Reforming and Transforming Care: Considering Person- Centredness

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1 Reforming and Transforming Care: Considering Person- Centredness Professor Brendan McCormack Head of the Division of Nursing, Queen Margaret University, Edinburgh Professor II, Buskerud Vestfold University College, Drammen, Norway; Extraordinary Professor, University of Pretoria, South Africa; Adjunct Professor of Nursing, University of Technology, Sydney; Visiting Professor, University of Aberdeen

2 Tradition evolves with time and place while holding strongly to certain formal, cultural, and personal principles. Nostalgia seeks the security of past forms without inherent principles (Callthorpe, 2008)

3 Are our services more responsive to persons? Person-centred moments vs Person-centred cultures The fragility of person-centredness dependent on: Consistency of care delivery Effectiveness of coordination Quality of leadership (team/unit/organisational/strategic) Knowledge, skills and expertise of care team Existence of a person-centred culture Systems-wide commitment to person-centredness Existence of flexible models of care delivery (McCance et al, 2012)

4 Psychologically Unsafe Environments: characterised by Misuse of power and lack of autonomy Horizontal violence and oppressed behaviours Transactional leadership (Brown & McCormack 2010)

5 There is a need for organisations to change structurally and create more positive conditions if transformational leadership is to be sustained. Otherwise, nurse leaders will become frustrated in an environment that is expanding regulatory mechanisms (Hewison & Griffiths 2004)

6 Why does one <leader> bolster our spirits, calm our nerves and nourish our soul? Why does another drain us of our vitality, leaving us feeling flat? (Adapted from Quillien, 2008)

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8 Capacities of the U movement (Brown & McCormack 2010, adapted from Senge, Sharmer et al 2005). Suspending Seeing our seeing Sensing Create space to see connection with existent reality & transform perceptions Realising Bringing new action to transform context Embodying the new (project completion) PROTOTYPING redirecting Envisioning reaching clarity & connection to inner knowing Letting go Presencing Group & individual reflection to transform self & will Courage Commitment Facilitative leadership Letting come

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10 The Fifteen Properties of Nature Strong Centres Levels of Scale Boundaries Good Shape Positive Space Local symmetries Alternating Repetition Deep interlock & ambiguity Contrast Gradients Roughness Echoes Voids Simplicity & Inner Calm Not separateness The Nature of Order by Christopher Alexander

11 A Strong Centre

12 Levels of Scale All life tends to form multi-levelled structures of systems within systems the different nested levels help each other, perform different tasks, and are necessary to the functioning of the whole (Quillien 2008)

13 Boundaries A boundary helps focus attention on the centre

14 Good Shape

15 Positive Space Accomplished dancers will naturally create between and around themselves a flow of changing positive spaces. Beginners not well centred in themselves and out of sync with their partners will be less connected by the spaces in-between

16 Local Symmetries

17 Alternating Repetition

18 Roughness Roughness pertains to the resolution of problems when diverse elements come together in three-dimensional space

19 Every successful centre depends on the existence of a still place

20 Simplicity and Inner-calm

21 Not-Separateness Not-seperateness is experiencing a living whole as being at one with the world. Ponds, such as this one, cannot be sharply isolated from their surrounds. In the same way, old farming villages are not separate from their fields.

22 A coaching model that promotes a sense of safety, openness, and trust. Use of authentic methods that support a learner-centred approach. Facilitation of leader autonomy, participation and collaboration. Engagement with activities that encourage the exploration of alternative personal perspectives, problem-posing, and critical reflection Communicative spaces for democratic dialogue and experimentation

23 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete (Buckminster Fuller, cited in Quillien, 2008)