Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

Abstract

Several studies identify obstacles to patient-centered care that can be eradicated by bridging the gap between policy goals and practice. In this article, “patient-centeredness” is theorized as an unstable entity riddled with intrinsic, ineradicable tensions. The purpose of the article is to propose a reflexive approach to the tensions as the most appropriate strategy for narrowing the gap between policy and practice. The reflexive approach is illustrated in an account of an action research project on a Danish, patient-centered initiative, “Active Patient Support.” The account focuses on the development of a dialogic communication model through collaborative, reflexive analyses of the tensions in the enactment of “patient-centeredness” in dialogue between health care practitioners and citizens—in particular, the tension between empowerment and self-discipline. Finally, the conceptual expansion of one of the dimensions of patient-centeredness, “health-practitioner-as-person,” is discussed as a platform for reflexivity, and the limitations of reflexivity are addressed.

Protecting Personhood: A Classic Grounded Theory

“…They are not straightforward processes (Gulbrandsen et al, 2016). There are issues of empowerment versus power relations (Calvès, 2009;Gulbrandsen et al, 2016;Phillips & Scheffmann-Petersen, 2020). The focus on the relationship allows for the recognition of the person in the patient (Berntsen et al, 2022;Langberg et al, 2019).…”

Unpacking ‘patient‐centredness’: how knowledge is negotiated dialogically in the interweaving of genres and voices in counselling conversations

“…Therefore, in the action research project attached to the APS programme, we have worked to cultivate that reflexivity through joint analyses with the counselling team of nurses of extracts from counselling conversations including the ones analysed in this article (see Phillips and Scheffmann‐Petersen 2019, 2020). One of the methods used was the ‘forum play’ in which nurses did not just talk about practice but repeatedly acted out different ways of tackling the tension between self‐discipline and empowerment in a specific conversational situation.…”

“…One of the methods used was the ‘forum play’ in which nurses did not just talk about practice but repeatedly acted out different ways of tackling the tension between self‐discipline and empowerment in a specific conversational situation. This method was designed to generate embodied learning from ‘within practice’ (Phillips and Scheffmann‐Petersen 2019, 2020). We suggest that the strategy of reflexivity in the action research process helped to strengthen the logic of care in the APS programme.…”

Thinking with autoethnography in collaborative research: A critical, reflexive approach to relational ethics

“…This makes it difficult to take notice of, and critically attend to, tensions arising from the inexorable play of power in the practices constructed in their terms. As a result, the terms form a discourse that often signifies symmetrical power relations and romanticizes collaborative research as smooth, straightforward processes of inclusion (Phillips et al, , 2020(Phillips et al, , 2021. Our approach works with relational ethics by integrating critical, reflexive analysis of the tensions in the "with" in "research with, not on, people" and the "co" in "co-creating knowledge" into the research process.…”

“…Within this wave of research, there is a body of systematic critical, reflexive analyses of how power is always in play in the research process itself, notwithstanding the democratic, collaborative, dialogic ideals and transformative aims of social justice and social change (e.g. Groot et al, 2020; Kumsa et al, 2015; Olesen and Nordentoft, 2018; Phillips et al, 2013, Phillips and Scheffmann-Petersen, 2020). In this article, we draw on, and aim to contribute to, this body of critical, reflexive work with an approach to relational ethics building on a poststructuralist, Foucauldian understanding of power.…”