Quality improvement by promoting relationships in care environments: the PRiCE model

Abstract

Person centred services are becoming the norm across developed countries with the concomitant ageing of the generation known as the baby boomers. Older people associated with this generation are more consumer-oriented and have higher expectations of services as they age. Service provision is being developed in many countries, including Singapore, to reflect a person centred approach. Although there are a number of frameworks for person centred care (PCC), there is limited guidance on how to implement such frameworks or how they might be aligned to quality criteria. This study was based in the long term care (LTC) sector in the UK where the main objective was to explore relationships from the perspective of all stakeholders. Using a constructivist methodology, data were collected from three LTC organisations using participant observation, interviews and focus groups with staff, older people and families. The results demonstrated that staff adopted three approaches to care, which influenced relationships and had different outcomes for older people. Subsequent work has developed a framework for the implementation of relationship based approaches to care, including PCC. This included aligning the findings to the Donabedian model of quality (Structure, Process, Outcome). Structural factors included leadership, staff motivation continuity of staff and teamwork. The Process was defined as the different approaches to care that staff adopted and outcomes were defined as the consequences for the older person when staff adopted these approaches to care. The outcome that best described PCC from the perspectives of all stakeholders was: 'Care that matters to me'. This phrase describes how older people, families and staff in the LTC sector defined quality of care. The PRiCE model of quality improvement will be used to offer practical strategies to implement PCC in the ILTC sector, aligning these outcomes to current quality criteria. [ABSTRACT FROM AUTHOR]