19th October 2017 Written by Colin Wright, Development Manager (Frameworks)

Colin Wright photo 2Introduction

The framework provides a description of behaviours, knowledge and skills to put a person-centred approach into practice.  It begins with the underpinning values and core communication skills.  Different types of conversations are then described in three ‘steps’:

Step 1.  Conversations to engage with people

Step 2.  Conversations to enable and support people

Step 3.  Conversations with people to collaboratively manage highest complexity and significant risk

The appropriate step will depend upon the type of conversation needed in a particular situation – this is not necessarily dependent on a workers job role or level of seniority.

Implementation of the framework[1]

The framework outlines the desired learning outcomes which will guide the content of education, training and follow-up.  The method of education and delivery of training is not prescribed and will need to be tailored to local needs.

Importantly, this is more than just education. Person-centered approaches require a significant behaviour change for workforces. Achieving successful implementation across whole organisations requires clear and strong leadership, together with systems and process that support this way of working.

Essential additional underpinning principles are described below.

Behaviour change

To achieve and sustain positive impact for workforces who are adapting and/or adopting new ways of working, recent research[2] suggests that taking a behavioural approach (including capability, opportunity and motivation) to supporting people is more successful than isolated training.  Development of capability must simultaneously be supported with the right processes, system and opportunity together with locally relevant incentives, which build those intrinsic and extrinsic motivations.

The principles of behaviour change are essential to understand, whatever methodology is used to deliver the training or education. There are factors that can impact the ability of staff to learn and their motivation and confidence to implement new skills and behaviours. These include psychological, social, economic and cultural factors within their lives and working environment.

In practice, this means people need to:

  • Know what to do
  • Know how to do it
  • Think it is a good thing
  • Believe that they are capable
  • Believe that it is their role
  • Believe that people who are important to them think it is the right thing to do

Co-producing training

The active involvement of people and carers with experience of using services and managing health conditions is central to effective training on person-centred approaches.

Sessions should be co-designed to model person-centred approaches and to meet learning outcomes.  As well as articulating the experiences and perspectives of people using services, co-production demonstrates the wider positive strengths, contributions and impact that they can make.

Individuals may contribute by sharing their story (either in person, or through a medium such as video or podcast) while others may wish to actively co-deliver theory and techniques as much as possible.

There are valid steps along the way to achieving co-production, such as engagement, involvement, participation and consultation.

When developing models for co-delivery, it is important that these include:

-          Robust mechanisms for feedback

-          HR process including development and support

-          Remuneration

-          Boundaries between dual roles of patient and educator, collaborator and service provider

Reflective practice

To develop person-centred behaviours and approaches, it is important for individuals to take time to think about what they are doing and how they are doing things and the impact this has on other people. This draws on an individual’s experiences, knowledge, values and feedback (and evidence where appropriate) to analyse and identify opportunities to change their thoughts and behaviours.

Examples of how this might be achieved include:

  • keeping a diary
  • talking to peers,
  • focusing on specific events,
  • informal or formal mentoring
  • local role specific activities such as Schwatrz rounds
  • listening and acting on feedback from people who have used service and their carers

Continuous Improvement

Continuous improvement is a principle that runs through everything we do. Embedding person-centered care will require improvements in how some services are designed, delivered and reviewed. The opportunities for improvement need to be identified, developed and evaluated in partnership with people who deliver and use those services.

A continuous feedback loop is an essential component of this.

Training and development for person-centred approaches can be a component of quality improvement projects, and the principle of quality improvement should be included in training to enable staff to drive this agenda.

Values-based approaches to workforce recruitment and development

The foundation for a strong person-centred workforce begins with attracting, recruiting and developing individuals who embody the values as described at the start of the framework. It is important that the organisation commits to:

  • ongoing support to build the person-centred skills, behaviours and motivations of its workforce
  • continually seek feedback and involvement from people who use services for ongoing improvement
  • supporting staff with these approaches in the context of professional revalidation

Examples of how this might be achieved include induction programmes, mandatory training, appraisals, local initiatives, campaigns, networks and opportunities for ongoing development.

Methods for delivering training

All members of the workforce need to be trained in the core relationship building and communication skills. It is important to stratify the workforce to identify those for whom the three steps are appropriate.

At each step, the mindsets of behaviour change (e.g. COMB[3]), coproduction, continuous improvement, values based approaches to workforce development and reflective practice, should be all considered.

All steps should be grounded in real life examples and complexity to experience the importance and impact of these conversations.

[1] The following summarises the section of the framework Delivery of training, education and learning opportunities (pages 33-41)

[2] Realising the Value (2016), Supporting self-management at: http://www.nesta.org.uk/sites/default/files/rtv-supporting-self-management.pdf

[3] Michie S, Atkins L & West R (2014), The Behaviour Change Wheel: A Guide to Designing Interventions, Silverback Publishing

You can download the Framework here