Introduction: The interaction between patients and clinicians is at the heart of health care. They are the first point of contact and a familiar interaction with the health service for most patients. Consultations happen in a variety of contexts, locations and with many different clinical professions. Relationship Centred Practise is about enablement, viewing patients as assets not burdens and seeks to support them to recognise, engage with and develop their own sense of resourcefulness building on their own unique range of capabilities. Such interactions consider the patient’s life goals, how they plan to work towards them and what support they need to help get there.
Practice Change Implemented: Principles of grounded theory were used to develop a framework for relationship centred practise. In the first phase, workshops were held with over five hundred participants including policy makers, leaders of health services and clinicians and these insights used to develop a framework for testing. In the second phase, semi structured interviews were held with thirty one participants from professional backgrounds of doctor, nurse and therapist and at levels of policy maker, leader and clinician and these insights used to refine the framework.
Aim and Theory of Change: The framework contains seven elements namely ; preparation; agenda setting; information gathering; discussing options; agreeing the way forward; implementation; review and further actions, with each of these elements supported by reflective learning and service improvement. Insights obtained led to development of a grounded theory model for implementation with roots in the theory of planned behaviour and describes elements of clinician attitude, clinician norms and controls impacting on intention with action factors of patient self-efficacy, the framework and leadership support leading to behaviours. The most significant issues perceived were ; conflict between the framework and current models; power relationships; the context of the interaction; patient self-efficacy; clinician understanding ; the conflicting expectance of patients about the clinician’s role; time constraints and ; clinician training.
Discussion: Relationship centred practise has increasing recognition and evidence base as a transformative approach to delivering health care. It is acknowledged that changing health outcomes requires a transformational change in the relationship between clients and clinicians. A training package has been developed that builds on Maori models of care, international knowledge of relationship centred practise and the framework.The training package consists of :
- Initial Introductory e-learning module suitable for all Central Region employees
- Face to face skills training for clinicians of three half day sessions spaced one month apart
- Advanced e-learning module to consolidate and develop skills
Conclusions: Relationship centred practise is widely accepted as an opportunity to deliver person and whanau centred services. A training package has been developed based on 17 years developing and implementing relationship centred practise training models. The training package is relevant to the New Zealand context, integrating Whanau Ora, Maori models of care, aligning with the Triple Aim, and the New Health Strategy. The training package is based on nine elements of practise that improves clinicians’ resilience and well being in preparation for relationship centred interactions with patients.