing patient notes⁵.

A variety of tools have been used in the field, but there is no one specific resource that can evaluate all aspects of person-centred practice.

Person centred practice and discharge planning

The chronic nature of many of the conditions our older patients experience means that we must encourage them to participate in their care in hospital and involve them and their families and carers, as appropriate, in the process of discharge planning.

Patients and their families and carers play a critical role in keeping themselves well once they are discharged. Consider how aspects of each person's unique biological and psychosocial needs interact with their environment. By understanding their particular values, preferences and social supports we can shape meaningful discharge plans, encourage participation in social activities of interest and equip them with realistic strategies they can implement once discharged to keep well. Each of the clinical topics on this site emphasises the role of partnership in this process.