Person-centred practice provides a central tenet underpinning health and social care internationally [1, 2]. The Person-centred Practice Framework  is internationally recognised and is being implemented globally . This paper provides for the first time, statistical evidence of the relationships between the theoretical constructs of the framework and what these might mean for developing our understanding of person-centredness and its operationalisation in healthcare practice. Whilst the data reinforces the importance of the constructs of the framework and their relevance to person-centred healthcare, a number of issues are raised by the findings of the study.
The significance of interpersonal skills as a core component of person-centred practice is reinforced by the finding that the constructs ‘Developed Interpersonal Skills’ and ‘Being committed to the job’ offer the largest contribution to ‘the ‘Prerequisites’ domain. The prerequisites of the Person-centred Practice Framework focus on the qualities of the practitioner that need to be in place in order for person-centred practice to be realised. The fact that interpersonal skills and commitment to the job emerge as the most significant qualities that need to be in place for person-centred practice to happen is an illuminating finding. In their writing, McCormack and McCance  argue that person-centredness is essentially a relational practice that is dependent on well-established interpersonal skills that can be operationalised in different practice contexts. The significance of interpersonal relationships also reinforces the idea that person-centredness is more than the ‘doing’ of particular practices, but is much more about a way of ‘being’ as a practitioner. The dominant focus in healthcare developments and innovations on doing person-centredness is one of the reasons why despite more than 10 years of quality improvements focusing on person-centred practices, we continue to see problems in practice and the existence of what Laird et al  have described as ‘person-centred moments’ at best. Commitment to the job further reinforces the being of person-centredness. McCance & McCormack  define commitment to the job as ‘the dedication of practitioners demonstrated to patients, families, and communities through intentional engagement that focuses on achieving the best possible outcomes’ (pp55). Dedication implies presence and being in the moment with patients, families and communities and through such presence enables engagement. The findings of this study reinforce the need for practitioners to have well-developed interpersonal skills that will enable them to be present with patients and families.
The fact that ‘clarity of values and beliefs’ had the least significance in explaining the theory, raises important issues about how person-centred practice cultures are developed. The data shows that values and beliefs are important and of course are essential to the being of the person-centred practitioner. However, the data also suggests that having clear beliefs and values is not enough in itself for person-centred healthcare. In contemporary healthcare there is significant emphasis placed on values and beliefs among healthcare teams through programmes such as ‘Values in Action’ https://www.hse.ie/eng/about/our-health-service/values-in-action/valuesinactionblog/how-the-nine-values-in-action-behaviours-were-developed.html that reinforce the importance of particular values being evident in healthcare practice behaviours. What such programmes fail to recognise, however, are the complex factors that have to be addressed on a continuous basis for such values to be translated into everyday practice. Emancipatory and transformational practice development  methodologies however have played a significant role in demonstrating the need for continuous facilitated meaningful engagement to develop person-centred health cultures. Evidence from practice development programmes show how clarity of beliefs and values acts as a foundation for culture change, leadership development, team effectiveness and consistency in patient care [26, 27]. Notably, such programmes also depend on long-term engagement for the development and embedding of culture change in healthcare settings – it is not a quick-fix solution. This is both a strength and a weakness of practice development as in a fast-moving healthcare context, quick-fix solutions that are the artefacts of person-centredness will always be favoured. Furthermore, the findings from this study suggest that this focus needs to be questioned and challenged if we are to see a large-scale shift towards person-centred cultures becoming a norm in healthcare organisations.
The data also suggests that the ‘shared decision-making systems’ construct of the care environment domain was the most likely predictor of a person-centred culture. This finding reinforces the importance of interdisciplinarity and service-user participation in healthcare practice. An organisational commitment to collaborative, inclusive and participative ways of engaging within and between teams is essential for person-centred practice  (McCormack & McCance 2017). Shared decision-making among team members is the foundation of interdisciplinary practice  and the essence of person-centred healthcare. Ensuring that service-users play a key role in shaping their care plans is fundamental to person-centred practice and something that has been demonstrated to person-centred outcomes [29, 30]. Research by Ekman and colleagues shows that when patients are active agents in the development of a care plan, when healthcare teams collaborate to ensure the implementation of the plan and when evaluation of the impact of the plan is undertaken from the perspective of the patient, then patient and team outcomes can be demonstrated. The findings from the research reported in this paper reinforce the importance of this collaborative working and illustrate engagement in action and negotiation being achieved.
From the perspective of the ‘person-centred processes’, it is illuminating that the data suggests that being sympathetically present is core to all of the other person-centred processes – thus suggesting that being sympathetically present is a core person-centred practice. McCance & McCormack  (pp.57) define being sympathetically present as – “An engagement that recognises the uniqueness and value of the patient by appropriately responding to cues that maximise coping resources through the recognition of important agendas in the person’s life”. The statistical significance of sympathetic presence in this research further highlights the need for the professional development of healthcare practitioners to focus as much on helping them develop their ‘ways of being’ as much as it does focus on the competence of what they do. Being sympathetically present is a phenomenological process that reinforces the individuality of persons. As Callaghan  (pp.21) asserts:
One of the difficulties in dealing with anything related to human experience is caused by no two people being exactly alike. There is so much that we have in common that we are inclined to imagine everyone is the same. Everybody is not. That which has meaning for one person may have none for another. Something of immense significance for one will mean little or nothing to another. The basic axiom is that each person is an individual and as such, a unique entity. This must never be forgotten in our attempts at self awareness or in our dealings with others”
Recognising this individuality is core to person-centred practice and the evidence from the research reported here reinforces that it is not something that person-centred practitioners do as a ‘practice’ but that it is an essence of being person-centred and underpins all practices. This is a significant finding from this research as it begins to surface issues that healthcare organisations may need to address for person-centred cultures to become a norm, including the reorganisation of services, challenging the standardisation agenda and protocolised care, as well as support systems for practitioners to enable them to sustain such individualised and engaged ways of being.
The findings from the study provide new and innovative data relating to the realisation of person-centredness in healthcare and redress issues relating to the translation of person-centred principles into practice as identified by Moore et al  and Sharp and colleagues . The evidence suggests that all the theoretical constructs make a statistical significant contribution to the overall understanding of person-centred practice and with varying degree of significance. Importantly, the findings highlight the focus on specific aspects of the framework to identify areas for change, facilitate change and evaluate it, so that the development of person-centred cultures can be sustained as a continuous focus in quality improvement programmes.
The findings add to a growing evidence base for a psychometrically sound tool [12, 19], that maps onto an established theoretical framework, redressing De Silva’s  critique of tools to measure person-centred practice and relate the findings to an acceptable theoretical framework. The PCPI-S has shown its value in measuring person-centred practice . The findings from this study continue to demonstrate that the PCPI-S has acceptable psychometric properties and displays the usefulness of the instrument as a means of informing how a theoretically driven approach to developing person-centredness in healthcare can be systematically developed through targeted interventions. The findings show the role that ‘prerequisites’ (practitioner qualities) play in shaping the ‘care environment’ and engaging in ‘person-centred processes’. This is as expected in McCormack and McCance’s  theoretical framework and indicates that a focus on ‘prerequisites’ can produce significant changes in shaping the overall approach to realising person-centred healthcare cultures.