The complexities of implementing person-centred care in a real-world setting : A case study with seven embedded units

Sammanfattning: Background: Implementing complex innovations such as person-centred care (PCC) is gaining international momentum. Studies in real-world settings have the potential to designate factors crucial for large-scale implementation.Overall aim: To increase the knowledge about the implementation process of PCC in a real-world setting.Methods: The thesis consists of a case study with seven embedded units conducted between 2016 and 2019. Study I explored the strategies and how they were enacted to support implementation of PCC by triangulating data from activity logs, interviews with change agents, and written documents. Study II explored how the PCC model of the Gothenburg University Centre for Person-centred Care and its underlying philosophical principles were operationalised. Study III explored health care professionals’ perceptions of PCC characteristics by an interview study using focus groups, dyadic interviews, and individual interviews. In study IV a mixed-methods design was applied to develop a generic questionnaire measuring patients’ perceptions of PCC. The study was conducted in three phases and included interviews, a Delphi study and patients responding to the questionnaire, and taking part in cognitive interviews. Data were analysed using Rasch and qualitative content analyses.Results: The overall results of this case study show the complexity of health care and change processes, focusing the implementation of a new care approach. Specifically, study I revealed how 43 discrete strategies were used in the participating units to support implementation of PCC with wide frequency and dose variation of activities. Strategies used to train and educate HCPs and develop interrelationships between stakeholders were most often reported (78%). A limited number of strategies (4.6%) reported using evaluative and iterative strategies. Study II highlights the challenges of operationalising an abstract ethical approach into concrete core practices. Both similarities and dissimilarities between the participating health care units were identified. In study III, nine constructs from the CFIR were identified as pertinent to describe HCPs’ perceptions of PCC and showed how their perceptions were shaped by diverse factors, including local context and individual understanding of PCC. In study IV, a questionnaire measuring patients’ perceptions of PCC was developed and found to be psychometrically satisfactory.Conclusions: This case study contributes to an increased understanding of the complexities of implementing PCC in various health care settings. The complexities are apparent in all aspects of the case and contribute with guidance into the different factors that need to be considered during the change process, preferably before organisations embark on implementation of PCC.