Before I say anything, I’d like to begin by thanking the Elizabeth Garrett Anderson Programme for starting me along this journey, and, Helen Sanderson for making it meaningful. If anyone is interested in reading more, please check-out Helen’s books or Helen Sanderson Associates’ website.
I have written a few blogs about Person-Centredness – mostly how we treat and care for patients, or, as I prefer to consider them, people. Much of this has been in relation to those living with dementia or others who become delirious and end-up in hospital.
About 18 months ago I realised (or was helped to realise), that in order to receive Person-Centred Care, you needn’t have dementia or delirium, or even be old, for that matter – just being a person was enough. Yet, we work and live in a system and society which has created pathways and avenues of existence that seek to distract from this essential component of who we are; things get in the way – IPhones, Google, mass communication, data streaming, time compression, schedules, all seek to pull us from what it is to be human or a person.
It started in Mallard Ward and has spread-out – radiated might be the best word; the sense that behind the fear and anxiety, the misunderstanding and miscommunication are people, essentially vulnerable individuals who all experience the same ups and downs, worries and challenges.
Moving from the care that we provide our patients, to the ways in which we work together, collaborate, interact and listen, to see that I am a person, as are you and they and us…
Person-Centre Care, has sort of become the life-raft that I have clung to during the past difficult months, it is the centre I know I can always return to when things are getting tough, and, although not a panacea (for nothing really is), it effectively seems to work in every situation, at every time when things aren’t going well.
What are Person-Centred Teams? They are working together with others in teams – this is self-evident, but not everyone knows what a team is, in the real sense; a team being a group of people with a shared understanding and purpose who are able to communicate openly and freely, and, who can respond and negotiate challenges and obstacles from within, not by dictate, not in isolation, but through togetherness and collaboration.
Many people believe they operate in teams – I can think of a few in my own organisation, when in reality, the way they organise and work together are in no sense ‘real’ – their purpose is ill defined, or at odds with what they do, their ability to influence the way they work is limited or sometimes nil, resulting in frustration and paralysis.
The English Academic and thinker Michael West in his work has described these elements of teams and, over many years, demonstrated the incredible outcomes when people work as teams – when individuals come-together to share ideas, resources and ability.
Yuval Noah Harari in his recent TED talk and in his book Homo Deus describes how it is this component of humans that has allowed us to become the dominant species on the planet.
Underlying this is the question of what allows teams to not only be real but to be successful, sustaining, organic – living? It is the move from teams that operate at a certain level of – evolution, into teams which acknowledge the uniqueness, the diversity, variety of each member. That allows people to connect as equals who approach one another from a sense of enquiry and curiosity, who ask before judging, who seek to understand as a prerequisite to engagement.
This I feel is the key to Person-Centred Teams.
Lots lies underneath this – processes, tools and theories as to how people can be supported and, to see that it is though identifying what brings us together, our humanness – likely our failings, limitations and vulnerability which when acknowledged, accepted and appreciated allow us to grow.
Dr Rod’s Odd Blog (almondemotion) 
The term Person centred care often causes a mild sneer on the faces of many. It’s a term used in many settings and can at times be used critically by those with a supposed higher value set than those helping, caring for, treating, supporting the person Rarely if ever will you find a patient or resident on a ward or in a care home shouting ‘help ! Can someone give me some person centred care please’. Don misunderstand. Our work is to embed kindness, sensitivity, and capability in those caring for others as second nature. Individual focus. Knowing the person and perhaps even being known by them to a significant appropriate level too. I’m really no expert. But I have a strong sense of what PCC means in our care homes and after many years in health care work. It must include respect, time, curiosity, good listening, good boundaries, integrity and well judged humour too. We can do training workshops distance learning, supervisions, mentoring and buddying to high heaven but embedding PCC needs more than this. I could elaborate If provoked I will !. Thanks for your thoughts on this.
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Hi George,
Thanks for your reply –
Bizarrely, I had just finished replying to you when I accidentally pressed the wrong button on my keyboard and all disappeared – I suspect this means, that my response, although probably more succinct is more relevant.
I don’t know a better way of describing the care that I value and aspire to provide than, person-centred care; not patient, for I have overcome the hump of realisation, the awareness that people are more than patients, that diseases don’t define people. (I think this features in my blogs)
In the 15 or so years since I became a doctor (actually almost 20 years, sigh…), I have changed, grown and learned lots. I have moved from a medico-centric (randomised-controlled, evidence-based) world view to one that sees that the CT scanner or the blood test isn’t always right – for, it may tell you the right level of sodium or potassium, but it doesn’t tell you how the person feels or whether they want the test or the treatment.
When I first became a consultant 10 years ago, and talked about holistic assessment, people looked at me as if I was bonkers – nowadays, people realise more and more that unless you look at the head that is attached to the chest, and the arms and the legs and the psyche and the soma, your treatment, intervention, operation or whatever is likely to fail.
I haven’t yet found a better way to describe care; that is, care where the person is at the centre – in a position more elevated than guidelines, protocols and pathways. In most care and hospitals in the Western World, the system is still the dominant mover; utilitarianism wins every time.
I too find it tiresome to have to tell people – ‘this is how to be human,’ ‘this is how to avoid the marginalisation, the straight-jacket of the system,’ but, what other ways are there?
This isn’t at the level of Tolkien with good versus evil; this is the good who don’t understand that their world-view is skewed and harmful versus those who can’t imagine another way of seeing reality.
21 Century Medicine is a whirlpool.
Rod
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Hi again Rod.
Certainly a topic that stirs the thinking and one worth exploring I feel
I would never regard myself as having it all worked out despite some strong views on PCC. I spent 15 yrs in direct clinical practice as a mental health nurse mostly a CPN, team manager, specialist & generalist but for a decent period a would be therapist and counsellor immersed in lots of therapy training. The best of which undoubtedly being all that we refer to as Humanism where primarily PCC comes from I believe. I am still Chair of the Mental Health Nurse Association with its circa 2-3,000 U.K. Wide membership We convened a large group of us in Eastbourne last week for a prioritising event exchanging many views. Political, professional and addressing themes that unite us. One conve station I had with a fellow PCC activist included thoughts on the humanist work of Carl Rogers. I said 2 central underpinning principles are at the best of PCC and I attribute to Rogers
1- people are basically good
2- people, regsdless of past errors, bad decisions or disposition, have the capacity to change
I hold these elements central to my instinctive and genuine ( another Rogerian principle) core values and beliefs that I believe enable me to have a fair crack at ‘PCC ness’ most of the time Translating this into real life I hope is best witnessed in my tweets @cocongeorge and our blogs from one of my care homes pottles court. http://www.pottles.co.uk/blog.html
I hope I haven’t strayed too far from the central theme of what PCC means to us and how.
Many thanks ahan
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Hi
After another very long day with my Aunt yesterday , my sister and I reflected on what was missing .
I talked about my frustration at what wasn’t ‘noticed’ , about the ‘basics’ about the ‘intuitive’ acts of care .
As I say another long day , another long conversation between 2 sisters about Why ? Why is it what it is ?
My Sister concluded”It all just lacks the Human touch ”
She is right . The system is set in place to find the most efficient method of ‘delivery’. As it grows it becomes less able to ‘feel’ .
The smiles are still there . So is the courtesy . We are all ‘told’ to have a ‘Nice day’ as we leave the room .
http://fabnhsstuff.net/2016/08/24/can-common-sense-prevail-or-have-we-lost-the-battle/
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Hi Elizabeth,
I don’t quite know where you are coming from, although, from experience, I can imagine it is the world of acute hospital care, where systems, processes, guidelines and protocols have become so dominant that people get missed.
This is my story from today in the hospital…
I went to see one of the patients – an older woman who had fallen. She had a record of ‘previous MRSA’ – this means, at some point in the past she had been colonised (not necessarily infected) with MRSA (possibly because some doctor or nurse hadn’t used the hand-gel properly).
The patient, let’s call her Enid (not her real name) was, after I had ‘gowned-up’ (put on a yellow apron), in the loo, so I moved to see another patient – not removing my yellow plastic gown.
I knew what was coming… I was just waiting –
In the ward, waiting for someone to pull me up on the infection-control breach, for, although I hadn’t seen the patient and the yellow apron was pristine, wearing an MRSA gown out and about in the hospital is anathema.
And sure enough, within perhaps 20 seconds I was called-out.
It was a kind-hearted call-out and as the gown hadn’t been sullied even with the potential of MRSA, I kept it on (aspiring to save the NHS from too much plastic waste).
Later, when I went to see Enid (not her real name!), I discovered an elegant, 90 year old woman who was almost blind.
Enid recounted her fall – she had over-balanced as one of her carers had misplaced her commode – causing her to lose her footing and fall.
None of this is the point.
The point is that Enid, (not her…), had, after returning from the hospital toilet, faeces on her legs and dressing gown.
This had been missed by the nursing staff.
Also missed by Enid.
After talking with Enid and promising I would do my best to get her home, I told the nurses about the faeces.
Enid is still a patient in the hospital, despite having fallen from a commode that was in the wrong place because of a careless carer and despite being little different physically from the person she had been before the fall, yet, hospitals have incredible transformative powers, with the ability to render perfectly fit, independent, autonomous people ‘patients’
Rod
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Hi George,
I don’t know that much about Carl Rogers, although the concept of accepting people for who they are, without preconceptions of judgments is how I like to see everyone – acknowledging that we have a subconscious that we don’t necessarily fully control;
I think this goes back to the original thesis – isn’t this what nursing, medicine and care is about – how can you have any form of therapeutic relationship without this? Alas, I encounter too often examples where, whether because of pressures of time or distractions, people relate to their patients not as infinite, unique universes, but as things, as parts of the process, cogs within the machinations that are the NHS – the NHS (do you know teal? Orange organisations) push people into these extremes of behaviour, where they are often left feeling empty, if not bereft of humanity, let alone spirituality.
Your association sounds fantastic & I would love to be a member, although suspect as a doctor I wouldn’t be allowed-in!
Thanks also for the heads-up re your blog;
Take care.
Rod
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I’ve been mentioning your blogging and the discussions about PCC to lots of people I have checked this out with my staff a bit and chatted with some of our residents about this during world mental health day yesterday It’s good to see Elizabeth joining in too. We all have a view on how we react response and reach people in need or in distress etc. ingredients for me will always include curiosity, humility, enthusiasm and making the time to be interested I will call this PCC I suppose though I am still wincing a tad about the PCC notion. Knowing very well as I said it’s too often a term that is either used as a weapon or as a devise to criticise or take a somewhat pious view on care. My staff I sincerely believe do great care and are kind calm under pressure good humoured too but will only talk about PCC if I make a fuss about it generally because if CQC come a calling they will want to hear them use the PCC words regardless of how they do this or what it is. Maybe I’m being unfair here. But language whilst important can be as disempowering and destructive and liberating and vindicating
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Hi – thanks.
I haven’t yet met anyone who has used PCC as either a short-cut or an excuse for care.
I can’t see it happening, at least not for a little while. As to people rolling this out when the CQC visits, again, I can’t see it – in my experience, either you can see PCC or it is invisible.
I would love us to either have a better way talk about what we are describing, or perhaps, for us to reach some a future evolutionary plane where this is no longer an issue – it just is.
That however might take a little while.
Rod
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I know I’m sounding a wee bit cynical about PCC I’m sure you’ve come across people using the expression that you would trust to feed the ducks at the local pond !! I have I’m afraid. I just think talking the talk is easy. walking the walk takes a greater embedded instinctive humanism that’s PCC I think
How to air this more widely? I do this often Maybe a bit of devils advocate perhaps but essentially I am perplexed that more people don’t get the buzz out of learning about others, making them feel good and feeling good themselves as a result !!!
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I just don’t see it –
Most – that is, something like 99.9% of people get it, they just forget how to apply it; it’s a little like healthcare in general – for all the tens of thousands of people treated each day in the NHS – the operations, the clinics, therapies, treatments, the vast, vast majority have an overwhelmingly positive experience, because, folk are essentially good.
We just need to reinforce the purpose, so that people don’t forget what they are working for and, they don’t slip-into the ever intoxicating elixir of ‘pathway, process, task and finish’
Rod
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Reblogged this on Dr Rod’s Odd Blog (almondemotion) and commented:
I am pleased to be attend a session with Michael West this morning thanks to the leadership team at Rotherham NHS Foundation Trust… We continue along the road of compassionate, person-centred care, making things better every patient, carer and employee at a time!
I wrote this five years ago. My world has changed massively in that time. Some things have remained the same… We have the pressures of life, the struggles, strains and pressures of work. We had and have Covid.
Person-centred care remains a fundamental to improving care and the experience of work for us all.
Here is to the future!
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