A person-centred approach is like a field of wildflowers – free flowing, varied and full of emotions. The sight of it will always make you feel humble and in full bloom. It entices others to share its purity and feel its warmth.” – Tracey Nenadic.
If you have not already discovered, there can be a number of barriers to the implementation of a person-centred approach philosophy. There can be many barriers to any cultural change process. It is how change is lead that will determine much of the outcome. The principles of effectively implementing cultural change within an organisation or workplace will also be essential to implementing a person-centred approach. We recommend that you have a good foundation in understanding some of the complexities of key components of cultural change and leadership. Poor leadership skills will play a role in inhibiting a successful implementation plan.
A person-centred approach sits in a holistic, psychosocial and spiritual paradigm. This is very different to the paradigm of the current medical model. Currently, there is a struggle for them to co-exist but for the best outcomes for clients, co-existing is essential, and that is true holistic care. Finding ways for them to co-exist is a key to the success of implementing a person-centred approach. The result of this will eventually be a shift away from the scales leaning toward medical paradigm and shifting to a person-centred approach paradigm. Although there will always be the need for them to co-exist, the shift is away from the medical management of patients to the ‘being in relation with’ support of patients. One of the foundational problems with a person-centred approach is that many people do not have a good understanding of what it is, what it means to be person-centred and how this might look in a workplace and function. A person-centred approach is often taught and explained with diagrams, long training sessions and long paragraphs! But the essence of a person-centred approach is that it is about people – about being with people, about relationships and partnerships between people and about values that are rooted in respect, enablement, support, comfort, empathy, compassion and understanding.
Over complicating the concept in the initial stages of implementation can be counterproductive. If staff do not understand what a person-centred approach is, it will be difficult to implement. This sounds obvious but often little time is put into imparting the core principles and philosophy of this approach. Each area of the organisation will need to understand the very basic, essential values and aspects of a person-centred approach before any movement and acceptance of the concept will occur. There is plenty of time and creative ways to teach the broader parts of these values and person-centred approach concepts. Do not over complicate it! It is not a medical model; it is different. Start with the basics as they will resonate with most people. Keep it simple to begin with, get the foundations right and then grow the tree!
A good starting point may be finding out what staff currently understand about a person-centred approach and to look at how person-centred your services already are. Do they feelwhat it is? Do they feel like they are treated in this way by the organisation? If not, then that is a good starting point to build a foundation that will enable a person-centred implementation to work. Use practical examples in education sessions as they can be helpful rather than just explaining the concept. You could juxtapose current practices with a person-centred approach as a clear explanation of what it is and what it looks like in practice. There is oftern too much theory about person-centred approaches and not enough practical examples. Debriefing and case conferencing can also help clarify what a person-centred approach means practically on a day to day basis.
Staff trained in a medical model may resist the shift towards a person-centred approach. It could be that they feel threatened by the process or that it undermines the work they have always done. They may have to re-learn the way they approach their work and to some, this can be a challenging and confronting prospect. They may also value medical practices over person-centred practices. Often, these staff members are in leadership roles, so it is essential to get them in on the first instance because leadership is integral to the success of the implementation process. Education sessions can be helpful in this process and open discussion with anyone struggling with accepting the need to change the way they approach their work.
Some members of your team may feel a loss of decision-making power and this will be determined by how much buy in you give them. Enabling staff to have a voice in the implementation of a person-centred approach is essential to its success. It can be especially hard to get on board with change when you are not the one that recognises that change needs to take place. The challenge is to find ways for staff to discover and become aware of the changes that need to be made by guiding them rather than telling them. This is another way to give them a sense of buy in. Team members may feel like they are losing their autonomy about how they approach their work. Getting them to a point where they have the realisation that a person-centred appraoch will actually give them more autonomy and decision-making capacity could also help. Remember that it is important to feel and have an experience of a person-centred approach in the same way we want the clients to feel and experience this philosophy. If we are trying to give back autonomy, decision-making and power to the client, we need to make sure that staff have this too. This does not mean they will have free rein. They will still need to be accountable for their work and follow corporate policies and procedures.
If workloads are already perceived as or are too heavy, a person-centred appraoch may be seen as another burden added to an already stretched capacity. Staff working directly with clients may have already been expressing that they feel there is not enough time to assist the client in the way they would like. Although they may not have full understanding of a person-centred approach, they may already have the intent. Having the intention is like gold. It would be wise to not underestimate the value of this as it is an in-road to change. This perception or reality of lack of care time is a BIG factor in the person-centred appraoch implementation process. However, extra time is not necessarily needed to work in a person-centred way. Because of this limited time, direct care staff may feel like they are unable to holistically care for the client and may have felt they needed to leave that ideal behind. Find ways to remind staff of why they wanted to work in healthcare in the first place and acknowledge any shared frustration from the past regarding time to care for the client. Openly discuss this and explain how a person-centred approach will give them tools to fulfill their desire for quality care, even with limited time frames. Explain that the concept is not necessarily about doing anything that will take extra time but rather the approach that is taken while doing what needs to be done in the time that is available. It can also help to highlight the things that are currently perceived as priorities needing to be done in that time, and it may be that some of these can be changed to a focus on different priorities. Discuss the feelings of satisfaction staff may experience by allowing themselves to commit to trying this approach. Share that it may be a way to get back the ideal they left behind.
It would be essential for management and those in leadership positions to have a good understanding of a person-centred appraoch before implementation and to alter any part of their approach to staff or work that is not within the scope of person-centred approach principles. If the concept a person-centred approach is introduced to staff and the reason they identify with it is because they feel like they are not being treated in a person-centred way, then there will be instant barriers to its success. An open conversation about where leadership and management have not been in alignment with person-centred approach principles in the past and where changes have been made would be beneficial.
Organisational values need to be in alignment with person-centred appraoch principles. Managers and leaders need to carry those organisational values and person-centred approach values into their approach with other team members and their core staff group. If managers and leaders have a person-centred approach with employees, then they will be more likely to have a person-approach with clients. It needs to happen at every level. All departments and levels of an organisation must act within the framework of person-centred principles, or its success will be fragmented. Ground staff who are the direct care workers will unlikely be willing to come on board with a person-centred approach if they do not perceive the organisation to be so itself. This may mean acknowledging past mistakes. It may mean some organisational changes are essential. It cannot just be something that is expected of direct care workers. They must be able to expect it from management and leaders on all levels.
Often there is a constraining nature of institutions. To combat the impact of this on the roll out of a person-centred approach, identify how the structure of systems and workforce might restrict the ability for person-centred practices. Staff may have been communicating some of these problems for a long time already, listening to what they are saying will help with implementation on the front line. Their problems are your roll out problems. They may already have some solutions, or at least, it could be an opportunity for them to learn a problem-solving process that may result in solutions.
Look at where resources are going and where money is being spent in the organisation. Does it enable capacity on the ground level for workers to actually feel like they can implement person-centred approaches? After all, isn’t an effective person-centred approach on the frontline the end point? Inadequate capacity will be the biggest blocker of all. An imbalance of resource distribution is a key focus for workers feeling burnt out, overburdened, and unheard. What are the capacities for the provider? Do not put pressure on or have expectations that are unrealistic. Identify how capacity can evolve at each given site. What capacity do they have and how can this grow and be supported? Finding new ways to build capacity may take some creative thinking. The idea of a person-centred approach philosophy is one thing, but the capacity to implement it is another. This is a major blocker to the success of a paradigm shift and cultural change.
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