This ethnographic study aimed to describe and analyze the processes of implementing person-centred care at a Swedish medical emergency ward in order to gain a deeper understanding of how these processes were experienced and met by healthcare providers and patients. The wider aim was to better understand barriers and facilitating factors for achieving change in complex environments such as healthcare institutions. Introducing a complex innovation such as person-centred care needs to be explored carefully if we are to be able to provide practical guidelines for healthcare leaders and professionals. The first part of the study focused on the healthcare providers and management leaders participating in the implementation programme. The second part was a follow up study at the ward with patients, healthcare providers and their management leaders. The follow up study included two multi-disciplinary group discussions with healthcare providers on person-centred care and teamwork.
We found that the implementation programme brought about processes central for person-centred care, but that organizational factors and a lack of attention to ethics counteracted these positive effects. In the follow-up study, we found that a new person-centred rounding system and documentation practices facilitated patients’ understanding of their diagnosis and care plan. We could also see that the new rounding system opened up space for nurses’ voices, as well as patients’ voices. Patients felt well-informed concerning their condition and the care plan. Yet, they returned home with main questions un-answered. Significantly, dialog between healthcare providers and patients was hindered by the overall routines and care practices in the ward. For instance, the round was still physician-centred in the meaning of the privileged knowledge being biomedicine and the other team members’ knowledge considered information for the physician to add for a holistic picture of the patient and the best medical decision. Person-centred ethics was reflected on and strived for by individual healthcare providers and the management, but routines, practices and customary care approaches hampered these strivings. Thus, a change in the social care context is needed for the healthcare providers’ strivings to reach their full potential. Management leaders need support in learning about the dynamic and collective nature of learning processes and change. Also, inter-professional dialogue on professional boundaries, disciplinary knowledge and power relations is needed, particularly in relation to person-centred documentation and teamwork - the overall lack of a critical inter-professional dialogue on knowledge traditions, professional boundaries and relations in the team may be one of the reasons that it is so difficult to implement person-centred care in general. In a project that analyses barriers and possibilities for person-centred care, the challenges that the current era of corporate managerialism and economic steering presents to an implementation of a person-centred care cannot be ignored.