Three keys to a shared vision of diagnostic assessment: an initiative in person-centered care from the Department of Health in the UK.

Diagnosis is the missing link in person-centered care. Person-centered care has covered many different aspects of such important areas as treatment, resource allocation, and ethical practice (particularly concerned with patient autonomy). But with important exceptions [1, 2], diagnosis has been widely assumed to be, somehow, reserved to the scientific and other skills of doctors and healthcare professionals, and hence as being beyond the relevant scope of person-centered approaches.


Introduction
Diagnosis is the missing link in person-centered care. Person-centered care has covered many different aspects of such important areas as treatment, resource allocation, and ethical practice (particularly concerned with patient autonomy). But with important exceptions [1,2], diagnosis has been widely assumed to be, somehow, reserved to the scientific and other skills of doctors and healthcare professionals, and hence as being beyond the relevant scope of person-centered approaches.
It is thus particularly exciting that the Department of Health of the UK government in London has included within a range of recent policy and service development initiatives under the broad banner of 'personalisation' [3,4], a programme specifically concerned with diagnosis. This paper outlines this programme-called the 3 Keys programme [5]-and sets it briefly in context with the wider personalisation agenda.

What are the 3 Keys?
The 3 Keys are three aspects of assessment that a majority stakeholders in a wide-ranging consultation, including patients and carers as well as professionals, agreed are important: • • Key 1 is active participation of the service user concerned in a shared understanding with service providers and where appropriate with their carers • • Key 2 is that there should be input from different provider perspectives within a multidisciplinary approach, and • • Key 3 emphasises the importance of building on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges.
These 3 Keys may seem obvious: surely, you may think, everyone approaches assessment in a way that actively involves the service user (or patient) concerned, that takes note of the views of other professionals, and that looks at strengths as well as problems. Yet our consultation showed that while many stakeholders had experienced or could give examples of one or more of the 3 Keys in action, there were very few instances where all three came together. Service users and carers, in particular, told us that if the 3 Keys could be used together more widely, they would feel more empowered and that this would make an important contribution to their recovery and to their chances of developing the skills for self-management.
As with the other Keys, a strengths approach to assessment was broadly endorsed in the consultation by a large majority of stakeholders. However, 'aspirations' was an exception to this general rule. Service users and carers believe that their aspirations were vital to recovery; while by contrast, many professionals felt that trying to meet people's individual aspirations, went well beyond what they could offer. It was thus particularly exciting to find in the consultation that support workers, i.e. members of multidisciplinary teams without professional training, had developed a previously unrecognised role in supporting aspirations.

Next steps: implementation
The 3 Keys programme is being implemented, not separately but in close partnership with other programmes directed towards the personalisation of services and values-based practice [6]. The implementation programme, which is being coordinated nationally by NIMHE East Midlands (the National Institute for Mental Health in England is part of the policy delivery side of the Department of Health), thus includes a research and development project with minority cultural groups, and an impact study in connection with a new care pathways policy [5].
It is early days yet. But the strength of support for the 3 Keys approach from service users and carers as well as professionals, gives us hope that the programme will be successful in bringing person-centered approaches in at the vital stage of assessment. As one service user put it, if we are to understand a person's problems, it is essential that 'everybody's voice is heard, including families and carers'.