Health systems strengthening through person-centred care: development of a feasible and acceptable theory-based workforce approach to improve quality.

我们要解决的问题是什么？重病对病人和家庭都有重大影响。在低收入和中等收入国家，这些问题可能是身体上的（如疼痛及其症状）、心理上的、社会上的（对收入、儿童学费、污名造成额外压力）和精神上的。这可能会影响患者和家属的健康，以及他们获得和维持护理的能力。卫生系统必须处理的不仅仅是疾病——它们必须变得更加“以人为本”。以人为本的护理意味着卫生系统的组织方式符合个人的偏好、价值观和信仰，提供尊严和尊重。以人为本被视为确保护理服务高质量的一种方式。通过劳动力（卫生保健人员）、其掌握的信息（关于个人需求和偏好）以及提供服务的方式来改善卫生系统，我们可以使护理更加以人为本。我们该怎么办？在这项研究中，我们想做一些重要的初步工作，为一项更大的研究提供信息，以提高以人为本。我们将利用我们在英国、津巴布韦和乌干达的合作伙伴关系，从面临严重疾病的患者和家庭的角度，以及非常重要的那些负责提供服务的人（卫生保健专业人员）的角度，找出最好的以人为本的护理是什么样子。我们将利用这些新信息与卫生保健团队合作，制定一项患者和工作人员都能接受的战略，并作为加强卫生系统的范例在这些国家付诸实施。我们还将研究衡量以人为本的最佳方法，这样当我们进行更大规模的研究时，我们就能准确地知道我们是否实现了目标。输出是什么？世界卫生组织有一个改善以人为本的所有人护理的战略——这项研究将从非洲的角度提供一种实用的方法来实现这一目标。我们还将提供一种适应的方法，从患者和家庭的角度来衡量护理体验。我们提出的战略将以患者、家属和保健专业人员的意见为主导，使其更有可能取得成功。我们正在与社区卫生组织和各国政府合作，确保我们能够通过更强大的卫生系统实现更好的护理。

What is the problem we want to address? Serious illness has major effects on both the patient and family. In low and middle income countries these can be physical (such as pain and their symptoms) psychological, social (with additional stressors on income, children's school fees, stigma) and spiritual. This can affect both the wellbeing of the patient and family and their ability to access and stay in care. Health systems must address more than just the disease- they must become more "person centred". Person-centred care means that the health system is organised to meet the needs of the individual in ways that respond to their preferences, values and beliefs, offering dignity and respect. Being person-centred is seen to be a way to ensure that care services are high quality. By improving the health system through the workforce (the health care staff) the information it holds (on the individual's needs and preferences) and the way things are delivered, we can make care more person-centred. What will we do? In this study, we want to do some of the important initial work to inform a larger study to improve person-centredness. We will use our partnership across the UK, Zimbabwe and Uganda to find out what best person-centred care looks like from the view of patients and families facing serious illness, and very importantly from those who would be responsible for delivering (health care professionals). We will use this new information to work with health care teams to develop a strategy that is acceptable to patients and staff that can be put into practice in these countries as examples of health systems strengthening. We will also look at the best way to measure person centredness, so that when we conduct a larger study we have an accurate way to knowing if we have achieved our goals. What will be the outputs?The World Health Organisation has a strategy to improve person-centredness of care for all- this study will provide a practical way to deliver this from an African perspective. We will also deliver an adapted way to measure the experience of care from the patient & family perspective. Our proposed strategy will be led by the views of patients, families and health professionals- making it more likely to achieve success. We are working with health organisations in the community and with Governments to make sure that we can achieve better care through stronger health systems.