Care as a human endeavour
Two of the world’s leading thinkers on person-centered care share their thoughts on its implementation and on why Mosaic was awarded the European Society for Person Centered Healthcare’s Gold Medal for Excellence.
Welcome to 2023 and our special guests Professor Andrew Miles and Professor Sir Jonathan Elliott Asbridge from The European Society for Person Centered Healthcare
By Professor Andrew Miles and Professor Sir Jonathan Elliott Asbridge
Person-centered Care?
Together we can do it, but it needs us all.
We believe that modern medicine and healthcare are victims of their own successes. How is it that we can confidently make such a claim? Have not the last 120 years seen exponential advances in the technological and biomedical power of healthcare systems that have radically transformed the scope, possibility and power of clinical practice, driving enormous shifts in individual and population health? The answer to such a question is a resounding and unequivocal ‘yes’. What, then, is ‘the problem’? The problem is this – that as medicine and healthcare have become increasingly more scientific, they have also become increasingly depersonalised, and in so many ways worryingly dehumanised. What, then, to do?
The first stage in rectifying this problem is to understand what medicine and healthcare are all about. We have long argued that medicine and healthcare are not sciences per se, but primarily human endeavours with a moral character which employ science, and only in part. They are, then, science-using practices. Both have the unalterable imperative to care, comfort and console (humanity) as well as to ameliorate, attenuate and cure (science). If there is a preferential emphasis on either cure or care then we distort the fundamental philosophy and historic mission of healthcare, risking poor and sometimes grave outcomes for patients, clinicians and carers alike.
The second stage, for which we have long called, is the urgency to move away from impersonal, fragmented and decontextualised systems of healthcare towards personalised, integrated and contextualised models of practice. Here, affordable biomedical and technological advances can be delivered to patients within a solidly humanistic framework of care which recognises the importance of applying science in a manner which respects patients as persons and not subjects, objects or complex biological machines. Such an approach, by its nature, necessarily takes a full account of the person’s illness stories, values, preferences, cultural context, fears, worries, hopes and anxieties, and recognises and responds to their emotional, social and spiritual necessities in addition to their purely physical needs. Although a plethora of simple and complex definitions exist, it is this, we contend, that is the essence of person-centered care (PCC). PCC rests on a solid evidence base, with quantitative, qualitative, mixed methods, and other study designs, all having shown superior clinical outcomes and wide-ranging institutional benefits within the health systems in which PCC has become embedded.
The third stage is the operationalisation of PCC through the development of innovative methods and measurements based on a specific working definition of PCC that is selected with reference to the given care context, since care contexts differ. This, alone, however, is insufficient, and it is vitally important to develop associated training programmes in parallel, and to identify the teaching and training staff, and the transformational leaders, who will bring about a cultural change at the level of the individual clinician/carer, at the level of individual clinical teams working integrally together, and at the wider level of the whole institution itself. This represents the commencement of the embedding process for PCC within the given health system as a whole.
The fourth stage is the maintenance and audit of implemented systems, the generation of multifaceted feedback, the identification of failures and the particular solutions necessary to address and correct these, and the documentation of best practices for dissemination to the broader academic and clinical field of PCC, so that other individuals, teams and organisations may develop their own methods with reference to the success stories published by others. This completes the embedding of PCC within the health system as a whole. Having discussed the four separate sequential stages for developing and imbedding PCC within health systems, we turn now to the particular example represented by MOSAIC Home Care Services.
In evaluating the candidates for the award of the Gold Medal for Excellence in Person Centered Care of the Society at the Fourth Annual Conference and Awards Ceremony held in Westminster on 26 & 27 October 2017 (which MOSAIC in fact won), it was clear to us that MOSAIC, as an institution, was not simply a standard care home organisation, but represented a great deal more than that. The Society had been particularly impressed by MOSAIC’s provision of an extensive range Copyright © Mosaic Home Care Ltd. All Rights Reserved. 1 A116R1_14DEC2022 of services that focused on the wider emotional and social needs of the person that are far too numerous for us to list in the limited space available to us here. These services clearly addressed meaning, being and community within home care, so that no person becomes defined by the nature or extent of their illness, or by limiting factors such as what they can and cannot do for themselves. The Society had been particularly impressed with the sensitivity of MOSAIC’s model to the importance of community, the place of the person in that community, and what can be termed the wider dynamic that illustrates and encompasses the multifaceted dimensions of a person’s essence and being. Through such sensitivities and understandings, we saw that the MOSAIC model was able to deliver an entirely personalised support which provided a fundamentally humanistic care, and one that was integrated with medical and clinical intervention when and where necessary, so that an authentically client-centered care could be guaranteed. In order to document and disseminate the MOSAIC best practice model as an exemplar for other such institutions and to illustrate the key principles of PCC in action for others, the Society commissioned a paper from MOSAIC which was published within the Society’s international journal in September 2018 [Teasdale, J., Anderson, N., & Teasdale, A. (2018).“The meaning of me®: A Canadian blueprint for addressing the complex whole that is the person at the center of the communitybased homecare services model.” European Journal for Person Centered Healthcare 6 (3) 485-491]. While this paper represents a formal and seminal account of the MOSAIC model, a rapid overview of the model and its benefits, entitled ‘A 5 Minute Introduction to an Internationally Recognized Person Centered, Community Integrated Model of Home Care’, and presented as part of a SHS/UHN COVID-19 Special Geriatrics Institute Education Day in 2020, can for the benefit of the reader be accessed here [https://sinaigeriatrics.ca/wp-content/ uploads/2020/07/Community-Booths-Institute-2020. pdf].
In conclusion, the ESPCH has recently finalised its second 10 Year Strategic Plan to take our work forward over the next decade in which post-pandemic challenges to implementing and maintaining PCC will continue to be experienced for many forthcoming years. The plan contains a major emphasis on methodological development for the implementation and embedding of PCC within health systems. We have agreed a major new publishing division for PCC within the high impact Journal of Evaluation in Clinical Practice and are keen to receive submissions for publication from colleagues working in this field. Work continues on a 120-chapter three volume textbook entitled ‘Person Centered Care.
The New Professionalism’, a major Opus predicated on the Society’s firm view that achieving a higher order of care, which is to say an authentically person-centered model, will require the coordinated action of a variety of stakeholders. These include policymakers, researchers and educators, multidisciplinary clinical teams, social services professionals, family carers, professional carers, chaplains, service managers and transformational leaders, patient advocacy groups, media professionals and the pharmaceutical and healthcare technology industries, collectively termed the ‘healthcare ecosystem’.
The Society continues to maintain that the ‘job’ of PCC, is to raise the bar of clinical and care professionalism from what we term the lower common denominator of legally acceptable, basic technoscientific and regulatorapproved competence, to what we describe as the higher numerator of person-centered excellence. The time has come, we fervently believe, to return to clinicians and carers an ambition to treat patients and clients as persons. In our contribution to this Newsletter we have aimed, within the constraints of available space, to provide a snapshot of what PCC is and how it can be realised in operational reality. Further reading, and the bibliographic references which underpin what we write above, are available from MOSAIC on request.
Professor Andrew Miles BMedSci MSc MPhil PhD DSc (hc) is Senior Vice President and Secretary General of the European Society for Person Centered Healthcare (ESPCH), and a full professor of person-centered care in the UK and at several universities across Europe. He is Editor-in-Chief of the European Journal for Person Centered Healthcare, and Editor-in-Chief of the Division on Person-Centered Care of the Journal of Evaluation in Clinical Practice. [andrew. miles@pchealthcare.org.uk].
Professor Sir Jonathan Elliott Asbridge DSc (hc) DHSc (hc) DSc (hc) is President and Chairman of Council of the ESPCH and the Chief Clinical Officer at Sciensus UK. Sir Jonathan was formerly President of the UK Nursing and Midwifery Council, Chief Nurse at the Oxford and Cambridge teaching hospitals, and Chief Executive/ Chief Nurse of Bart’s and The London NHS Trust, London, UK. [jonathan.asbridge@btinternet. com]. Fuller biographies for interested readers are available at: http://pchealthcare.org. uk/about-espch/officers-european-society-person-centredhealthcare