Person-Centered Care

Transforming Systems and Services to Achieve Better Outcomes for All.

JSI’s Global Leadership in Person-Centered Care

JSI’s Person-Centered Care Framework integrates the human-rights-based approach by focusing on the Rights Holder (person) and the obligations of the Duty Bearers (providers, policymakers, etc). The five principles that surround the Rights Holder establish a common vision of person-centered care that is inclusive across different health technical areas and settings. Implementing person-centered care requires multi-level changes. The principles can be operationalized and assessed at each socio-ecological level (policy+environment, health system, facility, community, family, and individual) through interventions within six domains, as labeled on the outside of the Framework. Each dot within the Framework represents the intersection of how the principles can be operationalized in each domain at different, oftentimes overlapping, levels.

framework for person-centered care

JSI is shifting the global paradigm of health systems and service delivery. We are disrupting medical paternalistic norms that expect people and their circumstances to change to enable changing access to health services. Instead, we are putting the person at the center and focusing on how systems and services can be shaped to meet the person where they are. We use behavioral science to understand the preferences and motivations of the individual and examine each level of the system and service delivery context to transform each person’s experiences and enhance outcomes.

Our Behavior Initiative harnesses JSI’s collective global experience and thought leadership on person-centered care to share cutting-edge practices with our donors, partners, and across our global and domestic divisions, projects and staff. Through coalescing our resources and examining the evidence base, we have developed a common framework through which person-centered care is operationalized.

Person-Centered Care

A doctor helping her patient

Person-centered care acknowledges people’s essential human dignity, treating people as individuals and finding out what is important to them, relevant to their treatment and care. Person-centered care is collaborative, localized, and rights-based healthcare designed and delivered with the individual at the center. It purposefully engages all stakeholders across the socio-ecological framework as active contributors to health systems, services, products, supply chains, and experiences. This ensures responsiveness to the individual’s needs and preferences.

Person-centered care represents a transformational change in service delivery which traditionally has been shaped for the convenience of providers and the health system. Instead, person-centered care prioritizes the individual and considers how services can be shaped to meet their needs and expectations.

Person-centeredness is an important function for improving system performance. Person-centered systems contribute to a variety of benefits for both the user and the system including improved access to care and health outcomes, increased health literacy, higher rates of patient satisfaction, improved job satisfaction among the health workforce, and more efficient and cost-effective services in addition to improved health outcomes and a meaningful quality of life.

Principles

These principles establish a common vision of person-centered care, describing key characteristics that are generalizable across different health interventions and settings.
Trust & Transparency
  • Operations, workforce development and services are conducted with transparency with the goal of building and maintaining trust between stakeholders.
  • There is a concerted effort to ensure information about policies, procedures, decision-making and costs (privacy, confidentiality, data collection and storage, fees, payment options are accessible to all stakeholders — easy to find and easy to understand.
  • The roles of rights holders (individual) and duty-bearers (organization and staff) are clearly articulated and respected and each is accountable for their decisions and actions.
Safety & Dignity
  • Staff and the people they serve feel physically, emotionally, and psychologically safe. Communications, settings (workplace and care), interactions, and experiences bolster a sense of safety, dignity, and respect — primarily defined by the people being served.
  • Care is evidence-based, delivered in a timely fashion, and according to recognized quality standards that include the importance of empathy and communication that is nuanced to meet the needs of diverse populations and their various circumstances.
  • Dignity involves service provision that is free of stigma and discrimination and that instead recognizes the shared humanity between the client and provider. This will help to ensure that the client feels comfortable sharing information, trusting that it will be kept confidential. It also includes consideration of the physical infrastructure where the client receives services, to ensure that the client is not visible to others during their appointment and that the visit cannot be overheard by others.
Culture & Identity
  • The design of policies, processes, protocols, products, and services take into account people’s lived reality and contexts, as well as their culture and identity (race, ethnicity, sexual orientation, age, religion, gender identity, geography, legal or housing status, etc) and where they are in lifecourse.
  • Policies, protocols, and processes are responsive to individuals’ housing and legal status, as well as their individual needs based on their culture and identity, legitimizing the person’s health beliefs.
  • Duty bearers’ biases that adversely affect care options and experiences are identified and addressed.
Voice & Choice
  • Individuals and communities are able to understand and make decisions about their goals, service options, and care. People are supported to cultivate self-advocacy, self-care skills, and build on their strengths. Staff are facilitators of wellness and recovery rather than controllers.
  • Individuals and communities are active and meaningful participants in program and/or service design, implementation, and monitoring. They are encouraged to advocate for program and/or service improvements that better meet their needs.
  • Operations, workforce development, and services are organized to foster empowerment for staff and clients alike.
  • Duty bearers actively listen to, consult, and openly communicate with clients throughout their care journey.
  • People have control over their services, including the amount, duration, and scope of services, as well as choice of providers
  • Staff seek explicit consent from all individuals when they seek and receive care.
  • There is an awareness of power differentials, an empathy for, and client-informed efforts to overcome the ways in which clients may have experienced discrimination, trauma, coercion, or the diminishment of their perspective, preferences, and choices.
Empathy & Collaboration
  • The concept of treatment and care goes beyond the individual to include a broader ecosystem, which considers the client’s caregivers, partners, and family as defined by the individual, and the variety of settings in which care takes place.
  • The diverse life course of the individual is taken into account, focusing on where clients are in the stage of their lives. For children, this includes considering developmental readiness versus chronological age.
  • Staff and providers account for the fact that the individuals they treat are connected to other people, broader communities, and specific contexts that influence their lives and their healthcare decisions.
  • In the design and delivery of services, close attention is paid to systemic factors that influence perceptions of options and health behaviors.
  • Empathy and communication are considered essential to providing person-centered care.
  • All stakeholders/duty bearers are treated with empathy and work in a collaborative environment that provides them with the support and systems to deliver person-centered care.

Domains

Developing a person-centered approach requires change at multiple levels — individual, family, community, organization, and system. The principles that describe a person-centered approach are operationalized and assessed through the domains described below.
Engagement, Leadership, & Governance
  • Organizational leadership and governance support and invest in implementing and sustaining a person-centered approach.
  • There exists amongst leadership a person-centered care champion who initiates and is held accountable for the implementation of person-centered change processes. There is an identified point of responsibility within the organization to lead and provide updates about this work.
  • There is meaningful engagement with community stakeholders: Stakeholder representatives are regularly consulted and informed (patients, family, caregiver, community, peer group) and have significant involvement, voice, and meaningful choice at all levels and in all areas of organizational functioning (e.g., program design, implementation, service delivery, quality assurance, cultural competence, access to person-centered peer support, workforce development, and evaluation). This is a key value and aspect of a person-centered approach that differentiates it from the usual approaches to services and care.
  • The organization has identified multiple channels of communication with stakeholders and these channels are active, with formal feedback happening on a regular basis. This may include monthly meetings with village health teams, community representatives attending facility meetings, patient satisfaction surveys, community score card processes, mystery shoppers, client advisory boards, hotlines, and comment boxes, among others. Informal feedback is also valuable, but harder to measure and organizations should use both formal and informal feedback.
Workforce Environment Support & Development
  • There is an investment in a culture, environment, and incentives that support staff safety, wellness, and development — strengthening their motivation and ability to provide person-centered care. Human resource systems incorporate person-centered principles in hiring, supervision, and performance evaluations.
  • Staff have access to regular opportunities to improve their competence, cultural and communication skills, and confidence. This includes the facilitation of platforms to strengthen peer engagement and for HWs to provide feedback up the chain.
  • It is acknowledged that duty bearers require adequate skills-building, support, systems, and psychological safety in order to deliver person-centered care. Staff are provided with the equipment, supplies, and commodities they need to do their job well.
Monitoring, Learning, & Accountability
  • Monitoring metrics reflect person-centered care principles. Similarly, evaluation favors strengths-based and participatory approaches that prioritize beneficiary voice and priorities. Both monitoring and evaluation are conducted regularly and geared toward learning and adapting — prioritizing feedback loops, generating actionable data, and the utilization of findings.
  • Monitoring and evaluation practices balance accountability with a spirit of mutual support, adaptive management, and learning from challenges and failures.
  • Clients have full and easy access to paper/electronic records as permitted by local regulations.
  • The Community engages in monitoring of service delivery on a routine basisThere are mechanisms in place for third parties (government agencies, CSOs, or other groups representing citizen interests) to monitor and hold those at the organization and policy level accountable for improving person-centered care.
Policy & Financing
  • There are written policies and protocols establishing a person-centered approach as an essential part of the system or organization’s mission.
  • A person-centered approach is “hard-wired” into practices and procedures at the organization and system levels — not solely relying on individual leaders.
  • There are routine mechanisms in place to flag and address person-centered care challenges and failures.
  • Organization resource allocations and financing structures support a person-centered approach. Resource allocation for assessing, strengthening, and monitoring person-centered care is included in annual planning and budgeting.
  • Financial information defaults open to facilitate third-party oversight, except in cases where safety, privacy, or confidentiality may be threatened.
  • Financial barriers to accessing services are recognized at an organization and system level and there is a reflexive policy to resolve these by promoting or partnering with CSOs, mutual aid societies, insurance companies, and similar financial service providers, as appropriate.
Service Design, Integration, & Delivery
  • The design and range of services, supplies, and information are informed by people’s lived experiences that reflect their whole health needs and a life course perspective. -Services are co-created using participatory approaches like human-centered design.
  • Practitioners use and are trained in interventions based on the best available empirical evidence and science, that are in line with national guidelines, culturally appropriate, and reflect person-centered principles.
  • Quality services and supplies are desirable, available, accessible, and effective. When needed services and supplies are unavailable, there is an effective referral system in place that facilitates connecting individuals with vetted providers. The referral experience is included when assessing quality, monitoring, or conducting evaluations.
  • People are educated on and offered choice in their health care and/or product; when they want it, how they want it, from who, and where.
Point-of-Care Access & Experience
  • The design of the point of care settings and experiences — both physical and digital — is inviting, user-friendly, and promotes a sense of physical and psychological safety for all stakeholders.
  • Care settings and interactions minimize accessibility barriers (affordability, availability, physical accessibility, and acceptability of services) and reinforce person-centered principles.
  • Clear explanations of all examinations and procedures are given to patients and caregivers.
  • Supportive, empathetic, and responsive care is provided to help patients in all facets of caregiving, including pain management and keeping calm.

Examples of Our Work

In Ethiopia, JSI’s USAID DHA improves digitization and data use for service providers to strengthen the quality of care delivered to the person. By using data to inform and improve how services are delivered, and through ensuring accountability and transparency, the DHA project supports the Ministry of Health (MOH) of Ethiopia in its goal to deliver person-centered care (PCC).

In Ethiopia, JSI supported community engagement in the immunization micro planning process, enabling HCWs to design and adapt service delivery through systematically integrating community voices and participatory approaches. This ensured that services were designed and delivered in the right place at the right time by trusted providers.

In the Kyrgyz Republic, JSI developed an algorithm for a community-based subgrantee that works with TB patients from high-priority groups who are at risk of treatment interruption. The algorithm, guided by USAID’s PCC strategy, describes how to support different types of patients at different stages of their treatment process through a psychosocial support program. This approach honors each person’s unique needs and circumstances while maximizing time and resources of the community group.

In Ghana, JSI brings HIV treatment services closer to people by caring for them at multiple points of care (in facilities, communities, and homes based on each person’s needs and preferences). Our innovative approaches support adherence, overcome access challenges and build trust through providing home-based ART refills, and offering community- and facility-based services, or any combination in between.

In Nigeria, JSI is increasing awareness, and optimizing distribution and use of HIV-prevention commodities among key populations. TMA involves multi-level stakeholders at the policy and financial space/domain taking into account the religious, cultural, and ethnic diversity to help improve access to points of care such as discrete walk-in clinics for men and one-stop shops for adolescents.

JSI and PATH are supporting > 20 countries to introduce and scale-up subcutaneous DMPA (marketed as Pfizer’s Sayana® Press). The project supports governments to create policy for the full introduction of DMPA-SC, ensuring that a person-centered care framework is in place to roll-out DMPA-SC. By focusing on going beyond a single product to informed-choice programming more broadly, JSI is moving beyond systems to empower individuals and to support self-care.

In Kenya, JSI’s affiliate inSupply has developed cStock. This supply chain strengthening approach combines simple resupply procedures with mobile technology and user-centered dashboards. The inSupply team used human-centered design to customize the product to work for resource constrained settings and accommodates both android application and unstructured supplementary service data (USSD) solution to support community health volunteers (CHVs) with feature phones and is integrated with DHIS2. This helps accommodate community volunteers with low literacy levels who serve nomadic populations in remote areas where network coverage is scarce. cStock connects CHVs to their facilities and promotes demand-based resupply, ensuring greater product availability at the community level.

In India, under the Gavi Health System Strengthening Phase 2 Grant, JSI developed an interactive, continuous, and adaptable knowledge-building system for different levels of health personnel to implement the recent guidelines in the Universal Immunization Program and provide five comprehensive modules on different immunization topics. Initially piloted in five districts of five states, the platform has scaled to 36 districts and catered to almost 14,000 learners. Officials can monitor staff’s learning progress and performance and offer individualized mentoring and coaching. The on-demand learning system enables person-centered care by ensuring that providers are continually available at their point of care and engaged.

USAID Advancing Nutrition helps countries around the world address the multiple causes of malnutrition. Together with an external technical advisory group, the project developed the Responsive Care and Early Learning (RCEL) Addendum package which aims to integrate these important components for child development with nutrition counseling to improve childhood outcomes. The package helps HCWs better understand a child’s development and support caregivers in providing loving care, play, and stimulation for their child. The materials address core principles such as trust, safety, and identity–nearly every principle of the PCC framework. They help HCW put a caregiver’s concerns front and center during counseling and actively listen to understand how they can support caregivers in a way that is responsive to their needs and understanding of their context.

The Last 10 Kilometers 2020 Project supported Ethiopia’s efforts to strengthen a responsive and resilient primary health care system that improves the health status of families and communities. L10K supported birth preparedness and emergency readiness by creating a tool for health extension workers to develop individualized birth preparedness and postpartum planning. The project also supported Ethiopia to implement and participate in conferences that strengthen the ability of health extension workers to guide discussions with pregnant women and their families to discuss pregnancy freely. These conferences also helped to create a support system, and reinforce home and community level planning.

Immunization service experience plays an important role in ensuring that immunization programs are valued by and accessible to everyone. JSI designed an Immunization Service Experience (SE) Toolkit to introduce the concept of SE at country level for immunization staff and implementing partners. The five toolkit products are meant to spark discussion around how country immunization programs may address and improve the delivery and experience of immunization.

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