Person-centredness - The ‘state’ of the art

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of person-centredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation

Interagency training to support the liaison and diversion agenda

Background In England and Wales there are an unacceptably large number of people in prison or in contact with the criminal justice system who have mental health issues. Integrated and effective interagency collaboration is required between the criminal justice system and mental health services to ensure early diagnosis, treatment, appropriate sentencing or diversion of these individuals from the criminal justice systems into mental health services. Liaison and diversion schemes are proposed as a means to integrated service provision through positioning mental health professionals within the criminal justice system. These schemes were recommended by the Bradley Report (2009) to be rolled out for all police custody suites and courts by 2014 in a National Diversion Programme. Working within these schemes, at the interface of the criminal justice system and mental health services, has its challenges (Hean et al., 2009) and the workforce from both systems must be prepared to address these. This was recognised by Bradley when he recommended that: “where appropriate, training should be undertaken jointly with other services to encourage shared understanding and partnership working. Development of training should take place in conjunction with local liaison and diversion services (p111; Bradley, 2009). The form this joint training should take is as yet unexplored. We have proposed elsewhere that joint training should equip different agencies and professionals with the skills and knowledge required to collaborate effectively, and not only focus on mental health awareness courses for those in police, prison and courts services (Hean et al. 2011). The criminal justice system and mental health services need to come together to learn about, from, and with each other in interagency training. Aim We present in this report our vision of what this joint interagency training between the criminal justice and mental health services should contain, how it may be delivered and its potential benefits. We explore the receptiveness of professionals from the criminal justice and mental health services to interagency training and explore their perceptions of the challenges to interagency working between the two systems. We focus particularly on one particular dimension: an interagency crossing boundary workshop and its theoretical underpinnings. We explore professionals’ expectations of this type of intervention as well as their perceptions of the knowledge and skills required to deliver the emerging liaison and diversion agenda in general and the content and delivery of interagency training in the future. These findings are synthesized into a series of recommendations and a model of interagency training that will prepare professionals in both agencies to respond to the liaison and diversion agenda more effectively and work collaboratively in the interest of the mentally ill offender. Method A crossing boundary workshop (Engeström, 2001) was delivered in December 2011 to a sample of 52 professionals from a range of non-health professionals associated with criminal justice system (probation, police and courts) and professionals from the mental health system or health domain (learning disability, substance misuse and mental health services). The receptiveness of criminal justice system and mental health service professionals to interagency training was assessed through the Readiness for Interprofessional Learning Scale (Reid et al., 2005) administered to respondents before the workshop. Perceptions of the challenges facing interagency working and the expectations of the workshop were explored through interactive exercises. Professionals from both agencies participated in a series of 6 parallel focus groups to discuss how to prepare the workforce to respond effectively to the liaison/diversion agenda and the constraints they worked under in terms of commissioning, delivering and attending this training. Findings Professionals from both the mental health and criminal justice systems need to build empathic relationships with staff from other agencies. They stressed the importance of actual face-to-face contact between professionals from different agencies to achieve this and saw interagency relationships as being built through increased knowledge of other agencies and the orchestrating of formal facilitated contact between them. They were strongly in favour of interagency training and its contribution to enhanced collaborative competence across the workforce and, in the long term, improved offender mental health. They believed interagency training would develop in the workforce a greater knowledge of other agencies and help them understand other professionals’ roles and responsibilities. They believed interagency training should occur pre-qualification, through into continued professional development and contain a variety of interagency training experiences. Professionals from both systems shared a high level of person centredness in their approach to their practice and stressed the importance of training being grounded and delivered in a real world environment. Participants acknowledged that training opportunities are under threat due to financial and time limitations and that joint commissioning, shared resources and economies of scale must be considered. Recommendations • A training package should be developed to prepare professionals both from the mental health and criminal justice system for the liaison and diversion agenda and integrated service provision. This training must offer a strong interagency component aimed at developing interagency collaboration skills and interagency knowledge. A four-stage training model is proposed in this report. This incorporates pre-registration or undergraduate training for trainee professionals in the mental health services and criminal justice system, general awareness training, interagency training for continuing professional development and the development of interagency reflective practice opportunities. This model may be supplemented by a variety of on-line resources, some of which are described. • These interagency training models should be developed in partnership between universities and local facilitators from within the criminal justice system and mental health services to provide both the theoretical and evidence based rigour associated with developing collaborative practice curricula alongside the real world contextual knowledge required of these programmes. • In the long term, interagency training should be delivered in practice by practitioners to ensure the continued validity and sustainability of these programmes. Training should be sensitive to changes in the workforce due to turnover and the pressures of organisational change. • In times of economic constraint, training should be well targeted at staff and organisations essential to the liaison and diversion agenda. • An interagency commissioning approach will be required to deliver the training package outlined to support the liaison and diversion agenda, and especially if there is to be joint training and sharing of resources

Review of developments in person-centred healthcare

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Tanya McCance - ORCID: 0000-0002-9787-2627 https://orcid.org/0000-0002-9787-2627In recent years, there has been a shift in orientation towards person-centredness as part of a global move towards humanising and centralising the person within healthcare. Person-centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. This article considers the emergence of person-centredness, including person-centred care, and how it is positioned in healthcare policy around the world, while recognising a dominant philosophical positioning in Western philosophy, concepts and theories. Second, the evolution of person-centred healthcare over the past five years is reviewed. Published evidence of person-centred healthcare developments is drawn on, as well as information gathered from key stakeholders who engaged with the partner organisations in an Erasmus+ project to develop a European person-centred healthcare curriculum framework. Five themes are identified, which underpin the literature and stakeholder perspectives: Policy development for transformation Participatory strategies for public engagement Healthcare integration and coordination strategies Frameworks for practice Process and outcome measurement These themes reflect the World Health Organization’s global perspective on people-centred and integrated healthcare, and give some indication of development priorities as person-centred healthcare systems continue to be developed.https://doi.org/10.19043/ipdj.10Suppl2.00310pubpubSuppl

A collective artefact design of decision support systems: design science research perspective

Purpose - The knowledge of artefact design in design science research can have an important application in the improvement of decision support systems (DSS) development research. Recent DSS literature has identified a significant need to develop user-centric DSS method for greater relevance with respect to context of use. To address this, this study develops a collective DSS design artefact as method in a practical industry context. Design/methodology/approach - Under the influence of goal-directed interaction design principles the study outlines the innovative DSS artefact based on design science methodology to deliver a cutting-edge decision support solution, which provides user-centric provisions through the use of design environment and ontology techniques. Findings - The DSS artefact as collective IT applications through the application of design science knowledge can effectively be designed to meet decision makers’ contextual needs in an agricultural industry context. Research limitations/implications - The study has limitations in that it was developed in a case study context and remains to be fully tested in a real business context. It is also assumed that the domain decisions can be parameterised and represented using a constraint programming language. Practical implications - We conclude that the DSS artefact design and this development successfully overcomes some of the limitations of traditional DSS such as low user uptake, system obsolescence, low returns on investment and a requirement for continual re-engineering effort. Originality/value - The design science paradigm provides structural guidance throughout the defined process, helping ensure fidelity both to best industry knowledge and to changing user contexts

A discussion of the synergy and divergence between Lean Six Sigma and person-centred improvement sciences

Background: This paper discusses if and how the improvement sciences of Lean Six Sigma and person-centred approaches can be melded or blended in the health care context. The discussion highlights the relationship between each approach to improvement science in terms of their respective purposes, intentions and probable outcomes; positioning these as either synergies or divergences. Comparison of the key theoretical and methodological principles underpinning each approach to improvement is also considered and implications for future practice, policy and research are drawn out. The discussion is informed by part of the findings of a realist review of relevant literature.Conclusions: Lean Six Sigma as a process improvement methodology appeals to a wide range of stakeholders in healthcare internationally. Four key synergies and three key divergences between Lean Six Sigma and person-centred approaches were found. The discussion here highlights the need for further research into Lean Six Sigma implementation and its possible contribution to developing person-centred cultures.Impact: Adoption of Lean Six Sigma in health care by stakeholder groups, external to nursing, has been taking place. At the same time there has been a loss of Lean’s original intention of respect for people in favour of a technical efficiency focus on reducing waste and variation. Our findings of four key synergies and three key divergences between both approaches indicate where synergies can be maximised and divergence narrowed to improve implementation and enhance methodological coherence. Researchers, policy makers and practitioners should be aware that use of Lean Six Sigma alone may have a limited impact on developing personcentred care and culture. Use of Lean combined with person-centred approaches may appeal to a wider range of stakeholders. Yet, their combined use and effectiveness has not as yet been evaluated.This paper was supported by Queen Margaret University Edinburgh and University College Dublinhttps://doi.org/10.3844/ijrnsp.2020.10.2311pubpu

Can the shift from needs-led to outcomes-focused assessment in health and social care deliver on policy priorities?

Assessment, planning and review are at the heart of the provision of services and support in health and social care in the community, providing key means through which professionals interact with people using their services. These interactions provide opportunities for relationship building, with evidence that involving the person in identifying their priorities and required support can itself improve outcomes. At the same time, professionals use assessment to assess eligibility for support, and assessment has also increasingly become a mechanism for data gathering, to inform a range of requirements at local and national level including planning, commissioning, inspection and performance management. Despite attempts to move assessment from being service-led to person-centred, meeting such a broad range of objectives and requirements can create tensions at the front line, influencing both how interactions are conducted, and the resulting decisions. More recently, there has been an increasing emphasis on outcomes for individuals using health and social care services, including a shift from needs-led to outcomes-focused assessment. This paper considers a recent literature review about shared health and social care assessment, including emerging evidence from the implementation of outcomes-focused assessment in the UK. It concludes that there are promising signs that the recent shift to outcomes-focused assessment might resolve longstanding tensions around assessment, delivering on person-centred objectives and resulting in more efficient and effective use of resources

Rakennuksen käyttöjärjestelmän luonti: kokonaisvaltainen lähestymistapa

Purpose of this thesis is to examine requirements for a building operating system from a holistic perspective. To understand the context of the subject, an extensive literature review was carried out which explores the evolution of operating systems alongside the history of computing, unravelling the concept of an operating system. In addition, various building information systems, including building automation systems and internet of things systems are reviewed in order to understand modern and future trends of building technology. Furthermore, literature review investigates telecommunications and digital identity authentication through their evolution and standardisation towards interoperability, to provide knowledge on how to achieve interoperability in building systems. An interview study was conducted as the empirical part of the study in order to complement the theoretical framework of the thesis. A dozen building digitalisation experts were interviewed, inquiring their insights on the current and future situation of building systems. More closely, open systems, open data, platform ownership, disruption, killer applications, user-centredness, and Finland’s opportunities were discussed in respect of the building operating system. Building operating system requires connection between various technology inside a building, and collaboration between various parties who use and manage the building. The system should exploit open standards and enable open data. User-centred development should be encouraged for the benefits of end users. The system needs to expand globally to achieve critical mass and unleash its full potential as a platform. Each building with similar properties should have the same features, being able to use same services and applications in any building with an operating system, thus enabling portability. The system requires convenient software development kits, application programming interfaces and abstractions for the needs of software and service developers. A vibrant developer community is required to expand the platform and enable a wide range of services and applications.Tämän diplomityön tarkoituksena on tutkia rakennuksen käyttöjärjestelmän holistisia vaatimuksia. Laaja kirjallisuuskatsaus tehtiin aiheen ymmärtämiseksi, joka tutkii käyttöjärjestelmien evoluutiota rinnakkain tietojenkäsittelyn historian kanssa, tarkoituksena hahmottaa käyttöjärjestelmän käsitettä. Lisäksi, eri rakennusten tietojärjestelmiä, mukaan lukien rakennusautomaatiojärjestelmiä ja esineiden internet -järjestelmiä käytiin läpi ymmärtääkseen nykyisiä ja tulevia trendejä rakennusteknologiassa. Edelleen kirjallisuuskatsaus tutkii televiestintää ja sähköistä tunnistautumista niiden kehityksen ja standardisoinnin kautta kohti yhteentoimivuutta, tarjoten tietoa siitä, miten yhteentoimivuutta voitaisiin kehittää rakennusjärjestelmissä. Haastattelututkimus tehtiin diplomityön empiirisenä osuutena, jonka tarkoituksena oli laajentaa työn teoreettista viitekehystä. Tusina rakennusten digitalisaation asiantuntijaa haastateltiin, joilta kysyttiin rakennusjärjestelmien nykytilasta ja tulevaisuudesta. Lähemmin, keskustelut käsittelivät avoimia järjestelmiä, avointa dataa, alustan omistajuutta, disruptiota, menestyssovelluksia, käyttäjäkeskeisyyttä sekä Suomen kansainvälistä potentiaalia rakennuksen käyttöjärjestelmän näkökulmasta. Rakennuksen käyttöjärjestelmä vaatii rakennuksen sisällä olevien eri teknologioiden yhteenliittämisen, sekä yhteistyötä rakennusta käyttävien ja hallinnoivien osapuolten välillä. Järjestelmän pitäisi hyödyntää avoimia standardeja ja mahdollistaa avoimen datan käytön. Käyttäjäkeskeistä suunnittelua pitäisi kannustaa loppukäyttäjien etuja suosien. Järjestelmän täytyy levitä globaalisti saavuttaakseen kriittisen massan ja ottaakseen käyttöön sen koko potentiaalin. Jokaisella samankaltaisella rakennuksella täytyisi olla käytössään yhtäläiset ominaisuudet, mahdollistaen samojen palveluiden ja sovellusten käytön missä tahansa käyttöjärjestelmää käyttävässä rakennuksessa, täten mahdollistaen siirrettävyyden. Järjestelmä vaatii sopivat ohjelmointirajapinnat, abstraktiot ja ohjelmistokehykset sovellus- ja palvelukehittäjien tarpeita varten. Laaja kehitysyhteisö vaaditaan alustan levittämiseksi ja sovellustarjonnan laajentamiseksi

Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement.

BACKGROUND: Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. METHODS: We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. RESULTS: When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. CONCLUSIONS: When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the heart of policy and services may discourage consumers from claiming rights to quality care by contributing to public unwillingness to challenge the status quo in service provision. If the democratic potential of patient and public involvement initiatives is to be realised, it will be crucial to help citizens to engage critically with how neoliberal rationalities can undermine their abilities to demand quality care

Design as an agent for public policy innovation

Described as units developing public policies in a design-oriented manner, Policy Labs are tasked to innovate to gain in policy effectiveness and efficiency. However, as public policymaking is a context-dependent activity, the way in which these novel organisations operate significantly differs. This study discusses the emergence of design approaches for policy innovation. The purpose is to map how Policy Labs in Europe introduce design approaches at distinct stages of the policymaking cycle. For this study, 30 organisations in Europe operating at various levels of government were surveyed. Based on the public policymaking process model, it investigates which design methods are Policy Labs deploying to innovate public policies. The study exposed a gap in the awareness of the utilised methods' nature. It also showed that the use of design methods is of less importance than the introduction of design mindsets for public policy innovation, namely ‘user-centredness’, ‘co-creation’, and ‘exploration’.</div