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Person and whānau centred care is collaborative healthcare focused on meeting the needs, values, and desired outcomes of individuals and whānau. This document presents a definition and model of person and whānau centred care for physiotherapy in Aotearoa New Zealand.
The model consists of:
A selection of stories from people who have received physiotherapy care that illustrate what different behaviours ‘look like’ in practice have been provided.
The model has been developed to support and enhance the physiotherapy profession, and to build physiotherapists’ capability, knowledge and understanding. Demonstrating the values and enacting the behaviours described in the model will enhance physiotherapists’ professional practice and ability to improve health outcomes. In contrast, centring care on the needs of the healthcare system or the professionals within the system perpetuates health inequities and contributes to poor health outcomes. Incorporating person and whānau centred care into practice will also assist physiotherapists’ adherence to the requirements that apply to physiotherapy in Aotearoa New Zealand as aspects of the model directly align with the Physiotherapy Standards framework1 and other parts of the regulatory framework, including the Code of Health and Disability Services Consumers’ Rights.2
The intended audience for this document are physiotherapists within Aotearoa New Zealand, those offering continuing professional development to physiotherapists, physiotherapy students, and others associated with the profession.
Supporting resources and further information to assist physiotherapists to enhance their practice in terms of developing and strengthening these competencies are available on the Physiotherapy New Zealand website.
Whaka paohotia oku painga kia ngaro oku ngoikoretanga
Highlight my strengths and my weaknesses will disappear
[Image description: Diagram shows the person and whānau centred care model. The person is located at the centre, with the whānau wrapping around the person. Values wrap around the whānau. Behaviours radiate out from the values. System-level components are located around the outside of the behaviours.]
Person and whānau centred care is collaborative healthcare that is focused on meeting the needs, values, and desired outcomes of the person and whānau.
The person is the individual who has a therapeutic or professional relationship with a physiotherapist.
Whānau is a concept that applies to many cultures and ethnicities. Whānau are those to whom the person relates in terms of shared experiences, values and beliefs. The people and relationships that comprise a person’s whānau may be lifelong, or time-limited and specific to the person’s life circumstances. These relationships are not necessarily reliant on kinship ties.
This model recognises that whānau is a core value of many people, particularly those who belong to communalist cultures. The embodiment and expression of this value will vary between individuals.
Person and whānau centred care is underpinned by the values of dignity, respect, empowerment, and collaboration.
Dignity is the inherent value and worth of each person and whānau.3,4 Physiotherapists treat all people with dignity by acknowledging and upholding their value and worth.
Respect is giving each person and whānau proper attention and consideration, and holding them in due regard.5 Physiotherapists afford all those with whom they interact appropriate care and attention, aiming to enhance personal and whānau mana in all interactions.
Empowerment is the process of supporting and enabling individuals, whānau, and communities, to take control of their own health needs, and become stronger and more confident in doing so.6
Collaboration is the process of individuals, whānau, and health professionals, working together in partnership to achieve a common purpose.6
Person and whānau centred care is demonstrated through the following behaviours. Although presented as separate behaviours, there is significant crossover and overlap between these. The order in which these are presented relates to the visual representation of the model; the order does not indicate relative importance or priority. Each story presented describes an example of what the behaviour ‘looks like’ in practice. These experiences were shared by physiotherapy consumers.
“Our mum has dementia and the physiotherapist developed a great rapport with her which was a significant factor in her recovery and optimising her mobility. Mum is very musical and creative and the physiotherapist went the extra mile with incorporating these interests with his therapies to make it work for her.”
Seeing the ‘patient’ as a person involves:
‘Culture’ is “a dynamic system of rules – explicit and implicit – established by groups to ensure survival, involving attitudes, values, beliefs, norms, behaviours, shared by a group, but harboured differently by each [person] within the group”.10 (p. 24) Culture varies between individuals within the same group and over time. Cultural competence and safety involves acknowledgement of your own culture as different from those of your patients and their whānau, so as not to impose your own cultural beliefs and practices onto them.11
“I will always always always remember the way you [the physio] took the time to build rapport with [my daughter, aged 11]. And SAW HER as a person. Not as “just a toddler” or “patient”. How you talked to her and ASKED her before you touched her.”
People and whānau have unique needs and values. Tailoring, organising and coordinating care around people and whānau involves:
Coordinating care around the person and whānau extends to the collaboration with other healthcare professionals, advocating for the needs of people, whānau and communities, and assisting people and whānau to navigate the health care system.
“From the first phone conversation organising the very first appointment, our family needs have been considered with the offer of home visits should we find it difficult to make it into the physiotherapist’s place of work. In a similar vein, once my daughter and I began attending speech language therapy appointments, these were combined successfully with physiotherapy appointments, thus reducing the number of visits we needed to make to the hospital and increasing the value (to us) of those visits we did make.”
Effective communication comprises all of the components of verbal communication, body language, and the content of the message communicated, as well as active listening, connecting and engaging. It involves:
“The physiotherapist took time to show me all the exercises and if I didn’t get it right she used a different way of explaining to help me understand it better. She never hurried me or seemed to be in a rush. She always made me feel safe and made sure I didn’t trip or fall over equipment.”
Information is shared between the physiotherapist and the person, whānau, and other professionals involved in the person’s care, as appropriate. Sharing information is a two-way process, involving both giving and receiving information.
Giving information involves:
Receiving information involves:
Sharing information is closely related to utilizing effective communication. As such, it involves using appropriate resources (e.g., interpreters) to enable information sharing to be effective.
“Immediately following my stroke, while still in hospital, the physiotherapists who worked with me always invited my husband to attend sessions. While always talking to me directly, they shared their professional knowledge with him. This meant that my husband was able to help me practise skills and exercises in our own time which was of great benefit to me.”
Supporting the person and whānau to increase their levels of health literacy is a key enabler for self-management and participation. This involves:
“Our physio helped us be able to connect with other whānau that were facing the same journey as us. It gave us a safe platform to discuss our experiences.”
Empowering individuals and whānau involves supporting people to recognise, develop, and enhance their own strengths, abilities, and confidence, to enable them to live an independent and fulfilling life. Empowering the person and whānau enables self-management and autonomy, and can be aided through engagement with consumers, whānau, family, work places and communities.
“Knowing that I couldn’t read print but could see colour, two physiotherapist students made a long programme and a short programme, each with a different coloured case. Since then, these exercises have been down-loaded onto my cell phone and Booksense* so that I have an accessible set of exercises which I can listen to and work through no matter where I am.”
[* Booksense is a portable electronic Digital Accessible Information System device with multiple functionalities including text-to-speech output.]
Integral to the notion of partnership is the sharing of power and control. It involves:
“The physio team visited and spent time explaining and answering all our questions, enabling us to feel confident in our decision-making.”
Enabling participation involves supporting the person and whānau to develop the knowledge, skills and confidence that they need to fully participate in the partnership and therapeutic process.
Encouraging participation is about supporting individuals and whānau to engage and be actively involved in the therapeutic process and partnership. It may also involve working with the person, their whānau, community or workplace, to develop further supportive resources and structures. Supportive environments have been found to enhance people’s participation and self-management, and support health improvements.16
“The physiotherapist was so attentive to my own views, ideas, experiences and observations (as the mother of the patient), which definitely contributed positively to my level of participation and involvement in appointments. This means I felt it worthwhile to observe my child carefully and prepare for appointments; I also acted on the advice and guidance given by the physiotherapist because I was confident that it came as a result of a communion between the physiotherapist’s expertise and experience and my knowledge of my own child.”
The essence of partnership is recognising the person, whānau, and practitioners as equal partners with different expertise. It involves:
“The centre of conversations during physiotherapy appointments was what our family’s experience and perception of our child’s development had been. The physiotherapist offered advice and guidance (not instructions - note the difference!) after careful listening and observation and was encouraging at all times regarding the strategies developed within our family for supporting our daughter’s specific needs.”
Integral to goal-oriented care is collaborative goal-setting, where goals that are meaningful to the person and whānau are collaboratively negotiated and agreed. Negotiation is fundamental to this process. Goal-oriented care focuses on these explicit objectives, encouraging achievement of the highest possible level of health as defined by that person, and including “the ability to adapt and to self-manage, in the face of social, physical and emotional challenges”.17 (p. 1) Progress against the goals is regularly and jointly monitored and evaluated, and progress and achievement are recognised and celebrated.
“Our physios have always focused on goals which is [a habit that is] now ingrained in my daughter’s life since her [brain] injury. Her first goal was learning to walk again. Now her goal is to swim in the Paralympics.”
The person and whānau centred care model also recognises a number of system-level components. These are components that may not be under the direct control of the physiotherapist, but nonetheless, impact on the care of people and should be actively considered by physiotherapists. Physiotherapists and others within the wider community are encouraged to reflect on these, and influence them wherever possible.
Significant differences exist in the health and health outcomes of different groups of people, linked to their socioeconomic status, ethnicity, gender, sexuality, and geographic location.18 Differences that are unnecessary, unwarranted, unfair, unjust, and avoidable are health inequities.19 Health equity does not mean that the health care or services provided to all groups are uniform or the same. Instead, it means that approaches and services are tailored to different groups to enable them to get the same outcomes; health equity is about equity of health outcomes. Equitable approaches consider the impact of avoidable differences and aim to minimise the impact of these.9 Principles aimed at enhancing health equity should be considered in the development of all interventions and actions at all levels within the health sector. Improving health equity assists provision of person and whānau centred care, and vice versa.6
Fostering relationships with communities encourages community engagement and participation in health initiatives. Community engagement and participation can improve health outcomes, provide support networks to members, help communities to identify and understand factors that contribute to certain health issues, and raise awareness of preventative and other health care options. Time and ongoing commitment are required to build strong relationships between health care providers (professionals and managers) and community members. The strength of these relationships helps determine the effectiveness of community engagement and participation.
Interprofessional practice optimises the use of multiple skills sets (including those of professionals, patients and whānau) to provide well-coordinated, high-quality, person and whānau-centred care.20 Higher levels of collaboration are needed when health needs are complex and individuals receiving care require diverse skills.21 Interprofessional practice requires effective communication, a clear understanding of roles and team dynamics, shared leadership and an ability to effectively resolve conflict.20,21 Interprofessional practice is supported by team members learning with, from and about each other.15
Individuals and whānau are key stakeholders in healthcare. It is important that all stakeholders (including those with lived experience) are involved in the co-design, development, delivery, monitoring, and evaluation of healthcare and health services. Stakeholder input into practice management, service design, quality improvement, and policy is encouraged whenever possible. There are a number of ways that people’s input can be gained, including consultation via focus groups or questionnaires, or the involvement of ‘consumer representatives’ on steering committees or working groups. It can also include ongoing measures such as providing channels through which individuals and whānau can give feedback, (e.g., comment boxes).
There are many potential barriers to individuals and whānau receiving optimal care. Barriers can include the attitudes of healthcare providers and/or funders,22 the attitudes of individuals and/or whānau members, adherence to a biomedical paradigm, and expectations of those involved. Other barriers that may exist include the time available for physiotherapy sessions (or the timing of those sessions), the space available in consultation rooms for whānau members, the models of service delivery implemented, access to the healthcare services required, cost, and the healthcare system itself.22 Explicit identification and planning is required to enable the management or removal of these barriers.
The person and whānau centred care model endorses the regulated requirements to which physiotherapists and physiotherapy practices must adhere in Aotearoa New Zealand, and the component behaviours are integral to many of these requirements. These include the Physiotherapy practice thresholds in Australia and Aotearoa New Zealand (2015),23 the Physiotherapy Standards,24 the Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct,25 as outlined in the Physiotherapy Standards framework 2018,1 and the Code of Health and Disability Services Consumers’ Rights.2 The model complies with all applicable legislation that governs physiotherapy practice, including the Health Practitioners Competence Assurance Act 2003,26 the Privacy Act 1993,27 the New Zealand Bill of Rights Act 1990,28 and the Health and Disability Commissioner Act 1994.29 The model coheres with the strategic themes and areas for action of the New Zealand Health Strategy 201630,31 and He Korowai Oranga32 (New Zealand’s Māori Health Strategy), and aligns with many of the characteristics of Whānau Ora.33 The model and component behaviours also align with a number of the strategic objectives in Physiotherapy New Zealand’s
This model and supporting definitions has been prepared as part of the PNZ Professional Development Committee’s Person and Whānau Centred Care work stream (work stream leads, Ben Darlow and Karen Evison). It has been informed by input from consumers, members of the work stream’s reference group, and existing literature. The development process has included initial literature review,6,23,35-46 the development and analysis of vignettes provided by consumers and physiotherapists demonstrating the presence or absence of elements of person and whānau centred care, initial model development, stakeholder consultation, further literature review,8,22,47-62 subsequent model redesign, and further extensive stakeholder consultation. The Professional Development Committee are grateful to all those who have provided input to the model, including members of the reference group: Martine Abel, Amelia Buick, Dawn Birrell, Karen Elliott, Ben Hinchcliff, Lynda Kirkman, Dave Nicholls, Meredith Perry, Jess Radovanovich, Madeleine Sands, Di Scott, Ashley Simmons, Erin Swan; Tae Ora Tinana; consumers who have generously shared stories.
Authors: Ben Darlow and Anna Williams, on behalf of the Physiotherapy New Zealand Professional Development Committee.
Publisher: Physiotherapy New Zealand, Wellington, NZ.
Year of publication: 2018