What is person-centred practice?

Person-centred practice is treatment and care provided by health services that places the person at the centre of their own care and considers the needs of the older person's carers [2]. It is also known as:

• person-centred care
• patient-centred care
• client-centred care.

Person-centred practice is treating patients as they want to be treated.

Why is person-centred practice important?

It makes sense that:

• When you get to know the patient well, you can provide care that is more specific to their needs and therefore provide better care.
• By promoting and facilitating greater patient responsibility, patients are more likely to engage in treatment decisions, feel supported to make behavioural changes and feel empowered to self manage.

A recent literature review found that person-centred practice can make a positive difference to health outcomes and patient satisfaction and can improve health care workers' sense of professional worth [3].

Philosophy of care

Person-centred care underpins the information presented in The toolkit. The National Health and Hospitals Reform Commission recommended 'people and family centred care' as the first principle for guiding the delivery of health care [4].

It describes this as health care that is:

• Responsive to individual differences, cultural diversity and preferences of the people receiving care.
• Easy to navigate.
• Provided in the most favourable environment.

We 'are human beings, our patients or clients are human beings, and it is shared humanity that should be the basis of the relationship between us' [5].

What are the principles of person-centred practice?

Getting to know the patient as a person

Health care workers need to get to know the person beyond the diagnosis and build relationships with patients and carers.

Sharing of power and responsibility

Respecting preferences and treating patients as partners in setting goals, planning care and making decisions about care, treatment or outcomes.

Accessibility and flexibility

Meeting patients' individual needs by being sensitive to values, preferences and expressed needs. Giving patients choices by providing timely, complete and accurate information they can understand, so they can make choices about their care.

Coordination and integration

Working as a team to minimise duplication and provide each patient with a key contact at the health service. Teamwork allows service providers, and systems working behind the scenes, to maximise patient outcomes and provide positive experiences.

Environments

Physical and organisational or cultural environments are important, enabling staff to be personcentred in the way they work.

Further information

For further reading on the principles of person-centred practice, refer to Person-centred practice: Guide to implementing person-centred practice in your health service.

What can I do to become more person-centred in my practice?

Culture change requires a long-term effort. It starts with analysing individual, team or organisational practices to identify areas requiring development.

For this reason, the recommended tools allow each individual, team and organisation to identify and improve in areas that are uniquely important.

The health care decision-making process can be a positive example of promoting truly person-centred care. For example, person-centred treatment decision making and care planning helps ensure that people:

• Are able to express their wishes, including consent or refusal of treatment, even in advance, if they want to.
• Can participate in the decision-making process to the extent they wish to, and are able to include whoever is important to them in this process.
• Can appoint a substitute decision maker if they wish to.
• Receive treatment that accords with their values, goals and beliefs.
• Do not receive unwanted treatment.
• Have their wishes for future treatment known across the health and broader community sectors.

Refer to the following resources and tools to assist in improving person-centred care in practice.

Further information

Person-centred practice: Guide to implementing person-centred practice in your health service Advancing practice of patients and family centred care: How to get started Patient and family centred care: A hospital self-assessment inventory Improving the environment for older people in health services: An audit tool Benchmarking person-centred care statewide survey Benchmarking person-centred care statewide survey: Instructions for use Nursing best practice guideline: Client centred care Essence of care: Patient-focussed benchmarks for clinical governance Patient rehabilitation charter for in-patients Patient rehabilitation charter for in-patients: Staff accompaniments Human rights and responsibilities charter: Protection of freedoms and rights for everyone in Victoria.
Refer to the following table for recommendations of resources to assist in improving personcentred care in practice. Recommended resources can be located on the accompanying USB.

Principles of person-centred practice	Key elements	Top resources
1. Getting to know  the person	Patient and family or carer support	Client Centred Care: Nursing Best Practice Guideline Planetree organisation www.planetree.com
	Holistic assessment	Essence of Care Patient-focused benchmarks for clinical governance
2. Sharing power and responsibility	Goal setting	Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/ pchc/pchc_good_practice.htm
	Care planning and decision making	Consumer, Carer and Community Participation Information www.health.vic.gov.au/consumer/index.htm Respecting Patient Choices: An Advanced Care Planning Initiative Ottawa Health and Research Unit
	Case conference	Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/pchc/pchc_good_practice.htm
	Patients, families and carers as advisors and in quality improvement	Consumer, Carer and Community Participation Information www.health.vic.gov.au/consumer/index.htm Institute for Family-Centered Care www.familycenteredcare.org Developing A New Approach To Koori Hospital Liaison Services Final Report
	Patients rights and responsibilities	Rehabilitation Charter
3. Service flexibility and accessibility	Information and education for patients and families	Consumer, Carer and Community Participation Information www.health.vic.gov.au/consumer/index.htm Victorian Charter of Human Rights and Responsibilities www.justice.vic.gov.au/humanrights Client Centred Care: Nursing Best Practice Guidelines
	Language and different cultures	Centre for Culture, Ethnicity and Health www.ceh.org.au The Picker Institute www.pickereurope.org
	Resource availability to patients and families	Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/pchc/pchc_good_practice.htm Client Centred Care: Nursing Best Practice Guidelines Planetree organisation www.planetree.com
	Triage	Person-Centred Health Care Good Practice  www.nari.unimelb.edu.au/pchc/pchc_good_practice.htm
4. Coordination  and integration	Charting and documentation and minimising duplication	Client Centred Care: Nursing Best Practice Guidelines Essence of Care: Patient-focused benchmarks for clinical governance www.institute.nhs.uk/index.php?option=com_joomcart& Itemid=194&main_page=document_product_info& products_id=230>
	Making sense of services including key person and single access point	The Picker Institute www.pickereurope.org Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/pchc /pchc_good_practice.htm Client Centred Care: Nursing Best Practice Guideline
	Discharge planning and post discharge follow up	Incorporating patient and care concerns in discharge plans: Patient centred checklist Improving Care for Older People www.health.vic.gov.au/older/improvingcare.pdf Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/pchc/pchc_good_practice.htm
5. Environments	Leadership, mission statements, recruitment, use of volunteers, orientation, quality	Planetree organisation www.planetree.com Consumer, Carer and Community Participation Information www.health.vic.gov.au/consumer/index.htm American Hospital Association www.aha.org
	Attitudes and organisation culture	Enhancing Practice Program Victorian Charter of Human Rights and Responsibilities
	The physical environment	Improving the Environment for Older People in Health Services: An Audit Tool www.health.vic.gov.au/older Planetree organisation www.planetree.com Institute for Family Centered Care www.familycenteredcare.org
	Transport	Person-Centred Health Care Good Practice www.nari.unimelb.edu.au/pchc/pchc_good_practice.htm

How can I measure person-centred practice?

Evaluating the broader picture of person-centred care as a philosophy of care takes additional planning. Generally, evaluation involves repeating the assessment you initially completed to see if the results differ.

Further information

For further information and guidance on evaluating person-centred practice in health services, refer to Person-centred practice: Guide to implementing person-centred practice in your health service.

Patient and carer satisfaction surveys can also be used to help measure person-centred practice in a health service:

COAG LSOP Initiative Assessment Domain Excel Database Instructions Patient satisfaction survey Patient satisfaction survey: Pre-intervention database Patient satisfaction survey: Post-intervention database Carer satisfaction survey Carer satisfaction survey: Pre-intervention database Carer satisfaction survey: Post-intervention database Post-discharge patient satisfaction survey Post-discharge patient satisfaction survey: Pre-intervention database Post-discharge patient satisfaction survey: Post-intervention database Post-discharge carer satisfaction survey Post-discharge patient satisfaction survey: Pre-intervention database Post-discharge patient satisfaction survey: Post-intervention database Tell us about your stay.

Further reading

Refer to the following resources to assist improving person-centred care in practice with regard to medical treatment, consent and advance care planning: Information published by the Office of the Public Advocate, Victoria.
www.publicadvocate.vic.gov.au Phone: (03) 9603 9500 or 1300 309 337 Can your adult patient consent? Medical/dental treatment for patients who cannot consent: The person responsible Enduring Power of Attorney: Medical treatment Refusal of medical treatment Guardianship and administration Australian Resource Centre for Health care Innovations (ARCHI) www.archi.net.au Consent: Patients and doctors making decisions together Darzins, P, Molloy, W, & Strang, D, 2000, Who can decide? The six step capacity
assessment process, Memory Australia Press, South Australia End of life treatment and care: Good practice in decision-making
(A draft for consultation).

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