The aim of the person-centered coordinated care (P3C) is to meet the person’s health and social life needs. Health demands are changing, and organizations must also change to meet the demands of these changes. Some of these changes are causing various challenges to the NHS requiring them to increase their efficacy, productivity and at the same time deliver quality care with reduced deficits. The health demands have caused the healthcare sector to come up with the approach of P3C. This approach involves moving away from the traditional approach of the disease-focused models to a more effective approach which focuses on the efficacy and integration of the care into the patient’s and the carer’s life. The P3C is particularly seen as the most appropriate way of providing care to people living with long-term health conditions (LTCs), multiple long-term health conditions (MLTCs) and Individuals with multimorbidity. The determination of this paper is to provide a detailed discussion of the critical components to the implementation of the P3C and to also discuss the obstacles that are faced when implementing P3C.
P3C is a care system which focuses on improving the consumer’s both mental and physical wellbeing, with an end goal of improving the person’s quality of life. Enhancing the quality of life involves ensuring that the people’s health demands are cared for to relieve them stress and guarantee them a healthy future. P3C also involves management of medical condition and restoration of functional independence. According to (GOV. UK. Department of Health and Social Care, 2012) the P3C is one relevant ways of helping individuals with LTCs, MLTCs and those with multimorbidity. For better results in P3C, care professionals should embrace an approach to care coordination. They need to understand that systems filled with confusion, fragmentation, and discontinuity will lead to poor results. An elaboration of this notion was provided by (Ekman et al., 2011) that P3C can be approached through three techniques; eliciting a consumer narrative, co-creating a care plan, and documenting the plan inside the care plan.
In summary, a P3C can be said as a care whose support is guided informed and organized efficiently to focus on an individual’s needs and preferences. The (NHS England, 2013) creates this summary by demonstrating P3C as a house of House of Care. According to (NHS England, 2013) this house of care was created to accommodate the changes needed for the management of LTCs. The approach was aimed to provide a holistic approach to the individuals of LTCs and support them reach maximum outcomes possible. The house of care symbolizes the health care system and the structural design symbolize the four components of P3C which are discussed below.
(“The House | NHS Year of Care,” 2018), “The house, its foundation, walls, and roof serve as a metaphor. The checklist, emphasis on the value of and inter-dependence of the components. One cannot function without the other.
Commissioning helps the care professionals to coordinate the care plan that the output of one unit of care will inform the other as they transition towards the desired goals. Commissioning takes five steps. The initial requires family members, friends and carers to support the patient in developing visions and strategies of the care. Next is the information gathering stage. Care systems must acquire information and resources that can help them in identifying the needs of the consumers. The third step is the planning and specification of the outcomes expected from the care systems. While designing the plans, the care systems should make in a way the outcome will exceed their projected results. The fourth step is the procurement. This essentially involves decisions making processes which is an exchange of information from the key stakeholders. The last stage is the monitoring the patient’s improvement. It is the assessment whether services have met the required results on the patient.
This component of P3C can take different interpretations from different persons. However, the general definition revolves around partnership for collaborative care as adopted in (Chambers and Coleman, 2016). The basic concept involves bringing together people with required information to foster self-management support. According to (Health Foundation, 2014), these are the people whose information would be resourceful in designing the care. For instance, the work of (Coulter et al., 2013) explains that consumers may need some extra encouragement to increase their level of participation. Since the aim is to attain maximum collaboration, care providers should be prepared to encourage them.
Encouraging people to participate is critical especially those with (LTCs) and (MLTCs). Participation would enable them to take the management of their care, and it can also improve other aspects of health such as emotions and stress. Patient’s participation is the key to self-management and support which plays a major part in recovery. Healthcare staffs need to acknowledge this new mode of working. Recognition of patient, families, and carers allows every person involved to contribute towards recovery. It is this contribution that also helps consumers to develop their skills in self-management. Also, collaboration extends to other staff as a healthcare system is made up of other subsystems and it cannot function without the collaboration of all the subsystems.
This component P3C is symbolized by the floor in the ‘house of care,’ and include but not limited to the safety of the procedures. The basic principle is that clinical processes should be organized in a way they are focused on meeting the specific patients and their carers’ needs. According to (Health Foundation, 2014), the organizational and medical processes could be established by using three strategies. These are the health literacy, digital health, and integration.
The digital health involves incorporating technological advancement into the care. The professionals need to embrace technological inventions which can help in the promotion of public health. In the case of P3C, some of these are devices and methods that can be used to reach out to patients where there is no need of face to face meeting. To illustrate, a healthcare system can have an online booking system for cancer patients where they can book appointments without coming to the hospital. According to (Wynia and Osborn, 2010), health literacy is the ability of a person to read, interpret, understand and utilize the health information provided. Health care literacy has been shown to increase patient satisfaction in P3C (Altin and Stock, 2016).
As mentioned above, healthcare systems are complex structures made up of small subsystems. Healthcare professionals need each both in practice and in decision-making processes. According to (NHS England, 2016), the exchange of information among healthcare professionals enables them to come up with complete decisions and this can only happen when they work as partners, and then involve patient to bring their feedback as experts of their care. The partnership brings two benefits in P3C. For one, having consumers as partners in the care and decision-making help in the personalization of the services. That is, as consumers are the experts of their care, they understand better what they need and involving them in decision making is giving them a chance to shape the services according to their demands (Levit et al., 2013). Secondly, the partnership allows a chance to expose the patients to different services which also allows them to decide on the one that suits their demands (Levit et al., 2013). Also, partnership encourages clinical implementation and efficient cultural interaction among service providers. A qualitative study done by (Wolf et al., 2017) to assess the realities of partnership found that both formal and informal facets of the partnership were found to inform discussions and agreements increasing coordination and corporation in the care delivery.
Despite the great benefits of P3C, its implementation has been hindered by various obstacles. However, most of these obstacles are born from within the components of P3C. For instance, the study undertaken by (England, 2015) showed that not all clinicians supported the idea of allowing people to take active roles in their care. Other obstacles to the implementation of P3C are discussed below.
Lack of care coordination:
Most of the problems with implementation of P3C are born from each other. When systems are fragmented, coordination also becomes a problem. According to (GOV. UK. Department of Health and Social Care, 2012), lack of coordination is demonstrated by the way patients are unaware of where to go or whom to approach in case of a problem. According to (Schang et al., 2013), lack of coordination within a healthcare system is a major cause of poor quality of P3C.
Encouragement and support
Encourage and support can be taken in two ways. On the part of the patient, poor psychological and Emotional support is greatly affecting the implementation of P3C. In particular, this is seen in giving little or no attention to patients’ mental health and their entire wellbeing. It is also noted in the failure to attend patient’s physical health conditions. lack of encouragement and support. On the part of healthcare professionals, the lack of better methods of encouragement and poor support to healthcare professionals is serious challenges in the implementation of P3C (Friedman et al., 2016).
The absence of informational continuity
The absence of informational continuity has been named as one obstacle in the implementation of P3C. Health care systems are characterized by numerous records but most of them are inaccessible to patients which limit their efficacy in shared decision making. Effective shared decision making relies on the patient exposure to informational materials covering their specific needs. According to (Barry and Edgman-Levitan, 2012), parties can effectively share the decision-making process when both have the shared information. The work explains that the care provider tells the patients all the benefits and risks, and then allow the patients to express their preference.
Fragmented care system
Healthcare systems remain within their own economy and they are not considered as part of the entire system approach to the social care or any other service that is helpful to people with LHCs. According to (The King’s Fund, 2015), the health and social care systems are most of the times fragmented and services are based on institution and professional boundaries rather than being one coordinated system focusing on the patients’ needs. Coming from the same point of view, (Local Government Ombudsman et al., 2016) states that fragmentation causes assessment delays, poor quality of care, failures in dealing with safeguarding issues, and lack of proper aftercare follow-ups after discharge.
Limited human resources
The work of (Daveson et al., 2014) states that resources greatly influence P3C. The work explains that care coordination requires more health professionals, time and money. With few professionals in the healthcare centers, the officials might be overpowered and would not be able to provide holistic needs when they are multitasking.
Infrastructure system and communication barriers
P3C can be a problem for those people living in rural areas or those who have to visit health care centers for specialized services. According to (Goodwin et al., 2013), it is sometimes hard to provide well-organized personalized care to consumers living in remote areas due to the fact that care providers have to travel long distances which can affect the resources allocated to healthcare systems. The poor roads and lack of means of communication like phone among some patients is also a problem to P3C.
Conclusion
Implementation of P3C is an intervention that is multifaceted and complex. For better results, the intervention must be supported an all levels. The aim of this paper was to provide a discussion of the main components for the implementation of P3C. Another object that this paper wanted to achieve is a discussion of the main obstacles to the implementation of P3C. The main components discuss were commissioning. engaged, informed consumers and carers, organizational and clinical processes, and health and care professionals working in partnership. The obstacles discussed were the lack of care coordination, poor encouragement, and support methods, the absence of informational continuity, fragmented care system, limited human resources, infrastructure system and communication barriers.
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