Reforming and Transforming Care: Considering Person -

CentrednessProfessor Brendan McCormack

Head of the Division of Nursing, Queen Margaret University, Edinburgh

Professor II, Buskerud Vestfold University College, Drammen, Norway;Extraordinary Professor, University of Pretoria, South Africa;

Adjunct Professor of Nursing, University of Technology, Sydney; Visiting Professor, University of Aberdeen

Tradition evolves with time and place while holding strongly to certain formal, cultural, and personal principles. Nostalgia seeks the security of past forms without inherent principles” (Callthorpe, 2008)

Are our services more responsive to persons?

� ‘Person-centred moments vs ‘Person-centred cultures’� The ‘fragility’ of person-centredness – dependent on:

� Consistency of care delivery� Effectiveness of coordination� Quality of leadership (team/unit/organisational/strategic)� Knowledge, skills and expertise of care team� Existence of a person-centred culture� Systems-wide commitment to person-centredness� Existence of flexible models of care delivery

(McCance et al, 2012)

Misuse of power and lack of autonomy

Horizontal violence and oppressed behaviours

Transactional leadership

(Brown & McCormack 2010)

Psychologically Unsafe Environments: characterised by …

There is a need for organisationsto change structurally and create more positive conditions if transformational leadership is to be sustained. Otherwise, nurse leaders will become frustrated in an environment that is expanding regulatory mechanisms

(Hewison & Griffiths 2004)

“Why does one <leader> bolster our spirits, calm our nerves and nourish our soul? Why does another drain us of our vitality, leaving us feeling flat?

(Adapted from Quillien, 2008)

https://www.youtube.com/watch?v=krPt8z0okoQ

PresencingGroup & individual reflection to transform

self & will

SensingCreate space to see connection with

existent reality & transform perceptions

RealisingBringing new action to

transform context

Seeingourseeing

Embodyingthe new

(project completion)

PROTOTYPING

Letting go

Envisioning reaching clarity & connection to inner ‘knowing’

Suspending

redirecting

Letting come

CourageCommitmentFacilitative leadership

Capacities of the U movement (Brown & McCormack 20 10, adapted from Senge, Sharmer et al 2005).

)

The Fifteen Properties of Nature• Strong Centres• Levels of Scale• Boundaries• Good Shape• Positive Space• Local symmetries• Alternating Repetition• Deep interlock & ambiguity

• Contrast• Gradients• Roughness• Echoes• Voids• Simplicity & Inner Calm• Not separateness

‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander‘The Nature of Order’ by Christopher Alexander

A Strong Centre

All life tends to form multi-levelled structures of systems within systems … the different ‘nested’ levels help each other, perform different tasks, and are necessary to the functioning of the whole … (Quillien 2008)

Levels of Scale

Boundaries

A boundary

helps focus

attention on the

centre

Good Shape

Positive Space

Accomplished dancers will naturally create between and around themselves a flow of changing positive spaces. Beginners not well centred in themselves and out of sync with their partners will be less connected by the spaces in-between

Local Symmetries

Alternating Repetition

Roughness

Roughness

pertains to the

resolution of

problems when

diverse elements

come together in

three-dimensional

space

Every successful centre depends on the existence of a

still place

Simplicity and Inner-calm

Not-SeparatenessNot-seperateness is

experiencing a living

whole as being at one

with the world. Ponds,

such as this one, cannot

be sharply isolated from

their surrounds. In the

same way, old farming

villages are not separate

from their fields.

• A coaching model that promotes a sense of safety, openness, and trust.

• Use of authentic methods that support a learner-centred approach.

• Facilitation of leader autonomy, participation and collaboration.

• Engagement with activities that encourage the exploration of alternative personal perspectives, problem-posing, and critical reflection

• Communicative spaces for democratic dialogue and experimentation

“You never change things by fighting the existing reality. To change something, build a newmodel that makes the existing model obsolete

(Buckminster Fuller, cited in Quillien, 2008)