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 haven’t discovered already yet, 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 / workplace will also be essential in implementing a Person Centred Approach. It is recommended 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.
Person Centred Approach sits in a holistic, psychosocial and spiritual paradigm which is very different to the paradigm of the current medical model. Currently there is a struggle for them to coexist, though for the best outcomes for clients coexisting is essential, that is true holistic care. Finding ways for them to coexist is a key to the success of implementing Person Centred Approach. The result of this will eventually be a shift away from the scales leaning toward medical paradigm and shifting into A Person Centred Approach paradigm. Although there will always be the need for them to coexist 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 don’t have a good understanding of what it actually is. What it means to be Person Centred and how that might look in a workplace and function in work practices. Person Centred Approach is often taught and explained with diagrams, long training sessions and long paragraphs! Really though, the essence of PCA is that it’s just about people, about being with people, about relation and partnerships between people, about values that are routed in respect, enablement, support, comfort, empathy, compassion and understanding.
Over complicating the concept in the initial stages of implementation can be counterproductive. If staff don’t understand what PCA means it will be difficult to implement. This sounds really obvious but often little time is put into imparting the core principles and philosophy of this approach. Each area of the organisation needs to understand the very basic, essential values and aspects of PCA 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 PCA concepts. Don’t over complicate it – it’s not a medical model, it’s different. Start with the basics, 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 PCA to be and to look at how Person Centred your services are. Do they feel what it is? Do they feel like they are treated in this way by the organisation – if not then that is a really good starting point to build a foundation that will enable PCA implementation to work. Using practical examples in education sessions can be helpful rather than just explaining the concept. So you could juxtapose current practices with a Person Centred Approach as a clear explanation of what it is, what it looks like in practice. Often there is too much theory about PCA and not enough practical examples. Debriefing and case conferencing can also help clarify what PCA actually means practically, on a day to day basis.
Potentially, staff trained in the medical model may resist the shift toward 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 relearn the way they approach their work and to some this can be a challenging and confronting prospect. They may also value medical practices over PCA practices. Often these staff members are in leadership roles so it is essential to get them on the first instance as 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, this will be determined by how much buy in you give them. Enabling staff to have a voice in the implementation of PCA 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 and it’s someone else telling you that you need to change how you are working. The challenge is to find ways for staff to discover / become aware of the changes that need to be made by guiding them rather then 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 PCA will actually give them more autonomy and decision making capacity could also help. Remember that it’s important to feel and have an experience of PCA 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 actually are too heavy PCA may be perceived 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 and although they may not have all the understanding of PCA they may already have the intent. Having the intention is like gold, it would be wise to not underestimate the value of this, it is an in-road to change. This perception / reality of lack of care time is a BIG factor in the PCA 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 care holistically for the client and may have felt they needed to leave that ideal behind. Find ways to remind staff about why they wanted to work in health care 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 PCA 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 highlight the things that are currently perceived as priorities for 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 PCA before implementation and to have altered any part of their approach to staff or work that is not within the scope of PCA principles. If the concept of PCA is introduced to staff and the reason they identify with it is because they feel like they are not being treated in a person centered way, then there will be instant barriers to its success. An open conversation about where leadership and management have not been in alignment with PCA principals in the past and where changes have been made would be beneficial.
Organisation values need to be in alignment with PCA principles. Managers and Leaders need to carry those organisational values and PCA values into their approach with other team members and their core staff group. If managers and leaders have a PC Approach with employees they will be more likely to have a PC approach with clients. it needs to happen at every level. All departments / levels of organisation must act within the framework of Person Centered principle’s or its success will be fragmented. Ground staff who are the direct care workers will be unlikely to willingly come on board with PCA 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 can’t 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 PCA, identify how the structure of systems and work force might restrict the ability for PCA 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 actually already have some solutions, or at least, it could be an opportunity for them to learn a problem solving process which may result in solutions. Look at where the resources are going, where is the money being spent in the organisation, does it enable capacity on the ground level for workers to actually feel like they are able to implement person centered approaches, after all isn’t effective PCA on the frontline the end point. Inadequate capacity will be the biggest blocker of all.
What are the capacities currently for the provider – don’t put pressure on or have expectations that are currently unrealistic. Identify how capacity can evolve at each given site. What capacity do they have, how can this grow and be supported. Finding new ways to build capacity may take some creative thinking. The idea of a PCA philosophy is one thing, the capacity to implement it is another and is a major blocker to the success of a paradigm shift / cultural change.
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