Developing cultures of person-centredness

Introduction :  (comprising context and problem statement) A national two year practice development programme took place in the Republic of Ireland from 2007 to 2010. The programme was commissioned to support staff to implement a framework for person-centred nursing practice-centred practice in residential settings for older persons. Eighteen sites took part in the programme and staff and managers from a variety of disciplines used a person-centred framework and practice development model to develop their practice. Since the programme finished there is evidence that this work sustained and in some places continued to grow. The Health Service Executive in Ireland (HSE) now wishes to extend this programme to all services incrementally using the same methodology so that care and practices can be more fully integrated from a workplace culture perspective.  Short description of practice change implemented : Process and outcome evaluation demonstrated improvements in practice and workplace culture for staff and improvements in care experiences for residents. A number of validated tools were used, both process and outcome that engaged residents and staff. Evidence indicated increased choice for residents and more meaningful relationships between them and staff to name but two. There was for example evidence of changes in workplace culture with improvement to quality of communication and support between staff, greater role satisfaction, improved staffing and resources, and greater commitment to the setting. Aim and theory of change : The overall aims of the programme were to: implement a framework for person-centred practice[1] for older people across multiple settings in Ireland, through a collaborative facilitation model and to carry out an evaluation of the processes and outcomes. The programme drew on numerous principles from different yet complementary theories and approaches: emancipatory practice development, co-operative inquiry and a specific person-centred nursing framework. Targeted population and stakeholders : Eighteen residential units for older people were involved in this programme. Along with residents in targeted sites, staff groups represented different areas within the units and grades i.e. Nurse Mangers, Staff Nurses, Health Care Assistants, Housekeeping, Catering and Administration staff. Timeline : An initial two year programme took place 2007 – 2010. The HSE will now replicate this programme by introducing a further three year national programme to develop cultures of person-centredness system wide which commences in February 2017.  Highlights: (innovation, Impact and outcomes) This is an innovative methodology and programme that has been replicated in many different settings internationally such as New South Wales, Netherlands, Norway, Malta, UK, and others. Using this methodology and framework staff were facilitated to critically explore their practice and Comments on sustainability : For long term sustainability it is vital that practice development activities contribute to the professional and personal development of staff and managers. The development of staff key facilitation and practice development knowledge and skills enabled staff to work effectively with colleagues to changes their workplace culture. Comments on transferability : This programme has transferability to any care setting demonstrated in the variety of settings it has been introduces in for example in the New South Wales programme Essentials of Care[2] The focus is on developing cultures of person-centredness that supports person-centred practices. Conclusions: (comprising key findings) The HSE had demonstrated considerable impact on care experiences for both service users and staff through the introduction of this programme in older persons’ residential services. Discussions : Developing workplace culture will impact on the immediate experience of both staff and service users[3]. Recognising the enablers and consequences of workplace culture development means that the focus is on basic assumptions that influence actions[4]. Lessons learned : Involvement and engagement of managers in organisations is essential to the success of culture change. Managers are part of the culture and therefore need to be part of making change. References : 1- McCormack and McCance. Developing a conceptual framework for person-centred nursing. Journal of Advanced Nursing, 2006;565(5):472-479 2- Essentials of Care Program - Projects - NSW Health - NSW Government(Accessed 17/01/2017) Available from: www.health.nsw.gov.au/nursing/projects/Pages/eoc.aspx Accessed 17/01/2017 3- Manley, K, Saunders, K., Cardiff, S., Webster, J. Effective workplace culture: the attributes enabling factors and consequences of a new concept. International Practice Development Journal 2011;1:(2). Available from: http://www.fons.org/library/journal/volume1-issue2/article1 (Accessed 17/01/2017) 4- Schein, E. H. Organisational Culture and Leadership, 2nd edition. Jossey-Bass, San Francisco, CA. 1985