Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering.

Autonomy and dignity in healthcare: a matter of person-centred practice Healthcare in the Netherlands is subject to major changes. Due to rising living standards and new technologies in healthcare, people are living longer and this is related to an increase in multimorbidity. The demand for and cost of healthcare are rising as a result. In the process of trying also focuses on the development of work/learning environments aimed at healthy living and working. Bienke Janssen, PhD, is lecturer and researcher. She obtained her doctorate on the question of how elderly people living independently manage to maintain control over their lives despite their decline in functioning and what role professionals can play in that process. Her current research is on maintaining autonomy of care recipients as an important indicator of personoriented practice and healthy living and working in the neighborhood. Correspondence to: Gaby Jacobs E-mail: [email protected] Received: 13 April 2018 Accepted: 16 July 2018 Category: Theory Gaby Jacobs, PhD, is a professor in Person-Centred Practice. She is head of the Knowledge Centre on Person-Centred Practice in Health and Social Care at Fontys University of Applied Sciences, and is also affiliated with the University for Humanistic Studies in Utrecht. She has extensive expertise in the participation and empowerment of vulnerable groups and the support provided by care and relief workers. She currently Journal of Social Intervention: Theory and Practice – 2018 – Volume 27, Issue 6 49 GABY JACOBS, BIENKE JANSSEN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Long line to transform healthcare and reduce costs, the government is trying to increase the amount of selfcare and self-sufficiency. Significant herein, is the development towards support for clients’ selfmanagement. This is not a new concept: patient empowerment and patient autonomy have been on the agenda since the 1970s. In order to explain the difficulties that healthcare is encountering in supporting patient autonomy, we use the theory of the American sociologist Eliot Freidson (2001), who makes a distinction between the logic of the market (consumerism), the logic of the organization (managerialism) and the logic of the profession (professionalism). Based on his theory, we would expect that although consumers do now have a stronger voice in their own healthcare, neither patients nor professionals experience autonomy in current healthcare practices. First of all, from a neo-liberal market perspective, the focus of self-management is on the controllability of life and health. However, this does not take account of the vulnerability that people experience and their need for respect, recognition and treatment as human beings. Consequently, patients often do not feel they are seen as people in their own right and do not feel supported in dealing with difficult life questions and issues. Secondly, from an organizational and bureaucratic perspective, the controllability of organizations in terms of goals and costs is central. This leads to the fragmentation of care, leaving patients to manage not only themselves but also their care. Organizational bureaucracy also conflicts with professional autonomy, turning professionals into the enforcers of rules and procedures. Person-centred practice can provide a solution to help overcome these issues and is the subject of increasing attention worldwide. It is part of a humanization movement in healthcare which sees the personal and interpersonal dimensions as essential to good care (Hummelvoll, Karlsson & Borg, 2015; Jacobs, 2015; McCormack & McCance, 2010). Our vision of person-centred practice is inspired by the ethics of care, relational psychology and relational constructionism. These currents are critical of individualism and the focus is on control and manageability in contemporary healthcare. Person-centred care is defined as the continuous co-creation of relationships and structures within care, learning and work environments in such a way that the patient’s own direction and dignity are realized. Self-management is therefore not an individual matter, but a question of “working together across the boundaries” of differences in values, knowledge and meanings. Person-centred practice provides an alternative model for the expert model, which is referred to as the cooperation model. In this model, collaboration involves not only professionals from various disciplines and sectors, but also clients and their stakeholders in healthcare. The expertise required for this by participants is known as dialogical or relational expertise. The intention of cross-border cooperation is to contribute to sustainable change by developing relationships and structures that promote autonomy and dignity.