An exploration of strategies employed by residential aged care managers to implement person-centred care
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Tom Kitwood, the founder of person-centred dementia care, called for a cultural change in care, focused on preserving the personhood of people with dementia. The person-centred model fosters a milieu where staff can provide supportive, encouraging and meaningful social relationships with care recipients and each other. Person-centred care (PCC) is not only an approach to care but also a whole of system strategy. To enable PCC, managers need to cultivate staff’s engagement with PCC; this occurs through organisational commitment to the preservation and promotion of personhood for residents and staff. While managers are key to promoting the workplace conditions necessary for implementing PCC, definitive management strategies have yet to be fully articulated. This study set out to identify management strategies and the progress being made to implement PCC in one Australian aged care facility. The research question posed to focus this investigation was: “What planned management strategies support the implementation of person-centred care in a residential aged care facility?” The research question was answered by conducting semi-structured interviews with senior facility managers and administering a validated assessment tool, the Person-Centred Environment and Care Assessment Tool (PCECAT), which was employed to assess the degree to which the facility supported PCC principles and practices before and 12 months after the PCC implementation process commenced. Analysis of the manager interview data identified three main themes: Thinking differently / changing systems; Promoting the ‘yes culture; and, Changing people’s lives. Subthemes included: Thinking differently / changing systems, changes were made firstly to the practices before a person came to the facility. Changing systems involved altering of serving of meals, care planning and care practices. Additionally, Thinking differently / changing systems extended to staffing arrangements incorporating rosters, recruitment procedures, position descriptions and training. In attempting to create a supportive PCC organisational culture, managers upheld the ‘yes culture’ through ‘autonomous decision-making, supporting staff, promoting flexibility in care and developing PCC leadership’. The PCECAT results revealed that there was an improvement twelve months after the project began in Domain 1 (Organisational Culture) and in Domain 2 (Care & Activities, and Interpersonal Relationships & Interactions), in both care units. This study identified that managers shifted their major focus away from compliance to a set of rules and showed their commitment to the values and vision of PCC. This occurred by building a PCC organisational framework that supported PCC. This strategy proved successful, according to the PCECAT findings.
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