Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation.

Methods
Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients’ perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model.

Results
The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient’s illness needed to be addressed or resolved for open listening to be perceived as a positive experience.

Conclusions
The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.

Discussion
The main finding in the present study is that obvious effects stemming from the new care model were present in the data. However, its implementation was both fragmented and gradual; fragmented because not all staff appeared to be working according to the new care model (respondents perceived a difference between how individual staff members interacted with them) and gradual because the data indicated that staff who worked according to the person-centred care scheme did so in various degrees.

Traces of the implemented new care model were obvious; however, it was also clear that the implementation was not complete. The analysis gave the impression that a large portion of the staff understood and followed the instructions of the new care model to different degrees. Some conflicting data were also evident, indicating that some staff did not work according to the new care model at all. The analysis shows that patients felt listened to and that their own perceptions of the situation were noted. This was perceived positively and created trust. Patients felt secure in knowing that the healthcare professionals had listened to them and that their concerns had been taken seriously. Patients spontaneously expressed that they felt that the staff saw them as people and did not solely focus on their disease. It was also stated that not every ailment or aspect of a person’s illness needed to be addressed or resolved for open listening to be perceived as a positive encounter. To have the opportunity to express one’s thoughts and feelings and be listened to was, in many cases, considered to be the most important aspect. The fact that staff had a wider understanding of the patient’s situation provided peace of mind. In cases where the patient was already aware of his or her disease, it meant a lot to be taken seriously and to receive the help they sought. This confirmed a sense of personal responsibility for his/her situation and seemed to be a basis for a continuing relationship with their healthcare providers.

Two of the features described in the new care model, initiating the partnership and operating the partnership, were richer in data than the last feature, safeguarding the partnership. This may be explained by the results found in a parallel study on management strategies to implement person-centred care [33]. In that study, it was found that there was a lack of common strategies, each manager had their own thoughts and understanding of how to implement and operate the model. One of the aspects of person-centred care that all the managers agreed on, was that by understanding the patients better, care could be more effective and that money could be saved [33]. Many patients had previous care experiences and they sometimes compared these experiences with on-going care. They pointed out how both nurses and physicians showed more interest in them as persons and they did not just focus on the disease as they had done on previous occasions. They perceived this change as a positive addition that did not reduce the exiting level of medical care.

The interviews also revealed that respondents had different reactions to the new care. Some respondents felt that they were included and able to participate in their care, and they approved of the regime. In contrast, others felt they were not included but did not expect it. Of those respondents who were not included in their care, some did not mind and considered it natural to leave all decisions to the staff. They saw the staff as experts who were supposed to have that role; this is a common perception found in other studies [27]. Other respondents did not see it that way at all: they really wanted to participate although some felt excluded and not allowed to do so. Several respondents had experiences where the staff talked to each other over their heads, and in some cases staff discussed matters with the respondents’ relatives instead, which made the respondents feel belittled. Thus, it may not be that patients do not want to participate in their care but rather they have not been appropriately invited to do so. Eldh et al. found that if the discussion emanated from a patient perspective, patients were more likely to participate [25]. Furthermore, Say et al. concluded that health professionals should be more sensitive to patients as people to provide person-centred care [26]. In some cases, the respondents expressed uncertainty about openly talking about their situation and felt that their personal experiences were of no relevance to their medical situation. Great respect for physicians made it difficult to express feelings and personal thoughts. When such thoughts had been encouraged and their value affirmed, respondents rated the discussions as being very positive and considered it an important experience during their hospital stay.

The patient as a partner, as described in the theoretical paper by Ekman et al. was never intended to make medical decisions; instead, they can contribute to their care by being experts about themselves and by jointly guiding the care towards personally set goals [2]. However, some respondents were unclear about their role and how they could participate. This may have been unclear because in the previous study on the managers in this specific department, it was found they had different views on this issue, thus giving mixed messages [33]. However, one way to engage and involve patients is to start from a personal perspective, discussing their circumstances, pointing out factors influencing the outcome in connection to their health plan. Thus, respondents are drawn into the planning process and it becomes natural for them to participate.

This article is adapted from Tariq Saleem J Alharbi, Eric Carlström, Inger Ekman, Anders Jarneborn and Lars-Eric Olsson, Experiences of person-centred care - patients’ perceptions: qualitative study. Source article. This work is licensed under a Creative Commons Attribution 4.0 License.