CHAPTER 1
Introduction

INTRODUCTION

In this introductory chapter, we provide an overview of the collaborative work we have engaged in to create the first person‐centred curriculum framework to inform the development of curricula to educate healthcare practitioners. We provide an overview of the need for such a framework as well as sharing the systematic and rigorous methodology we adopted in our work. We demonstrate the iterative and reflexive approach we adopted to the development of the curriculum framework. Finally, we present the full Universal Curriculum Framework for Person‐centred Healthcare Practitioner Education.

The major content of this chapter is drawn from previously published papers written by all the co‐authors of this chapter. We have summarised and adapted the text from these previously published papers to present a synthesis of that work and introduce the reader to the curriculum framework itself. The complete collection of papers underpinning this chapter is listed in Table 1.1 and we would encourage you to visit this collection of papers for a deep understanding of the research and each stage of the development process that led to the finalised curriculum framework.

PERSON‐CENTRED HEALTHCARE POLICY AND PRACTICE

Person‐centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. In the first phase of the curriculum framework development project, we considered the emergence of person‐centredness, including person‐centred care and how it is positioned in healthcare policy around the world, while recognising our dominant philosophical positioning in Western philosophy, concepts and theories (Phelan et al. 2020). We critically reviewed the published literature for the period 2016 and 2021 to show how person‐centred healthcare has evolved over this time. We drew on published evidence of person‐centred healthcare developments, as well as information gathered from key stakeholders who engaged with us in this project as partner organisations. We identified five themes underpinning the literature and stakeholder perspectives.

TABLE 1.1 Published Papers on Which this Chapter is Based.

1. Policy development for transformation.
2. Participatory strategies for public engagement.
3. Healthcare integration and co‐ordination strategies.
4. Frameworks for practice.
5. Process and outcome measurement.

These themes reflect the World Health Organization's global perspective on people‐centred and integrated healthcare and give some indication of development priorities as we continue to develop person‐centred healthcare systems. However, our review methods also revealed the need for intentional development of individuals and teams as person‐centred practitioners within pre‐ and postregistration programmes. The centrality of caring relationships and possessing holistic care skills is highlighted, but the day‐to‐day challenges experienced in practice result in the context in which learning takes place not being supportive of the developments needed. Therefore, if the global developments highlighted are to be sustained and developed at scale, then we need many role models of person‐centred practice integrated at every level of the healthcare system who can facilitate person‐centred learning cultures, wherever such learning takes place.

The need for healthcare education programmes to plan strategically for a workforce that is ready to respond appropriately is obvious, and education curricula need to be innovative and proactive in this respect. In practice, this ‘reality’ may seem unreal, as evidence from service user feedback, patient experience surveys and patient/family outcome data continues to suggest that only ‘modest’ improvements in patient experience have been achieved, despite more than 20 years of service improvement, quality improvement and practice developments. While there has been major investment into such improvements, as well as into patient safety (and yes, patients are safer – in hospitals at least), these data have not significantly changed over the years.

Despite these best efforts, there is little evidence of fundamental change in the core cultural characteristics of healthcare practice, and some commentators argue (drawing on culture theory as an explanatory device) that most person‐centred developments focus on the artefacts of practice rather than on the core values that drive health and social care delivery. O'Donnell et al. (2020) highlighted the lack of a consistent focus on person‐centred principles, even in curricula that purport to have person‐centredness as their underpinning framework. At best, person‐centredness is used as a heuristic for containing a diverse range of principles, processes and practices in teaching and learning, rather than being an explicit conceptual or theoretical framework informing all stages of education delivery. Although there are few examples of professional education curricula for healthcare practitioners that adequately prepare them to work in a person‐centred way, they are expected to graduate from their professional programmes with the qualities and attributes of a person‐centred practitioner.

It is the drive to address these ongoing challenges in developing person‐centred healthcare services that motivated us to undertake the research that is the bedrock of this book. The work began in 2019 when McCormack and Dewing published a position statement on person‐centredness in the curriculum. This position statement formed the basis of the case of need and the detailed funding proposal submitted to the European Commission Erasmus + Strategic Partnerships for Higher Education funding stream (KA203‐990E7AB4). The research and development work undertaken is all in the public domain (Table 1.1). However, being cognisant of our earlier commentary on the challenges associated with making person‐centredness real in the curriculum, we were committed not just to providing a curriculum framework but also to helping make sense of the framework through practical actions, methods and tools. So, this book provides practical applications and, if worked with, an implementation strategy for the curriculum framework developed by the project team who are also the co‐authors of this book.

DEVELOPMENT OF A UNIVERSAL CURRICULUM FRAMEWORK FORPERSON‐CENTRED HEALTHCARE PRACTITIONER EDUCATION

The findings from the evidence synthesised by Phelan et al. (2020) and O'Donnell et al. (2020) and the previous work undertaken by the International Community of Practice for Person‐centred Practice (PcP‐ICoP)1 in developing a position statement for person‐centredness in nursing and healthcare curricula (McCormack and Dewing 2019) were the impetus for developing a person‐centred curriculum framework for educating healthcare professionals, supported by funding from the European Union Erasmus + Strategic Partnerships for Higher Education Programme (Project ID KA203‐990E7AB4)....