Person-centred over patient-centred care: not just semantics

The term ‘person-centred care’ considers a person’s needs, values and preferences, and identifies that the healthcare professional and person must work together to plan optimal care.

Person-centrerd concept

During a TED talk in 2009, marketing consultant and motivational speaker Simon Sinek described how, despite strong competition in its market, Apple became a world leader in must-have electronic devices. 

Sinek described how, instead of coming up with a product and telling everyone how great it is and why they must buy it, Apple asked why people would choose to buy from them. They identified that it was because they were challenging the status quo in their market and then they described how they would do this: by creating simple, stylish, innovative products that the creators want to use themselves, and providing an easily accessible, high-quality, personal service. Finally, they talked about what they make.

But how does the technology giant’s marketing approach relate to person-centred care in health? What is person-centred care and why talk about the person, not the patient?

Balance of power

To answer these questions, we need to ask how we, as healthcare professionals, perceive ourselves when we require treatment — would we prefer to be called people or patients? While we may consider ourselves to be patients when we access healthcare, most of us are unlikely to define ourselves in this way. What do we want from healthcare professionals when we access healthcare? The word ‘patient’ has specific, but perhaps unrecognised, connotations. When we think of ‘patients’ rather than ‘people’, there is a mental shift in the balance of power from two equal people to ‘helper’ (with health knowledge, skills and experience) and ‘person needing help’ (needing our health knowledge, skills and experience). This unconsciously encourages a more paternalistic attitude to the person we are treating.

The person in context

The result of this is a shift in preference towards the term ‘person-centred care’ rather than ‘patient-centred care’ in relation to health. The term is now used by the World Health Organisation (WHO)[1]
and is internationally accepted; it focuses on an individual receiving healthcare (the patient) yet refers to the “whole person” who is living with their condition, in the context of their lives, families and communities, and has expertise to share around this. The term encompasses consideration of the person’s needs, values and preferences, and identifies that optimising the person’s health requires co-creation of care planning. Guidance for pharmacy, from the Royal Pharmaceutical Society (RPS)[2]
and the General Pharmaceutical Council (GPhC)[3]
, refers to person-centred care, and this is the first standard of the recently published GPhC standards.

In the same way that Apple has created products that their creators want to use, we need to deliver a person-centred service that we, as healthcare professionals, want to use. Rather than just thinking about what we do (provide a safe, effective, caring service) and how we do it (through good governance, robust processes and evidence base), we need to focus on why we do it, which is to deliver a good patient experience of a safe and effective medicines-related service. Pharmaceutical care and medicines optimisation puts the person, not the patient, at the front and centre of care.

Changes in policy

Over the past 30 years the UK public have sought more control over, and involvement in, their health. Government policy has reflected this, beginning with the publication of the NHS Plan in 2000[4]
,[5]
, which included a description of the essential role of self-management and self-care in delivering and sustaining healthcare. Later publications — such as ‘High quality care for all’[6]
in 2008 (also known as the ‘Darzi Review’), ‘Liberating the NHS: no decision about me without me’ in 2012[7]
, and the ‘Five year forward view’ in 2014[8]
— have all promoted patient involvement in healthcare, prevention of illness, shared decision-making and supported self-care. There has been a clear drive at policy level towards patient empowerment and partnerships with healthcare professionals[9]
,[10]
. No one can forget the lessons from Mid Staffordshire NHS Trust and the publication of the Francis Inquiry[11]
in February 2013, which brought person-centred care to the forefront of NHS care, calling on all healthcare professionals to deliver compassionate, consistent and safe care.

Healthcare professionals are responding to the call. The Royal College of Physicians and Royal College of General Practitioners[12]
,[13]
have created tools and resources, and there is increasing engagement between patient groups, such as National Voices and the Coalition for Collaborative Care, and healthcare professional groups. Pharmacy responded with the RPS’s ‘Now or never’ report[14]
, which highlights how pharmacists can support patients with self-management, and the RPS’s ‘Medicines optimisation guidance’ published in 2013[15]
, in which patient experience is listed as the first of four key principles of medicines optimisation.

The Centre for Postgraduate Pharmacy Education provides continuing professional education that acknowledges the move from patients as passive recipients of care to active participants in their care[16]
,[17]
. Methods to support self-care, such as the patient activation measure[18]
, which helps clinicians to identify the person’s level of knowledge, skill and confidence in managing their health, have been adopted within the NHS. Shared decision-making is central to both individual care and strategic planning[19]
. Behavioural techniques to support a person-centred approach — such as the introduction of health coaching to support medicines optimisation and improve adherence — are gaining traction and are being promoted in national policy[8]
as evidence for efficacy emerges[19]
,[20]
.

Pharmacy adds value

Person-centred care must be at the heart of everything we do in pharmacy. This is not just a national issue, but a global one. The WHO has recently launched its third patient safety challenge, ‘Medication without harm’, which includes the aim of developing “mechanisms for the engagement and empowerment of patients to safely manage their own medications”[21]
. In an age where information is freely and easily accessible, and patients have more options for seeking medicines-related support, pharmacists are in a unique position to add value to medicines-related consultations using the person-centred approach to evidence-based medicine. This is not a new concept – it was described over 20 years ago[22]
when evidence based-practice was defined as a combination of the patient’s expertise on their lives and condition with the clinician’s experience and knowledge.

Replicating the tech giant’s approach

Using Apple’s successful approach, let us ask why person-centred care? Because we believe this is the best way to provide high-quality, personalised and safe care. The how is demonstrated through modelling the behaviour we would want for ourselves and our relatives, and the what is achieved by providing a person-centred approach using our evidence-based knowledge and clinical experience to deliver medicines optimisation. In using this approach, pharmacists could become leaders of person-centred care in health, providing professional, unbiased interpretation of medicines-related information in the context of the beliefs, values, preferences and lives of our patients.

  • This piece was originally published on 28 March 2018 and republished on 29 March 2018 after several errors inserted during the editing process were corrected. 

Nina Barnett is a consultant pharmacist at London North West University Healthcare NHS Trust and NHS Specialist Pharmacy Service.

References

[1] World Health Organization. People-centred health care: a policy framework. 2007. Available at: http://www.wpro.who.int/health_services/people_at_the_centre_of_care/documents/ENG-PCIPolicyFramework.pdf (accessed April 2018)

[2] Royal Pharmaceutical Society and National Voices. The role of pharmacy in delivering person-centred care. 2015. Available at: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Publications/Role%20of%20pharmacy%20in%20person-centered%20care.pdf (accessed April 2018)

[3] General Pharmaceutical Council. Standards for pharmacy professionals. 2017. Available at: https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf (accessed April 2018)

[4] Department of Health. Pharmacy in the future — implementing the NHS Plan. 2000. Available at: http://webarchive.nationalarchives.gov.uk/20121013030701/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4068204.pdf (accessed April 2018)

[5] Department of Health. The NHS Plan: a plan for investment, a plan for reform. 2000. Available at: http://webarchive.nationalarchives.gov.uk/20130124064356/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118522.pdf (accessed April 2018)

[6] Department of Health. High quality care for all: NHS next stage review final report. 2008. Available at: https://www.gov.uk/government/publications/high-quality-care-for-all-nhs-next-stage-review-final-report (accessed April 2018)

[7] Department of Health. Liberating the NHS: no decision about me, without me. Government response. 2012. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf (accessed April 2018)

[8] NHS England. Five year forward view. 2014. Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed April 2018)

[9] The Health Foundation. Person-centred care made simple: what everyone should know about person-centred care. 2014. Available at: http://www.health.org.uk/sites/health/files/PersonCentredCareMadeSimple.pdf (accessed April 2018)

[10] NHS England. Shared decision making. Available at: https://www.england.nhs.uk/ourwork/pe/sdm/ (accessed April 2018)

[11] Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. Available at: http://webarchive.nationalarchives.gov.uk/20150407084231/http://www.midstaffspublicinquiry.com/report (accessed April 2018)

[12] Royal College of General Practitioners. Inquiry into patient-centred care in the 21st century. 2014. Available at: http://www.rcgp.org.uk/policy/rcgp-policy-areas/inquiry-into-patient-centred-care-in-the-21st-century.aspx (accessed April 2018)

[13] Royal College of General Practitioners. Person-centred care. Available at: http://www.rcgp.org.uk/personcentredcare (accessed April 2018)

[14] Smith J, Picton C & Dayan M. Now or never: shaping pharmacy for the future. Royal Pharmaceutical Society. 2013. Available at: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Publications/Now%20or%20Never%20-%20Report.pdf (accessed April 2018)

[15] Picton C & Wright H. Medicines Optimisation: helping patients to make the most of medicines. Royal Pharmaceutical Society. 2013. Available at: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Policy/helping-patients-make-the-most-of-their-medicines.pdf (accessed April 2018)

[16] Centre for Postgraduate Pharmacy Education. Patient-centred care. 2011. Available at: https://www.cppe.ac.uk/programmes/l/ptcentred-p-01 (accessed April 2018)

[17] Coulter A & Collins A. Making shared-decision making a reality. No decision about me, without me. The King’s Fund. 2011. Available at: https://www.kingsfund.org.uk/sites/default/files/Making-shared-decision-making-a-reality-paper-Angela-Coulter-Alf-Collins-July-2011_0.pdf (accessed April 2018)

[18] Hibbard J & Gilburt H. Supporting people to manage their health. An introduction to patient activation. The King’s Fund. 2014. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/supporting-people-manage-health-patient-activation-may14.pdf (accessed April 2018)

[19]  Rollnick S, Butler CC, Kinnersley P et al. Motivational interviewing. BMJ 2010;340:c1900. doi: 10.1136/bmj.c1900

[20] Health Education England. Health coaching for behaviour change programme. Available at: https://eoeleadership.hee.nhs.uk/Health_Coaching_Training_Programmes (accessed March 2018)

[21] World Health Organization. Medication without harm: WHO’s third global patient safety challenge. Available at: http://www.who.int/patientsafety/medication-safety/en/ (accessed March 2018)

[22] Sackett DL, Rosenberg WMC, Gray JAM et al. Evidence-based medicine: what it is and what it isn’t. BMJ 1996;312:71. doi: 10.1136/bmj.312.7023.71

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Citation
Clinical Pharmacist, CP, April 2018, Vol 10, No 4;10(4):DOI:10.1211/PJ.2018.20204578