Person-centered care on the move : Facilitation to support the implementation of person-centered ambulance care

In many countries globally, Integrated Care is a key focus, known in Sweden as Good Quality, Local Health Care (Nära vård). Within Good Quality, Local Health Care, ambulance service is described as having an important role and Person-Centered Care (PCC) is a central component. Research shows that there is a need for increased person-centeredness within the ambulance service, while there is also uncertainty about what PCC means – both in general and specifically within ambulance service – as well as how its implementation can be supported. To introduce PCC, changes in working methods are required, which in turn necessitate structured support and guidance. Previous research has identified facilitation as a potentially beneficial strategy to support such implementation processes. Therefore, this thesis aimed to increase knowledge about how PCC can be operationalized and integrated into the ambulance service, using facilitation as the overarching implementation strategy. An intervention study was conducted at four ambulance stations in Sweden, where eight nurses were selected and trained to act as facilitators with the responsibility to support the implementation of PCC. Study I explored how the facilitators described PCC in the ambulance service through an interview study with an inductive approach. The interviews were transcribed and analyzed using qualitative content analysis. Study II evaluated how PCC was integrated into the daily work of the ambulance personnel. The study was conducted with a deductive approach, using Normalization Process Theory as a theoretical framework. The interviews were transcribed and analyzed with qualitative content analysis. The findings show that PCC was perceived as an ethical approach that was difficult to operationalize and implement in the ambulance service. The facilitators described PCC as a vague concept but also identified opportunities to work more person-centered. However, the implementation efforts did not lead to a successful integration of PCC. The reasons included a lack of shared understanding and various approaches to PCC among the ambulance personnel, insufficient leadership support, and scarce evaluation of the implementation work. Another challenge was the Covid-19 pandemic, which changed priorities within the ambulance service. Overall, this thesis shows that PCC has potential within the ambulance service, but no actual integration took place within the actual study. For lasting change, stronger organizational support and better conditions for ambulance personnel to work according to PCC principles are necessary.