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Developing Person-Centred Cultures in Healthcare Education and Practice This book embarks on an ambitious journey to challenge existing paradigms and spark a radical shift in the way healthcare is perceived and delivered. Dive into a groundbreaking exploration of person-centred healthcare education, offering a multi-dimensional framework that redefines learning and practice in the healthcare landscape. This comprehensive guide, with contributions from top experts in the field, dissects the critical components of a person-centred curriculum, spanning philosophy, strategy, values, leadership, and practical skills. The book empowers readers with real-world case studies, tools, and reflective exercises, propelling the implementation of transformative person-centred healthcare practices. Derived from the concepts introduced by the first European-funded project to frame and develop a person-centred healthcare curriculum, Developing Person-Centred Cultures in Healthcare Education and Practice presents an indispensable resource for healthcare practitioners looking for a way to develop person-centred cultures within the workplace. Key features: * An innovative curriculum framework for person-centred healthcare education and practice * In-depth coverage of philosophy, strategy, shared values, leadership, and practical skills for fostering person-centred cultures * Practical tools and real case studies to facilitate effective implementation of person-centred practices This book is an indispensable resource for educators, healthcare practitioners, and policymakers looking to champion the shift towards person-centred healthcare practices.
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Seitenzahl: 465
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication
List of Contributors
Foreword
Acknowledgements
CHAPTER 1: Introduction
INTRODUCTION
PERSON‐CENTRED HEALTHCARE POLICY AND PRACTICE
DEVELOPMENT OF A UNIVERSAL CURRICULUM FRAMEWORK FORPERSON‐CENTRED HEALTHCARE PRACTITIONER EDUCATION
THE CURRICULUM FRAMEWORK
CONCLUSION
OVERVIEW OF THE BOOK
REFERENCES
CHAPTER 2: Strategy
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT STRATEGY
UNPACKING THE STRATEGIC THEMES
EXPLORING CULTURE AND CONTEXT – HOW TO DEVELOP PERSON‐CENTRED LEARNING CULTURES
DEVELOPING SHARED VALUES, VISION AND MISSION
TRANSLATING THE STRATEGIC VISION INTO PRACTICE
PULLING IT TOGETHER
SUMMARY
REFERENCES
CHAPTER 3: Structure
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT STRUCTURE
UNPACKING STRUCTURE THEMES
SUMMARY
REFERENCES
CHAPTER 4: Systems
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT THE SYSTEMS COMPONENT OF THE PERSON‐CENTRED CURRICULUM FRAMEWORK
SUMMARY
REFERENCES
CHAPTER 5: Shared Values
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT SHARED VALUES
UNPACKING KEY THEMES (THEMATIC ACTIONS)
SHARED LANGUAGE
CREATING PERSON‐CENTRED LEARNING CULTURES
AGREEING PRINCIPLES OF ENGAGEMENT
VALUES CLARIFICATION
COURAGEOUS CONVERSATIONS
GIVING AND RECEIVING FEEDBACK
EMBEDDING SHARED VALUES
SUMMARY
REFERENCES
CHAPTER 6: Style
INTRODUCTION
WHAT DOES LEADERSHIP MEAN TO YOU?
WHO ARE THE LEADERS?
LEADING IN A PERSON‐CENTRED WAY
VISIONING LEADERSHIP FOR A PERSON‐CENTRED CURRICULUM
NAVIGATING TENSIONS, DANCING WITH PERSONS
KNOWING SELF AS A LEADER
PSYCHOLOGICAL SAFETY AND LEADERSHIP
DEVELOPING A STRONG LEADERSHIP IDENTITY
LEADING OTHERS TO CREATE HEALTHFUL CULTURES
SUMMARY
REFERENCES
CHAPTER 7: Staff
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT STAFF
UNPACKING THE STRATEGIC THEMES
INTRAORGANISATIONAL LEARNING AND DEVELOPMENT FOR STAFF
SUMMARY
REFERENCES
CHAPTER 8: Skills
INTRODUCTION
FREQUENTLY ASKED QUESTIONS ABOUT SKILLS
UNPACKING THE STRATEGIC THEMES
SUMMARY
REFERENCES
RESOURCES
CHAPTER 9: Motivational Stories
STORY 1: THE POWER OF COLLABORATIVE WORKING – THE ULSTER UNIVERSITY STORY
STORY 2: DEVELOPING A PERSON‐CENTRED CULTURE IN EDUCATION – THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF MARIBOR STORY
STORY 3: BECOMING A PERSON‐CENTRED LEADER – A PROGRAMME FOR HEALTHCARE LEADERS
STORY 4: A NORWEGIAN PHD PROGRAMME IN PERSON‐ORIENTED HEALTHCARE
STORY 5: LECTURERS AND LEADERS AS AMBASSADORS OF PERSON‐CENTREDNESS IN THE FACULTY
STORY 6: A SLICE OF CAKE TO DEVELOP SAFE SPACES FOR LEARNING AND DEVELOPMENT
STORY 7: ASSIGNMENT WRITING AS TRANSFORMATIVE LEARNING
REFLECTING ON THESE MOTIVATIONAL STORIES
SUMMARY
REFERENCES
RESOURCES
Index
End User License Agreement
List of Tables
Chapter 1
TABLE 1.1 Published Papers on Which this Chapter is Based.
TABLE 1.2 Principles for Person‐centred Curriculum Design.
TABLE 1.3 The McKinsey 7S Framework with Adapted Definitions of Each Elemen...
TABLE 1.4 The Elements of The 7S Framework and Associated Questions.
Chapter 3
TABLE 3.1 Thematic Actions (Structure).
TABLE 3.2 A Mapping Template.
Chapter 4
TABLE 4.1 Thematic actions of the systems component of the Person‐centred C...
TABLE 4.2 Activities to illustrate the practical implementation of these th...
Chapter 5
TABLE 5.1 Thematic Actions (Shared Values).
TABLE 5.2 Essential Attributes of an Effective Workplace Culture.
TABLE 5.3 Factors for Successful Feedback.
TABLE 5.4 Job‐related Competency – Leadership.
Chapter 6
TABLE 6.1 Setting Principles For Working Together.
Chapter 7
TABLE 7.1 Consider the Frequently Asked Questions About Staff Teams.
TABLE 7.2 Inventory of Roles, Responsibilities and Tasks Required to Design...
TABLE 7.3 Overview of Roles, Responsibilities and Tasks Needed, With Corres...
TABLE 7.4 The Staff Expertise, Talent and Learning Needs Inventory.
TABLE 7.5 Matching Roles and Responsibilities to Staff Members with Require...
TABLE 7.6 Matching Tasks with Staff Members' Required Talents and Expertise...
TABLE 7.7 Basic Shadowing Agreement Plan.
TABLE 7.8 Observation Tool for Peer‐to‐Peer Shadowing.
TABLE 7.9 Feedback Action Planning Tool.
Chapter 8
TABLE 8.1 Stakeholder Analysis Template.
Chapter 9
TABLE 9.1 The 7S Framework with Definitions of Each Element.
TABLE 9.2 Motivations and Drivers for Developing the Ambassador Role.
List of Illustrations
Chapter 1
FIGURE 1.1 Overview of participative hermeneutic praxis methodology.
FIGURE 1.2 Core principles underpinning a person‐centred curriculum.
FIGURE 1.3 7S Methodology (www.mindtools.com/pages/article/newSTR_91.htm).
FIGURE 1.4 The adapted 7S methodological framework.
FIGURE 1.5 Curriculum framework definition.
FIGURE 1.6 Person‐centred culture defined.
FIGURE 1.7 Overview of methodological stages.
FIGURE 1.8 The Person‐centred Curriculum Framework.
Chapter 2
FIGURE 2.1 Person‐centred practice framework.
FIGURE 2.2 Defining the macro‐context.
FIGURE 2.3 Defining the prerequisites.
FIGURE 2.4 Defining the characteristics of the practice environment.
FIGURE 2.5 Defining the person‐centred processes.
Chapter 3
FIGURE 3.1 Flipcharts with statements.
FIGURE 3.2 Labelled flipchart.
Chapter 5
FIGURE 5.1 Visual representation of the seven elements of a healthcare educa...
FIGURE 5.2 Principles of engagement.
FIGURE 5.3 Feedback versus criticism.
FIGURE 5.4 Principles of giving and receiving feedback.
FIGURE 5.5 Performance enhancement review template.
Chapter 6
FIGURE 6.1 A concept analysis framework of leadership in a person‐centred cu...
FIGURE 6.2 Tensions experienced by leaders.
Chapter 7
FIGURE 7.1 The pathway of curriculum development.
Chapter 8
FIGURE 8.1 Adjusted circle of Sinek (2009) for strategy planning for facilit...
Chapter 9
FIGURE 9.1 The 7S person‐centred curriculum framework.
FIGURE 9.2 Partnership working with collaborators and strategic partners.
FIGURE 9.3 Using creativity to facilitate an understanding of person‐centred...
FIGURE 9.4 The person‐centred leadership framework.
FIGURE 9.5 Framework for reflecting and planning person‐centred curriculum i...
Guide
Cover Page
Table of Contents
Title Page
Copyright
Dedication
List of Contributors
Foreword
Acknowledgements
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Developing Person‐Centred Cultures in Healthcare Education and Practice
An Essential Guide
Edited by
BRENDAN McCORMACK
Susan Wakil Professor of Nursing, Head of School and DeanThe Susan Wakil School of Nursing and Midwifery(inc. Sydney Nursing School)Faculty of Medicine and HealthThe University of Sydney, Australia
This edition first published 2024© 2024 John Wiley & Sons Ltd
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Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for:Paperback ISBN: 9781119913863ePDF: 9781119913870epub: 9781119913887
Cover Design: WileyCover Image: © freshidea/Adobe Stock Photos
Dedication
We dedicate this book to the life and works of Professor Jan Dewing (1961–2022). Jan was a member of the original project team, and while she began the journey with us, she was unable to see it through to the end. Jan's commitment to and passion for person‐centred learning have been woven through the project to develop the first pan‐European curriculum framework for the education of person‐centred healthcare professionals. Her legacy lives on in this and other works and her voice permeates the rich tapestry of person‐centredness we are committed to as authors.
Some of us are … in the paradoxical position of enjoying or even taking for granted significant privilege while also being committed to addressing it in some way or other. This leaves us … asking: How can I/we deploy the benefits we have amassed to meaningfully contribute against the oppression of others? (Dewing 2020)
List of Contributors
Donna Brown
Senior Lecturer in NursingSchool of Nursing and ParamedicScienceUlster UniversityBelfast, Northern Ireland
Gobnait Byrne
Assistant ProfessorSchool of Nursing and MidwiferyTrinity College DublinDublin, Ireland
Shaun Cardiff
Senior LecturerFontys University of Applied SciencesEindhoven, The Netherlands
Neil Cook
Professor of NursingHead of School of Nursing and Paramedic ScienceUlster UniversityBelfast, Northern Ireland
Caroline Dickson
Senior Lecturer in NursingSchool of Health SciencesQueen Margaret UniversityEdinburgh, Scotland
Stephanie Dunleavy
Senior Lecturer in NursingSchool of Nursing and ParamedicScienceUlster UniversityBelfast, Northern Ireland
Helle Kristine Falkenberg
ProfessorDepartment of Optometry, Radiography and Lighting DesignFaculty of Health and Social SciencesUniversity of South‐Eastern NorwayNotodden, Norway
Erna Haraldsdottir
ProfessorDeputy Head, Division of Nursingand Paramedic ScienceDirector, Centre for Person‐centredPractice ResearchSchool of Health SciencesQueen Margaret UniversityEdinburgh, Scotland
Sergej Kmetec
Teaching AssistantFaculty of Health SciencesUniversity of MariborMaribor, Slovenia
Mateja Lorber
Associate Professor and Dean of FacultyFaculty of Health SciencesUniversity of MariborMaribor, Slovenia
Ruth Magowan
Interim Head of Division of Nursingand Paramedic ScienceSenior LecturerSchool of Health SciencesQueen Margaret UniversityEdinburgh, Scotland
Tanya McCance
Mona Grey Professor of NursingResearch and DevelopmentSchool of Nursing and Paramedic ScienceUlster UniversityBelfast, Northern Ireland
Brendan McCormack
The Susan Wakil Professor of Nursing; Head of School and Dean, Susan Wakil School of Nursing and Midwifery (Sydney Nursing School) Faculty of Medicine and Health, The University of Sydney, Australia; Professor II, Østfold University College, Norway; Extraordinary Professor, University of Pretoria, South Africa; Professor of Nursing, Maribor University, Slovenia; Visiting Professor, Ulster University; Adjunct Professor, Zealand University Hospital/University of Southern Denmark
Deidre O’Donnell
Senior LecturerSchool of Nursing and ParamedicScienceUlster UniversityBelfast, Northern Ireland
Amanda Phelan
Professor in Ageing and CommunityNursingSchool of Nursing and MidwiferyTrinity College DublinDublin, Ireland
Gregor Štiglic
ProfessorFaculty of Health SciencesUniversity of MariborMaribor, Slovenia
Siri Tønnessen
Head of Research and ProfessorLovisenberg Diaconal UniversityCollegeOslo, NorwayProfessor II, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South‐Eastern NorwayNotodden, Norway
Famke van Lieshout
Associate ProfessorKnowledge Centre Value‐orientedProfessionalisationUniversity of Applied SciencesUtrecht, The Netherlands
Foreword
There is consensus that healthcare systems need to be more person centred. People accessing healthcare services, caregivers and carers have all called for a shift towards person‐centred principles based on mutual respect and collaboration between them and health professionals.
Despite stakeholders and policy documents supporting the implementation of person‐centred healthcare, the process is slow and unclear in many countries. Thus, students in nursing, medicine and health programmes must be better prepared with theoretical and practical knowledge to practise and further develop this philosophy after completing their education. Unfortunately, university curricula in healthcare and medicine often lack philosophical, pedagogical and practical content about person‐centredness. Dedicated course leaders and teachers wanting to share their knowledge of person‐centred healthcare with students often find a lack of governance and support at university and department levels. It is far too uncommon to find institutional boards and student representatives in higher education institutions who have decided that the ethos and practice of person‐centred healthcare must be integrated into the entire educational process. This attitude might be because there is no systematic and rigorous methodology for educating students and concerned clinicians in this field.
Therefore, the Universal Curriculum Framework for Person‐centred Healthcare Practitioner Education presented in this book is an applauded endeavour to equip students to practise person‐centredness in care, particularly in changing healthcare systems. The curriculum framework was developed by researchers and specialists in healthcare and education representing several European countries with diverse health systems. The project sought to advance the development of person‐centred healthcare through an interdisciplinary curriculum to educate future healthcare practitioners and their supervisors, mentors and facilitators. Because person‐centred principles and shared values frame the curriculum, the generic design of the curriculum also makes it useful outside Europe.
The authors identify a set of thematic actions to help shape how shared values influence the effective functioning of a team and contribute to cultivating a healthy learning culture. Respecting self‐determination and negotiated autonomy are central to a person‐centred ethos, focusing on working with rather than on persons. The values that are fundamental to the work of the educational setting, whether academic or clinical, are operationalised through the curriculum framework. The curriculum framework is particularly useful as it conveys the ethical and philosophical content of person‐centred healthcare and provides an implementation strategy for the curriculum with practical actions, methods and tools.
I highly recommend this book because the Universal Curriculum Framework for Person‐centred Healthcare Practitioner Education focuses on a person‐centred philosophy and practice and extends beyond a vague understanding of this approach, helping all educators to develop the knowledge and skills in learners of person‐centredness in healthcare.
Inger Ekman RN, PhD
Senior Professor, University of Gothenburg, SwedenNovember 2023
Acknowledgements
The writing team of this book is grateful for the following support that has made this project possible.
The European Commission Erasmus + Program Call 2019 Round 1 KA2 – Cooperation for innovation and the exchange of good practices; KA203 – Strategic Partnerships for higher education FormId KA203‐990E7AB4. AGREEMENT NUMBER‐ 2019‐1‐UK01‐KA203‐061970 for supporting the development project (the First Pan‐European Curriculum Framework for Educating Health Care Practitioners in Person‐centred Healthcare) that has informed the content of this book. However, the authors of this book confirm that the views and practices presented in this book are those of the authors and do not represent the views or practices of the funding agency.
All the participants in the development project that has informed the content of this book. Participants in the project came from all over the world and participated in a variety of engagement events that resulted in the development of the first Pan‐European Curriculum Framework for Educating Healthcare Practitioners in Person‐centred Healthcare. That framework shapes the structure and focus of this book. We are truly grateful for the time and energy they gave to this work and in helping to shape the future of person‐centred healthcare.
Professor Angie Titchen and Professor Jan Dewing, who along with Professor Brendan McCormack wrote the first edition of Practice Development Workbook for Nursing, Health and Social Care Teams (Wiley Blackwell Publishers, 2014) and from which some of the activities included in this book have been derived. Jan started out on this journey with us, but sadly her untimely death meant she was unable to complete it.
All the colleagues, friends and family who supported us through this project. We undertook most of the work associated with the development project (the first Pan‐European Curriculum Framework for Educating Health Care Practitioners in Person‐centred Healthcare) throughout the Covid period. This required considerable pivoting by the project team to ensure the work could continue. We were supported in those endeavours by a variety of colleagues, friends and family members who helped us along the way. Thank you.
CHAPTER 1Introduction
INTRODUCTION
In this introductory chapter, we provide an overview of the collaborative work we have engaged in to create the first person‐centred curriculum framework to inform the development of curricula to educate healthcare practitioners. We provide an overview of the need for such a framework as well as sharing the systematic and rigorous methodology we adopted in our work. We demonstrate the iterative and reflexive approach we adopted to the development of the curriculum framework. Finally, we present the full Universal Curriculum Framework for Person‐centred Healthcare Practitioner Education.
The major content of this chapter is drawn from previously published papers written by all the co‐authors of this chapter. We have summarised and adapted the text from these previously published papers to present a synthesis of that work and introduce the reader to the curriculum framework itself. The complete collection of papers underpinning this chapter is listed in Table 1.1 and we would encourage you to visit this collection of papers for a deep understanding of the research and each stage of the development process that led to the finalised curriculum framework.
PERSON‐CENTRED HEALTHCARE POLICY AND PRACTICE
Person‐centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. In the first phase of the curriculum framework development project, we considered the emergence of person‐centredness, including person‐centred care and how it is positioned in healthcare policy around the world, while recognising our dominant philosophical positioning in Western philosophy, concepts and theories (Phelan et al. 2020). We critically reviewed the published literature for the period 2016 and 2021 to show how person‐centred healthcare has evolved over this time. We drew on published evidence of person‐centred healthcare developments, as well as information gathered from key stakeholders who engaged with us in this project as partner organisations. We identified five themes underpinning the literature and stakeholder perspectives.
TABLE 1.1 Published Papers on Which this Chapter is Based.
Cook, N.F., Brown, D., O'Donnell, D. et al. (2022) The Person‐centred Curriculum Framework: a universal curriculum framework for person‐centred healthcare practitioner education. International Practice Development Journal 12 (Special Issue), Article 4.
https://doi.org/10.19043/12Suppl.004
Dickson, C., van Lieshout, F., Kmetec, S. et al. (2020) Developing philosophical and pedagogical principles for a pan‐European person‐centred curriculum framework. International Practice Development Journal 10(2) (Special Issue).
http://dx.doi.org/10.19043/ipdj.10Suppl2.004
McCormack, B. (2020) Educating for a person‐centred future – the need for curriculum innovation. International Practice Development Journal 10 (Special Issue).
http://dx.doi.org/10.19043/ipdj.10Suppl2.001
McCormack, B. (2022) Educating for a person‐centred future – the need for curriculum innovation. International Practice Development Journal 12 (Special Issue).
www.fons.org/library/journal/volume12‐suppl/editorial
McCormack, B., Magowan, R., O'Donnell, D. et al. (2022) Developing a Person‐centred Curriculum Framework: a whole‐systems methodology. International Practice Development Journal 12 (Special Issue), Article 2.
https://doi.org/10.19043/ipdj.12suppl.002
O'Donnell, D., McCormack, B., McCance, T. and McIlfatrick, S. (2020) A meta‐synthesis of person‐centredness in nursing curricula. International Practice Development Journal 10(2) (Special Issue).
http://dx.doi.org/10.19043/ipdj.10Suppl2.002
O'Donnell, D., Dickson, C.A.W., Phelan, A. et al. (2022) A mixed methods approach to the development of a Person‐centred Curriculum Framework: surfacing person‐centred principles and practices. International Practice Development Journal 12 (Special Issue), Article 3.
https://doi.org/10.19043/ipdj.12Suppl.003
Phelan, A., McCormack, B., Dewing, J. et al. (2020) Review of developments in person‐centred healthcare. International Practice Development Journal 10(3) (Special Issue).
http://dx.doi.org/10.19043/ipdj.10Suppl2.003
Policy development for transformation.
Participatory strategies for public engagement.
Healthcare integration and co‐ordination strategies.
Frameworks for practice.
Process and outcome measurement.
These themes reflect the World Health Organization's global perspective on people‐centred and integrated healthcare and give some indication of development priorities as we continue to develop person‐centred healthcare systems. However, our review methods also revealed the need for intentional development of individuals and teams as person‐centred practitioners within pre‐ and postregistration programmes. The centrality of caring relationships and possessing holistic care skills is highlighted, but the day‐to‐day challenges experienced in practice result in the context in which learning takes place not being supportive of the developments needed. Therefore, if the global developments highlighted are to be sustained and developed at scale, then we need many role models of person‐centred practice integrated at every level of the healthcare system who can facilitate person‐centred learning cultures, wherever such learning takes place.
The need for healthcare education programmes to plan strategically for a workforce that is ready to respond appropriately is obvious, and education curricula need to be innovative and proactive in this respect. In practice, this ‘reality’ may seem unreal, as evidence from service user feedback, patient experience surveys and patient/family outcome data continues to suggest that only ‘modest’ improvements in patient experience have been achieved, despite more than 20 years of service improvement, quality improvement and practice developments. While there has been major investment into such improvements, as well as into patient safety (and yes, patients are safer – in hospitals at least), these data have not significantly changed over the years.
Despite these best efforts, there is little evidence of fundamental change in the core cultural characteristics of healthcare practice, and some commentators argue (drawing on culture theory as an explanatory device) that most person‐centred developments focus on the artefacts of practice rather than on the core values that drive health and social care delivery. O'Donnell et al. (2020) highlighted the lack of a consistent focus on person‐centred principles, even in curricula that purport to have person‐centredness as their underpinning framework. At best, person‐centredness is used as a heuristic for containing a diverse range of principles, processes and practices in teaching and learning, rather than being an explicit conceptual or theoretical framework informing all stages of education delivery. Although there are few examples of professional education curricula for healthcare practitioners that adequately prepare them to work in a person‐centred way, they are expected to graduate from their professional programmes with the qualities and attributes of a person‐centred practitioner.
It is the drive to address these ongoing challenges in developing person‐centred healthcare services that motivated us to undertake the research that is the bedrock of this book. The work began in 2019 when McCormack and Dewing published a position statement on person‐centredness in the curriculum. This position statement formed the basis of the case of need and the detailed funding proposal submitted to the European Commission Erasmus + Strategic Partnerships for Higher Education funding stream (KA203‐990E7AB4). The research and development work undertaken is all in the public domain (Table 1.1). However, being cognisant of our earlier commentary on the challenges associated with making person‐centredness real in the curriculum, we were committed not just to providing a curriculum framework but also to helping make sense of the framework through practical actions, methods and tools. So, this book provides practical applications and, if worked with, an implementation strategy for the curriculum framework developed by the project team who are also the co‐authors of this book.
DEVELOPMENT OF A UNIVERSAL CURRICULUM FRAMEWORK FORPERSON‐CENTRED HEALTHCARE PRACTITIONER EDUCATION
The findings from the evidence synthesised by Phelan et al. (2020) and O'Donnell et al. (2020) and the previous work undertaken by the International Community of Practice for Person‐centred Practice (PcP‐ICoP)1 in developing a position statement for person‐centredness in nursing and healthcare curricula (McCormack and Dewing 2019) were the impetus for developing a person‐centred curriculum framework for educating healthcare professionals, supported by funding from the European Union Erasmus + Strategic Partnerships for Higher Education Programme (Project ID KA203‐990E7AB4). The project partners were Trinity College Dublin, Ireland; Fontys University of Applied Sciences, The Netherlands; Ulster University, Northern Ireland; University of Maribor, Slovenia; University of South‐Eastern Norway; and Queen Margaret University Edinburgh, Scotland. The overall aim of this project was to advance the development of person‐centred healthcare through an interdisciplinary curriculum to educate future healthcare practitioners and their supervisors, mentors and facilitators.
We worked in a systematic way as partner organisations, using best practices in project management, stakeholder engagement and process monitoring. Ensuring that continuous and detailed stakeholder analysis addressed the needs of different stakeholders, these were mapped against key areas of activity as the project progressed. This systematic approach was enhanced by our shared values, agreed ways of working and clarity of roles and responsibilities, as well as a timeline for key deliverables. The use of a logic model of decision making also ensured that all activities were linked to project objectives, outcomes and outputs and to quality assessment, impact and dissemination strategies. We drew upon our collective continuing networks to enable the active engagement of a broad range of interested parties with the project activities. A project advisory board oversaw the work of the project and was drawn from experts by experience, leaders in the field of person‐centred healthcare, curriculum developers, higher education funding bodies, healthcare policy agencies, evaluation researchers and healthcare professional representative bodies.
In addition to the review of global developments in person‐centred healthcare (Phelan et al. 2020) to contextually position the project, we undertook three further phases of work towards developing a person‐centred curriculum framework for educating healthcare professionals.
Developing philosophical and pedagogical curriculum framework principles.
Designing a curriculum framework development methodology.
Designing a person‐centred curriculum framework for educating healthcare professionals.
Developing Philosophical and Pedagogical Curriculum Framework Principles
A participative hermeneutic praxis methodology was created as a means of systematically guiding the co‐creation of the principles underpinning the curriculum framework development. The process, consistent with person‐centredness, was grounded in respect for personhood and mutuality. Phases and steps in the process were realised progressively, guided by a form of practical reasoning and moral intent. Each partner participated actively in the process that was characterised by critical and creative dialogues. Understanding and respect for each cultural background and language used were key to the process, as well as mutual adequacy and growth for individuals and the team. Through mutual processes of inquiring about what is significant in the context of the project and how to apply it in a situation, a co‐constructed praxis design was generated.
Further methodological guidance was sought from the philosophical tradition of hermeneutics. Using the hermeneutics perspective of Gadamer and Dutt (1993), we aimed to develop an understanding of the study focus using the subjective interpretation of individuals as well as the collective consciousness of the group. Understanding arises from repetitive reading of the various datasets; being open to the concepts being sought; being aware of our prejudices and critiquing/allowing them to be critiqued in light of newly formulated meanings (Boomer and McCormack 2010).
Two processes key to understanding the data were the hermeneutic circle (Heidegger 1967) and the fusion of horizons (Gadamer and Dutt 1993). The hermeneutic circle is the idea that understanding of the data as a whole is established by reference to the individual parts and understanding the parts by reference to the whole. Neither the whole dataset nor the parts can be understood without reference to the other, and hence a circle of constant movement between the parts and the whole is established. Interpretation is never free of presupposition; what we know cognitively, precognitively and feel (preunderstanding) is the frame of reference (‘horizon’) from which a person starts. During dialogue with others, everyone starts from their own horizon and through listening, questioning and theorising, these personal or cultural ‘horizons’ were challenged, became broader and fused with others, resulting in a new, more encompassing understanding of what is needed to prepare practitioners for person‐centred practice.
Approach Used to Collaboratively Design Curriculum Framework Principles
The overall process consisted of three co‐designed phases that demonstrated movement between the parts and the whole, intersecting on several occasions of critical dialogue. Critical conversations aimed at collaboratively reflecting on and working with the data and creating the opportunity to fuse horizons were key processes (Figure 1.1).
FIGURE 1.1 Overview of participative hermeneutic praxis methodology.
Phase 1 – ‘Moving from the whole …’
: the project group co‐constructed questions to engage with stakeholders in the UK, Netherlands, Norway and Slovenia to collect perspectives on what is needed to enable person‐centred practice to become a reality. Each project partner used differing methods to engage with stakeholders to capture their views.
Phase 2 – ‘… to the parts …’
: moving through the hermeneutic circle, the intention of the second phase was to understand and create new meaning, through fusion of horizons. Multiple rounds of data analysis were conducted. A first step was a thematic analysis in each country, then a collective analysis of the whole dataset with partners. The third step was an abstract level of data analysis in which the partners engaged in theorising, using the Person‐centred Practice Framework and Hart's (
2019
) purpose, life and system world model. Methods used were creative workshops with all six partners and working in subgroups to synthesise data, identify and map themes within the datasets through moving up and down different levels of abstraction.
Phase 3 – ‘…and back to the whole…’
: during this phase, the analysed data were used for development of the principles framework which would inform the development of a person‐centred curriculum framework in the next phase of the project. The hermeneutic process continued with multiple rounds of identification and refinement of principles. A small workgroup with representatives from the different countries/partners led this process. Multiple draft versions of the framework were shared with partners for critique. As part of this process, the principles were checked with original stakeholder data to ensure consistency.
FIGURE 1.2 Core principles underpinning a person‐centred curriculum.
Through these iterative processes, consensus was reached about the core principles underpinning a person‐centred curriculum (Figure 1.2). To be person‐centred in healthcare, attention needs to be paid to a triadic relationship between the practitioner's competencies and commitment, together with the local environment. There also needs to be a whole‐system understanding and support for person‐centredness. Practitioners who ‘care with’ others, rather than ‘care for’ or just ‘about’ others, are essential. They need to acknowledge and work with the whole person and to be reflective and a good communicator. There needs to be reciprocal understanding and practitioners need to be able to reveal discrepancies between actual and espoused practices through critical reflection. Practitioners need to feel a responsibility for being competent and courageous in challenging and changing their practice and so championing person‐centred practice. There is also commitment to living person‐centredness and to connect with (those upholding) related perspectives. This requires facilitators of learning and learners to role model person‐centred ways of being and to live out person‐centred ideals in their interactions and in navigating conflicting values, structures and policies. Both the theory and practice of person‐centredness need to be understood in order for a person to become a proficient person‐centred practitioner.
There needs to be a local person‐centred environment and culture valuing staff diversity and expertise, sensitive to and understanding experiences, feelings and needs of all stakeholders. A collaborative inclusive and participative approach in the development of any relationship and student‐teacher nexus is needed. However, issues of culture, context and the behaviours of people, across healthcare and academic settings, act as barriers to individual learning. Generally, a whole‐system approach is needed in organisational thinking and design, in which there is minimal bureaucracy and structures and processes act as servants to the lifeworld and relationships of persons and not the other way round, which is often more common. A supportive meso‐/macro‐context that provides guidance for developments in effective learning environments is essential, for example for critical conversations with organisational leaders and managers and with experienced clinical and academic staff where boundaries are removed. In this context, the focus could be on coping with challenges to person‐centred practice, as well as reflecting on the intended outcomes of innovations in person‐centred practice, ultimately enhancing student (and practitioner) opportunities to learn and practise in more person‐centred ways in a safe environment. Learning can only happen in an environment where the evidence and knowledge of clinical and academic staff are contemporaneous. This set of philosophical dimensions, methodological and pedagogical principles for person‐centred curriculum design is shown in Table 1.2.
Designing a Curriculum Framework Development Methodology
We adapted the 7S methodology of Waterman et al. (1980) to design the person‐centred curriculum framework. Originally developed as an organisational analysis framework, the 7S methodology deals with snapshots of complex systems, usually as a means of change management. These complex systems are contemporary, or desired. Using the 7S methodology assists with the identification and alignment of the seven elements to achieve a desired future state; this can be, for example, through the addition, supplementation or enhancement of some or all of the seven elements. Therefore, although Waterman et al. describe the methodology as a ‘gap analysis’, it is perhaps better to see it as a thematic analysis permitting identification of areas of deficit that can be augmented/amended to align all elements of the system, but which can also identify areas of ‘added value’ which can be realigned or employed elsewhere. 7S can also potentially assist with the relationships (functional or dysfunctional) between the elements, meaning it is more powerful than a ‘simple’ gap analysis, i.e. where there are two fixed points that need to be brought closer together. Gap analysis often focuses on ‘bad practice’ or ‘what is wrong’ that causes the gap to exist, but use of the 7S methodology allows identification of ‘good practice across the whole system’ through the thematic analysis approach.
The 7S methodology recognises seven elements of a system and divides these into ‘hard’ and ‘soft’ elements (Figure 1.3).
The ‘hard’ elements are:
strategy
structure
systems.
The ‘soft’ elements are:
shared values
skills
style
staff.
Shared values are core to all the elements and Figure 1.3 shows the interconnectedness and interdependence of the elements and the centrality of shared values. It also highlights that a change in one element can affect all the others. All elements of the 7S methodology are equally important to the functioning of the complex system, and they are all mutually related and interdependent: they form and operate as a web.
TABLE 1.2 Principles for Person‐centred Curriculum Design.
Framework purpose, lifeworld, systems world
Methodological principle
: the philosophical approach to curriculum design
Pedagogical principles
: teaching, learning and assessment (TLA) and the context of learning
Purpose (person‐centred outcomes)
Philosophical dimension:
transformative
Methodological principle:
curriculum is transformative and enables journeying through knowing, doing, being and becoming a competent and committed person‐centred practitioner
A person‐centred approach to teaching, learning and assessment
TLA strategies:
Learning is holistic, focusing on multiple ways of knowing the whole person
Teaching, learning and assessment approaches guide learners journeying through knowing, doing, being and becoming a person‐centred practitioner
Learning is progressive: progressing to the point where person‐centredness is embodied as a learner, practitioner and leader of person‐centred practice
Reflexivity is integral to active learning approaches, enabling movement from preconsciousness, through consciousness to critical consciousness, creating perspective transformation as a person‐centred practitioner
Active learning enables new insights to become translated into actions to be tested and evaluated in practice
Eclectic teaching, learning and assessment strategies draw on critical creativity as well as technical‐rational approaches to enable learning to be systematic and incremental with deliberate intent
Learners and facilitators learn together with and from each other, shaping new knowledge
Learning environment:
Person‐centredness is embodied by all involved in and supportive of the curriculum
Learners experience and practise person‐centredness
Learners are helped to become brave in challenging practice
Lifeworld 1 (healthcare relationships)
Philosophical dimension:
co‐constructed
Methodological principle:
a co‐constructionist approach to curriculum design and implementation where the curriculum is flexible and adaptive to the learner
TLA strategies:
Learning is participative, inclusive and collaborative in all learning relationships
Opportunities for creating shared social responsibility, in co‐creation of curricula, based on moral intents
TLA are sensitive and responsive to these mutual learning needs which are open to negotiation
Learners determine their own learning pathway
Learners at different stages of the learning journey are encouraged to learn together
Learners and teaching staff actively engage in mutual learning
Learning environment:
A culture of safety, relationships and learning is co‐created
Safe learning environments are created for exploration, shared understanding, decision making and action
Preconditions are created by those with a stake in the curriculum to co‐create the processes necessary for curricular design
Educators show courage, humility and vulnerability in the facilitation of learning
Practice‐based mentors are engaged as part of the programme team
Freedom of individual expression is encouraged
Taking risks and (calculated or intentional/moral) experimentation are encouraged, supported and subject to wider critique through reflective processes
Practitioner and service user experiences are evaluation criteria used to critique and promote knowing, doing, being and becoming a person‐centred practitioner
Safe spaces evolve into brave spaces in which everyone feels comfortable with diversity and experiences respect, inclusion and emotional support
Lifeworld 2 (learner relationships)
Philosophical dimension:
relational
Methodological principle:
curriculum encourages connectivity with oneself, other persons and contexts
TLA strategies:
Fundamentals of person‐centredness are continually revisited
Learning involves maximising generation and transmission of multiple sources of evidence to support knowledge of person‐centred practice
Person‐centred facilitation is embedded in TLA approaches
Social learning and meaning making are encouraged through safe communicative spaces
Opportunities are given to reflect on relationships with others and with materials and space
Learning environment:
Person‐centredness is embodied by everyone engaging and communicating authentically
Critical questioning is embedded in learning processes
Caring relationships that foster mutuality are created
Diversity is welcomed and respected
All involved in the curriculum accept moral responsibility for others
Systems world (environmental/organisational structures, processes, administration) to create a systems world that supports the lifeworld in realising purpose
Philosophical dimension:
pragmatic
Methodological principle:
curriculum is built on a philosophy of pragmatism
TLA strategies:
Theory and practice are intertwined
Debate and discussion create opportunities to deconstruct idealism vs realism
Engaging in enquiry‐based learning to become facilitators within the whole and multi‐layered contexts
Learning is embedded in movement between local, national and global contexts
Generation and sharing of multiple sources of evidence will support the development of competence (knowledge, skills and attitudes) in a person‐centred way
Learners consider themselves to be agents of social change
Embracing, working and being comfortable with complexity through enquiry‐based learning
Ongoing evaluation of learning in relation to ever changing practice milieu
Learning environment:
Communicative spaces create opportunities for social learning and meaning making
Safe spaces evolve into brave spaces
Learners understand the relevance of person‐centred practice through contextualised learning within real‐life experiences
FIGURE 1.3 7S Methodology (www.mindtools.com/pages/article/newSTR_91.htm).
While the methodology was designed from an organisational science perspective, we adapted it to a healthcare context, i.e. a thematic analysis of existing healthcare curricula. Thus, it was vital that we were clear about definitions and translation of the elements from organisational science to healthcare, and between languages and healthcare settings. We needed to be precise in understanding terms and employed contextual translation techniques wherever necessary. Our adaptation process is set out in McCormack et al. (2022) and our adapted definitions of the seven elements are shown in Table 1.3 and Figure 1.4.
All elements of the 7S methodology are equally important to the functioning of the whole complex system, and they are all mutually related and interdependent, i.e. a web. Using this approach enables a thorough systematic analysis of key ‘core’ themes to be derived. Using the 7S methodology facilitated an analysis of the current situation (the extent to which existing curricula are person‐centred) and the desired future situation (person‐centred curriculum framework). We earlier presented a set of principles (philosophical, theoretical and methodological) that set out our ‘desired future’ person‐centred healthcare curriculum framework based on the work of Dickson et al. (2020). In establishing a methodology for developing a curriculum framework, we needed to determine the extent to which existing curricula already matched these principles or were unique and thus offered a new perspective.
Being clear about the purpose of the desired curriculum framework and agreement about the shared values that would influence the other six components of the 7S methodology were critical factors in designing the detail of the methodology.
Purpose
. What is the purpose of our desired complex system (the ideal, person‐centred healthcare curriculum), and of the whole curriculum framework? At the heart of this question is the need for an agreed definition of ‘curriculum framework’. Such an agreed definition acts as an ‘anchor’ for the analysis of curricula and ensures we are analysing curricula with the same focus in mind. We developed a definition of person‐centred curriculum, focusing on the idea of a ‘shared curriculum’ (
Figure 1.5
). This definition is wide enough to allow for the whole‐system analysis envisaged and makes clear that this is an enterprise involving more actors than just students/teachers, because multiple actors have an investment/stake in the system. The 7S methodology therefore provides an analytical methodology permitting analysis of existing shared curriculum frameworks to identify elements that do/do not conform to our desired common goal of supporting the design, delivery and evaluation of person‐centred healthcare education. In accepting this definition, we then extrapolated the underpinning shared values of the curriculum framework.
TABLE 1.3 The McKinsey 7S Framework with Adapted Definitions of Each Element.
Element
Definition
Strategy
This is the whole curriculum framework that identifies the unique selling point (USP) of the programme and what makes it unique, and thus attractive to potential students
Structure
How the curriculum is structured (modules/units/courses) to achieve the curriculum intentions as well as how the school/faculty/department is organised in terms of its structures to deliver the curriculum, including student/stakeholder engagement and processes to meet the intended regulatory requirements and quality standards
Systems
Teaching, learning and assessment methods used to achieve the stated curriculum outcomes
Shared values
The core values of the school/faculty/department and how these are made explicit in the curriculum
Style
The style of leadership used to deliver the curriculum
Staff
The general capabilities of the team with responsibility for delivering the curriculum, the skill mix of the team and the support for staff development to deliver the curriculum, i.e. the make‐up of the team, its ‘fit’ with the curriculum intentions and staff support to deliver curriculum outcomes
Skills
The actual knowledge, expertise, skills and competence of the academic team with responsibility for delivering the curriculum
FIGURE 1.4 The adapted 7S methodological framework.
Shared values
(
Figure 1.6
). In this project, we determined that it was not up to us to identify the values we wanted to see evidenced or to prescribe a set of values that we then go looking for. Instead, what we wanted to identify were the values that are central to the work of the department/school/faculty and how these are operationalised through the curriculum framework. The values should be consistent with how we define a person‐centred culture aligned with the Person‐centred Practice Framework (McCormack and McCance
2017
) which informs the overall Erasmus project.
FIGURE 1.5 Curriculum framework definition.
FIGURE 1.6 Person‐centred culture defined.
Source: Adapted from McCormack et al., 2021, p. 19.
How this worked in practice
. The purpose and values act as the ‘anchor’ for operationalising the methodology. Common in management science is the use of a ‘checklist’ of questions to complete the 7S system analysis. We developed a list of questions to guide our analysis processes (see
Table 1.4
).
The questions shown in Table 1.4 were used to build a database to undertake curriculum analysis and guide the next stage of the project – designing a person‐centred curriculum framework for educating healthcare professionals.
TABLE 1.4 The Elements of The 7S Framework and Associated Questions.
Element
Questions to guide completion of the 7S system analysis
Strategy
What is the curriculum seeking to accomplish?
What is distinctive about this curriculum?
How does the curriculum adapt to changing healthcare contexts?
How has the curriculum been developed through authentic co‐design with stakeholders?
How is the curriculum structured?
What are the reporting and working relationships for delivering the curriculum (hierarchical, flat, siloes, etc.)?
How is the team responsible for delivering the curriculum aligned to it?
How are decisions about the curriculum made (e.g. is decision making based on centralisation, empowerment, decentralisation or other approaches)?
How is information shared (formal and informal channels) across the organisation?
How is the learner/stakeholder voice heard in information sharing across the organisation?
Systems
What are the primary pedagogical practices that guide the curriculum?
What curriculum quality systems and controls are in place?
How are the progress and evolution of the curriculum tracked?
Shared values
What is the vision of the curriculum and what has shaped its development?
What are the stated values of the course team?
How do the values influence how the curriculum is delivered?
How do the stated curriculum values match those of the stakeholders?
Style
What are the management/leadership styles of those responsible for delivering the curriculum?
How do team members respond to management/leadership?
Do team members function competitively, collaboratively or co‐operatively?
What behaviours, tasks and deliverables do management/leadership reward?
Staff
What are the staffing requirements to deliver the curriculum (e.g. number of staff needed, level of academic preparation, etc.)?
Are there gaps in required capabilities or resources?
Skills
What skills are needed to deliver the curriculum? Are these skills sufficiently present and available?
Are there any skill gaps?
What is the department known for doing well?
Do the employees have the right capabilities to do their jobs?
How are skills monitored and improved?
Designing a Person‐centred Curriculum Framework for Educating Healthcare Professionals
In this part of the project, a multiphase, mixed methods design was used to synthesise evidence from multiple sources, to surface the key components of a person‐centred curriculum framework. The complete methodology is published elsewhere (O'Donnell et al. 2022). The eight‐stage, mixed methods design optimised opportunities for national and transnational collaboration. The eight stages are shown in Figure 1.7
THE CURRICULUM FRAMEWORK
Working from the perspective that while person‐centred principles may be context dependent, they are universal and can underpin healthcare education and practice, we present a person‐centred curriculum framework (Figure 1.8). Each element of the 7S framework is connected synergistically with the philosophical principles (pragmatism, relationism, co‐constructivism and transformation; Dickson et al. 2020) to create healthful, person‐centred cultures for education and practice. Ultimately, this results in person‐centred practice, brought about by the authentic engagement of stakeholders (educators, practitioners, learners, policy makers) represented at the centre of the model. The coloured spirals represent the 7Ss and the central spirograph represents how all of the four underpinning philosophical principles work together and are woven interconnectedly with the 7Ss.
Strategy
Strategy encompasses the whole curriculum framework that identifies the unique selling point (USP) of the programme and what makes it different, and thus attractive to potential students. In the context of this work, the USP for curriculum development is the explicit and intentional focus on creating person‐centred healthcare practitioners. Person‐centredness is the aspired standard of healthcare globally but how it is conceptualised and translated across multiple contexts remains a challenge (McCormack 2022). A focus on strategy brings to the fore the requirement for a shared and clear understanding of person‐centredness and what this means for programmes, roles and responsibilities. Furthermore, strategy emphasises the importance of a shared language that is meaningful for all persons, including students, educators/academics and practice partners across organisations (Short et al. 2018).
The curriculum framework presented is synergistic with the Person‐centred Practice Framework (McCance and McCormack 2021) as a means of making explicit the core concepts that inform the development of competent person‐centred healthcare practitioners. The Person‐centred Practice Framework, as an underpinning theory for this curriculum framework development project, encapsulates the 7Ss through the core constructs of macro‐context, prerequisites and practice environment. Embedded at every level of curriculum design and delivery should be person‐centred ways of being that characterise interpersonal relationships and this is consistent with the person‐centred processes of the Person‐centred Practice Framework. Person‐centred ways of being need to be supported by the strategic goals of the organisation that have person‐centredness explicitly stated in their mission/vision/core values and should be ‘known’ through all layers and parts of the organisation. This strategic embeddedness enables the development of curricula through authentic, collaborative, interdisciplinary partnerships with all stakeholders which, alongside person‐centredness, becomes the USP.
FIGURE 1.7 Overview of methodological stages.
FIGURE 1.8 The Person‐centred Curriculum Framework.
The outcomes expected from a curriculum with the strategic foci on person‐centredness will embed into and across the curriculum a humanising philosophy that views person‐centredness as a way of being; foster person‐centred learning cultures where everyone will flourish; and facilitate transformative personal and professional growth as competent and confident person‐centred practitioners (Van Schalkwyk et al. 2019).
Structure
In keeping with the strategic drivers, the philosophical principles of person‐centredness should be evident in how the curriculum is co‐constructed with key stakeholders (Dickson et al. 2020). All stakeholders should be represented, including educators (in academic and practice settings), students, strategy and policy leaders and recipients of healthcare. This could be achieved by establishing an active stakeholder/practice advisory board with the intention of creating collaborative, communicative spaces conducive to authentic co‐design, delivery and evaluation (Virgolesi et al. 2020). A partnership approach to curriculum evaluation is also advocated. By triangulating stakeholder perspectives, the evaluation of a person‐centred curriculum can support robust and continuous quality improvement. This could be achieved using a range of instruments and approaches to highlight areas for development so that the structural design of a person‐centred curriculum remains dynamic and responsive to changing educational and healthcare priorities (Cook et al. 2018; O'Donnell et al. 2020).
The structure of a person‐centred curriculum should be designed in the context of regulatory, organisational, programme and quality standards (Franco et al. 2019). A fundamental intention is to explicitly demonstrate that person‐centredness is the ‘golden thread’ running through the programme structure and associated documents (Royal College of Nursing 2012, p. 56). This ‘golden thread’ can be demonstrated by mapping person‐centred principles in a diagrammatic or visual representation to highlight linkages throughout the curriculum that are also evidenced in supporting documents, learning outcomes, unit structures and processes and assessment methodologies. The curriculum structure should reflect increasing levels of complexity commensurate with a constructivist approach to learning where the level of challenge increases as learning occurs (Charles 2018; Dickson et al. 2020).
Affording optimal flexibility in terms of what, when and how learning is organised is aligned with the principles of autonomy and self‐determination that are indicative of person‐centredness. The curriculum structure should therefore foster active learning and use creativity to inspire learners to enhance their critical thinking and intrinsic motivations for personal and professional growth in the development of their person‐centred practice (Bristol et al. 2019).
Systems
Systems that support the development and delivery of a person‐centred curriculum should align the teaching, learning and assessment (TLA) methods with the curriculum outcomes, explicitly articulating the philosophical principles of personhood (McCormack and McCance 2017). A person‐centred approach reflects the principle of co‐construction and requires flexibility; it offers choice for learners and supports them in understanding their own learning needs in relation to person‐centred practices (Gaebel et al. 2018; Dickson et al. 2020). Key to person‐centred TLA methods are educators and leaders who are committed to embodying the values of person‐centredness, using facilitated learning and assessment strategies. They encourage multi‐stakeholder assessments and portfolios where learners can use creativity to demonstrate their learning. The systems supporting ownership of learning include developmental tools such as learning analytics to monitor learning and progress. Learners should also have individualised and consistent coaching and mentorship. Creating safe reflective spaces throughout programmes enables learners to explore their personhood (Wald et al. 2019). Facilitated small group reflection gives learners opportunities to explore what is important to them, along with learning from practice. This is fundamental to having cultural humility, whereby learners critically reflect on their values, beliefs and assumptions in the context of shaping their worldview and how they interact with others (Sanchez et al. 2019
