“A chain is only as strong as its weakest link” : collaborative care planning as a person-centred practice

In recent years, person-centred care has become one of the major goals of health and social care policies. A method used, to facilitate collaboration and integrate the person’s perspective in the decision-making process, is the collaborative care planning process. The collaborative care planning process, taking place within primary health care with actors from different welfare services, is a relative new phenomenon. There is a need for more research to understand the process and outcomes. The overall aim of the thesis was to explore and describe the collaborative care planning process as a person-centred practice. This was achieved by conducting four studies describing the collaborative care planning conference (I), exploring how the person-centred practice framework can be applied to professionals participating in collaborative care planning (II), exploring which attributes contribute to making the collaborative care planning process work for all participants (III) and exploring documented collaborative care plans (IV). The design of the studies were a single – instrumental qualitative case study (I), explorative deductive approach (II), qualitative explorative with a grounded theory approach (III) and explorative descriptive approach (IV). Using different methodologies, data were collected through interviews with older adults, their care partners and health and social care professionals, focus group discussion with health and social care managers, observations of collaborative care planning conferences and documented collaborative care plans. Data were analysed with qualitative case study, qualitative content analysis, constructivist grounded theory and content analysis. Older adults wanted to be actively engaged in decision-making processes regarding their care and services. However, the professionals had challenges in carrying out the collaborative care planning process (I). Collaborative care planning and person-centred practice was a complex process that needed to take into account system factors both on macro- and micro level (II). A joint philosophy, an ethic, could facilitate and guide professionals in everyday practice (III). The collaborative care plans had poor quality, insufficient content and lack of personcentredness (IV). Further research is needed to understand the role of the documented collaborative plan and the best way of working to make the collaborative care planning process and collaborative care plan person-centred. To gain a deeper understanding of the studies (I – IV) results an interpreted synthesis were conducted resulting in two common threads, personhood and power asymmetry. The two common threads were discussed using philosophy and Paul Ricoeur’s (1994) “little ethics”. The collaborative care planning process has to be seen in a larger context for it to be person-centred. All levels, the older adult and their care partners, the professionals and the organizations, need to be permeated of ethics and human values, and these have to be visible in every action and practice. Health and social care are relational practices and organizations. During the collaborative care planning the professionals, the older adults, and their care partners become interwoven. By using reciprocity and balancing the different dimensions and perspectives, the plan, their relationships and the organizations can improve. In conclusion, the thesis highlight the importance of ethics, relationships and reciprocity during the collaborative care planning process. The philosophical texts by Ricoeur expand the perspectives and contribute to a greater understanding of the collaborative care planning process as a person-centred practice