Client-centered care: a major challenge for health care organisations

This presentation Why client-centered care (c.c.c.)? What is c.c.c. (from a client perspective)? Is it just a skill or is it more? Instruments to support c.c.c. Challenges for the professional

Why client-centered care? The ‘modern’ client does not automatically agree with everything the professionals says The client is becoming consumer Autonomy is (in western cultures) a basic right Economic motives: better match between needs and services: more efficiency

What is client-centered care? Diffuse/complex terminology: –Client-centered –Client-directed –Client-driven –Demand-oriented / tailored care I prefer to speak about ‘client-centered’ or ‘demand-oriented’

What is client-centered care? A qualitative study among experienced chronic patients (patient informants of a large patient organisation) Question: what is the perspective of experienced patients and informal caregivers regarding demand-oriented interaction with nurses and nurses’ aids? Methods: focus group interviews, observations, grounded theory approach

Recognition as a basis Central patient values: uniqueness, comprehensiveness, continuity of life, fairness, autonomy, equality, partnership and independence Feelings of recognition related to these values emerged as a key-concept of care tailored to the patient’s demand

Definition of c.c.c. Demand-oriented or client-centered care is care based on the wishes and experienced needs of the client, is defined in dialogue between client and professional, and is decided upon by the client

Is it ‘just a skill’ or is it more? It has to do with skills: –Needs assessment, communication skills –Empathy It has to do with knowledge: –Empowerment –Patient rights –Self determination But: it is more  it is about a fundamentally different role of the professional

From ‘helper’ to ‘ally’ A paradigm shift? Organisations and services will (dramatically) change

Examples of instruments COPM (occupational therapy) IPPA (provision of assistive technology) Client Centered Process Evaluation (occupational therapy) Competence scale (nursing)

IPPA Individually prioritised problem assessment Developed in a European project Very simple in use: –Client identifies most important problems related to activities for which he wants an AT device and gives weights the these problems –After 3 months problems are evaluated Still ‘young’ instrument with promising validity and reliability

CCPE Client centered care process evaluation Developed by a research team in Manitoba, Canada Consists of five parts: –Self evaluation questionnaire for the professional –Questionnaire to evaluate environmental factors influencing the work of the professional –Client questionnaire –‘reflective’ form –Suggestions for strategies to improve your work

Still ‘young’: only very first experiences We are planning a (multiprofessional) study to test the instruments and to gather experiences  anyone interested in cooperation?

Care in dialogue competence scale Based on the results of the qualitative study I discussed earlier: to what extend are central patient values recognised? Consists of a 40 item questionnaire for professionals and ‘mirror’ questionnaire for clients Still under construction: only used in one study. Will be published later this year

Challenges It is difficult and more than just skills It requires another role: the professional as ‘ally’ –Empowerment –Collaboration –Client involvement –Dialogue

Challenges 2 Recognition of patient values is essential There are some instruments that may help, but most are still under development Tensions with other values –Ethics / values –Professional standards / protocols –Legal frameworks –Organisational barriers It must be ‘in the veins of the organisation’

New competencies The professional goes through the care process in dialogue with the client, starting from the client perspective and on the basis of his/her professional expertise. The professional is able to handle the expected tensions and conflicts The professional supports the client in formulating his/her needs and demands with respect to the whole care process and actively stimulates selfdetermination by the client The professional seeks alternatives when personal, professional or organisational barriers appear