‘It’s a nice place, a nice place to be’. The story of a practice development programme to further develop person-centred cultures in palliative and end-of-life care

摘要

Background: Palliative and end-of-life care services need to be person centred. However, it cannot be assumed that such services are ‘naturally’ person centred as, in reality, they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this article. While the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff wellbeing and the sustainability of person-centred care. The work undertaken in this programme aimed to address this issue. Aim: To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Edinburgh Hospice.Methods: The programme was theoretically informed by the Person-centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of transformational practice development. Thirteen multidisciplinary team members formed a ‘core group’ and participated in 10 three-hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in between the workshops to be undertaken by the group members. Evaluation data were collected at the beginning of the practice development programme and as a continuous process throughout the 12 months. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Results: The findings are located within a framework exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be ‘known’ in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing ‘small’ practice changes as well as the need to ensure the hearing of different voices. Findings from routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and implications for practice: This programme is one of the first explicitly to use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: Practice settings need to be clear about the difference between patient- and person-centrednessThe engagement of a multidisciplinary team in interdisciplinary systematic transformational practice development has the potential to transform the culture and context of care, and produce sustainable outcomesHuman flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-centredness for all persons