Person-centredness has become a byword for high-performing health systems, featuring heavily in political and policy debates, and it has become ever more important in the context of the COVID-19 pandemic. Yet, what precisely is meant by person-centredness is still largely unclear, as are the key policies and strategies for how to achieve it. The European Observatory on Health Systems and Policies, in collaboration with the Swedish Agency for Health and Care Services Analysis (Vårdanalys), have just published an in-depth study on person-centred health systems – Achieving person-centred health systems: evidence, strategies and challenges – exploring the themes associated with a service user perspective of voice, choice and co-production (see figure), and examining existing strategies for person-centredness and their effectiveness.
Person-centredness and COVID-19
Lead editor, Professor Ellen Nolte, in underlining the importance of person-centredness in the time of COVID-19, says, “Responses to the pandemic unleashed rapid innovation in some areas of health services, in particular urgent and acute care. At the same time, they exacerbated inherent weaknesses in many health systems, such as a capacity to provide a coherent response that takes account of the diverse needs of populations and ensures that the most vulnerable people – because of age, ethnicity, ill health, poverty, disability, overcrowding, or victims of domestic violence, to name a few – are not left behind. The crisis provides considerable opportunity for decision-makers, planners, providers and the public at large to fundamentally rethink how their systems need to transform to place individuals, their families and communities firmly at the centre.”
Goals of person-centred approaches
This study shines a light on the diversity of ongoing health system challenges which person-centred approaches seek to address, including:
- the need to redesign systems to better meet people’s health and care needs;
- the need for an efficient use of resources and sustainable financing;
- the need to reduce fragmentation and improve coordination between services;
- continuing information asymmetries and power imbalances between providers and service users;
- the increasingly recognized need to harness the lived experience and expertise of service users and carers; and
- persistent social inequalities and inequity in access to information, support and services at different levels.
The study authors synthesize evidence from a wide range of mostly high-income countries by exploring different perspectives on person-centredness. This ranges from people:
- engaging in health service and system development and research;
- evaluating the quality of health services and systems;
- making decisions about purchasers or providers of services; and
- participating in their own care.
Drivers of person-centred strategies
For each of these perspectives, the study considers the strategic drivers of person-centred approaches, what success looks like, bottlenecks for implementation, innovations and future developments, and policy lessons learned. The study’s findings show that existing models and strategies for participation and involvement continue to fall short of systematically including the public voice in health services and systems, with much of the research evidence dominated by professional and organizational perspectives and those of policy-makers. The authors illustrate how drivers of person-centred strategies are often conflicting and potentially undermine the goal of achieving a person-centred health system. They argue that person-centred strategies continue to be dominated, largely, by a utilitarian perspective based on the idea that an informed service user behaves in ways that will ultimately improve the quality of their care and their health (and reduce costs and improve efficiency). The study also shows that many strategies lack a clear theoretical basis that would explain how certain activities will lead to anticipated outcomes, and why there is an urgent need for rigorous evaluation that takes account of context, equality and diversity.
A set of levers and strategies towards achieving more person-centred health systems is discussed in detail. This includes:
- implementing general policies to strengthen capabilities for engagement across all stakeholders;
- making better use of existing levers, such as digital technologies, while also considering their limitations;
- investing in education and training, since the delivery of person-centred care will require a new range of knowledge, skills and competences for professionals, managers and decision-makers; and
- measuring and monitoring to understand what matters to people and how this can be used strategically in the (re)design of service organization and delivery across the different tiers of the system.
Absence of public voice
Crucially, the research shows that achieving truly person-centred services and systems requires the systematic and serious inclusion of the perspective of the public, as service user, carer, community, taxpayer or citizen, in the (re)design of services across the different tiers. While it is encouraging to see that person-centredness has become a key priority for policy-makers nationally and internationally, those involved in service and system design would do well to recognize that the public voice still remains virtually absent in many of the local strategies that are being considered to achieve it. This is a fundamental shortcoming that should be addressed as a matter of priority by leaders at the organizational and system levels.
This study will be of most interest to those designing, directing and governing health care services, providing robust evidence on the range of strategies towards achieving more person-centred health systems. In particular, it will serve as a guide to implement effective approaches and strategies that place individuals, their families and communities at the centre of the health system and enable service users to play a more central and directing role in their own care as well as in shaping the system that serves them.