How is the partnership in person-centred care created? Article and researcher in focus: Axel Wolf
Article: The realities of partnership in person-centred care: a qualitative interview study with patients and professionals. Link to the article.
Researcher: Axel Wolf
Appointment: An academic appointment at the University of Gothenburg in combination with an appointment at the Sahlgrenska University Hospital/Östra as Associate Professor and Senior Consultant Nurse Anaesthetist in the Anaesthesia and Intensive Care Department.
What are your personal resources? How have you applied them in your research? My most important success factor as a researcher, teacher and clinician has been my curiosity and innovativeness. As I enjoy juggling many balls at the same time, I collaborate with many different research teams within innovation and utilisation projects across a number of fields. My curiosity has driven me to work with colleagues across a broad field when it comes to diagnosis groups, subject areas (sociology, management and organisational science, architecture, arts, scenography, economics) but also with methods such as randomised controlled trials, quasi-experimental studies, ethnographic field studies, systematic reviews and registry studies.
My weakness is that I am not particularly patient when it comes to analysing in great detail for instance. Luckily, other colleagues are good at this, not least within the GPCC! Being a generalist, I enjoy starting projects and brainstorming around them, their design, their value for the patient, the society or the profession. What I really enjoy is to gather different colleagues and create different constellations in order to make the most out of a project idea. For my own personal development, the proximity to colleagues and GPCC’s network has been a fantastic opportunity and resource.
You have a long history at GPCC. Please tell me about that. I have been part of the GPCC since its start in 2010 and I have participated in a great number of different projects, both in a hospital environment as well as externally. One of the first projects I initiated and managed was to design a PCV e-health app for mobiles and laptops. It was a symptoms diary with an incorporated chat function for persons aged 85 and above, admitted for heart failure. The purpose was to see if modern technology could be useful and interesting for older persons too.
Could you please tell me about study behind the article in focus here? We wanted to study the transition from theory to practice, i.e. how do we transform our knowledge in person-centred care based on the GPCC studies, into every day clinical life? We have been following different GPCC projects by observing and interviewing more than 18 researchers, 16 health care professionals and about 20 patients for a number of years. This work has resulted in six different publications.
All three GPCC fundaments have been investigated; the patient narrative, the agreement and the documentation, which, together, form the partnership concept, in order to better understand the drivers and also the barriers for implementing a person-centred approach (ethics, i.e. why/how) and the work procedure (the structure, i.e. how). This actual combination of an ethical approach and work procedure is unique and interesting to research. For instance, what does the partnership in everyday life look like? We also investigated the formal part of the health plan, the documentation and the structure of how the agreement is made. Our collected data was analysed from many angles, in order to understand which drivers and barriers researchers, health care professionals and patients are confronted with.
Could you tell me about the conclusions you made from the study? In the study we used data from 54 persons who had either received or delivered person-centred care (20 patients, 16 health care professionals and 18 researchers), in order to examine how the partnership in person-centred care may be initiated, created and maintained. We suggest that the partnership in person-centred care is created from a dialectical approach/work procedure that incorporates both informal and formal structures.
However, patients and health care professionals perceive these structures differently. The informal parts of person-centred care, such as feeling listened to, working in accordance to what has been decided with the patient and the health care professionals’ interest in their patients as persons rather than just as patients, all contribute towards making the patients feel calm and secure. For the health care professionals the informal partnership is perceived as the fundament for approaching the patient and co-designing a care plan.
The patients perceive the formal part of the partnership, for instance the documentation, as being a tool for the healthcare professionals. On the other hand, the healthcare professionals are focusing on the agreement and the care plan as being their tools in order to maintain the continuity and the partnership on an interprofessional level (i.e. the person-centredness within the health care team).
What are you currently researching? We continue working on how the narrative could be used in the initial meeting with the patient at the clinic. How may we use pedagogical tools in order to develop our ability to use the patient narrative and the agreement? There may even be difficulties in getting a patient to share his/her narrative, for instance if they do not speak Swedish, suffer from aphasia or a psychosis or if they are sedated. These challenges are particularly interesting.
Please tell me about the research team. It was a collaboration project between the University of Exeter with Professor Nicky Britten *, the LETStudio at the University of Gothenburg and GPCC. The study was managed by Professor Nicky Britten from Exeter, together with her colleagues Lucy Moore and Mark Elam, Öncel Naldemirci and Doris Lydahl from the LETStudio and myself from GPCC. Dr Helen Lloyd from the University of Plymouth is also participating in the most recent phase of the project.
What training in person-centred care had the staff that you interviewed as part of the study received? They had all been trained in person-centred care.