Valuing people as individuals: Development of an instrument through a survey of person-centredness in secondary care

Background. Person-centred care is regarded as the optimum way of delivering health care and is defined as valuing people as individuals (Winefield et al. 1996). So how can practitioners find out if their service 'values people as individuals'? Serious doubts have been expressed about the validity of the concept of patient satisfaction and the ability of instruments to measure patients' views of care. However, qualitative research among people who had experienced problems with their health care has identified an alternative concept better able to articulate patient's complex experiences (Coyle 1997). The study found that that patients' identity was threatened by experiences perceived as dehumanizing, objectifying, disempowering and devaluing. Thus the concept of 'personal identity threat' showed the extent to which people felt valued (or not) as individuals. Aim of the study. The aim of the research reported in this paper is to build upon the earlier qualitative work and to identify the frequency and distribution of inpatients' experiences of 'personal identity threat'. Design/Methods. The study adopted a cross-sectional survey design. Ninety-seven patients from general medical, surgical and otolaryngology wards completed a questionnaire developed from the qualitative study containing items on dehumanization, objectification, disempowerment and devaluation. Findings. Although many patients expressed positive sentiments about their care, problems were highlighted around power/control, involvement in care, and the approachability and availability of staff. The findings also revealed that women were more at risk than men of 'threats to identity' in health care settings. Conclusions. Improvements are suggested to help promote a service that truly values people as individuals. These include improving health practitioners' understanding of the impact of illness on everyday life, promoting practitioners' listening and enquiring skills, and increasing the 'visibility' and availability of staff. Further research should also explore gender and age differences in perceptions of the lay-practitioner relationship.