There is increasing recognition that genuinely focusing on the needs and wishes of consumers is a necessary central tenet of responsive and effective health services. Whilst this value is becoming more accepted, it’s not always clear how we can make it a reality. A relational approach acts as the backdrop to connecting people to care, for example, through navigation, based on principles of patient-centred care (Peart et al., 2018). Relationship-centred care focuses on developing relationships that support and meet the needs of consumers as the basis for providing care. Working in navigation with the relational aspects of care we’re able to act in practical ways beyond patient-centred care.
Relationship-centred care is said to be the lens that informs and shifts perceptions of what is meaningful, important, and of impact in health care (Soklaridis, et al., 2016). It came to prominence in the 1990s (Tresolini & the Pew-Fetzer Task Force, 1994), initially as an approach to health care affirming the biopsychosocial model (Engel, 1977) and building on the concept of patient-centred care in primary care (McWhinney, 1989). The biopsychosocial model was still perceived as reductionistic and objectifying the patient experience; and patient-centred care was seen as not inclusive of the interdisciplinary aspects of care (Tresolini & the Pew-Fetzer Task Force, 1994). Relationship-centred care goes further to reflect the team approach, where it is not just the dynamics between a consumer and provider, but relationships providers have with other team members, their community, and themselves.
The four dimensions of relationship-centred care are (using consumer-oriented terminology): consumer-provider relationship; provider-provider relationship; community-provider relationship; and, provider-self relationship. The consumer-provider relationship overlaps considerably with patient-centred care (Safran, Miller, & Beckman, 2006). It focuses on providing direct care to the consumer, encouraging collaboration in decision-making, promoting health, and preventing illness (Tresolini & the Pew-Fetzer Task Force, 1994). The provider-provider relationship resonates with team care arrangements, shared values, integrating services, and importantly, caring for and supporting each other (Tresolini & the Pew-Fetzer Task Force, 1994). The third dimension, community-provider relationship sees the community as the context for health and well-being, and acknowledges recognition of the social determinants of health. Here, a provider understands the local community and appreciates its importance in contributing to health (Beach et al., 2006). The fourth dimension, provider-self relationship includes the provider’s capacity for self-awareness, reflection, and integrity in challenging situations (Beach et al., 2006).
Navigation, in its various forms, relies on relationships. Relationship-centred care may help consumers navigate getting the care and supports they need. Some navigation projects rely on lived experience workers, who draw on their unique knowledge, abilities, and attributes to support others through relationships, based on their own life-changing experience of conditions and service use (Byrne et al., 2021).
One example of a navigation project is an innovative pilot funded by Portland House Foundation, undertaken in partnership between Turning Point, a national addiction treatment, research, and education centre, and Self Help Addiction Resource Centre, a leading Victorian non-for-profit, community organisation with expertise in lived experience and peer-based recovery. Callers to Turning Point’s DirectLine, a 24-hour telephone counselling, information, and referral service for anyone in Victoria wishing to discuss alcohol or drug-related issues, are offered a weekly phone call for six weeks from a peer worker. As stigma plays a large role in people experiencing addiction taking up to 20 years to seek treatment and support, programs embedded in an addiction helpline, where over 60% of callers are new to treatment, are an opportunity to engage people experiencing addiction, and connect them with the right support.
In the DirectLine project, peer workers use their lived experience of recovery, plus skills learned in formal training, to support others. It is this relationship that assists with enhancing a person’s feelings of hope, empowerment, and self-efficacy, key elements of a recovery-oriented approach to supporting people experiencing addiction. Having the assistance of a peer worker who has navigated the recovery process themselves, understands the impact of stigma, and encourages callers to access information and community support, is a core element of the pilot. The ultimate goal is for callers to be empowered to seek the relevant information, care, and support they need. The peer workers are supported and supervised by the Self-Help Addiction Resource Centre through the peer worker model, focused on reflective practice, exploring how they are able to connect with others using lived experience.
The role of relationships in navigation is clear. Patient-centred care has been a critical conceptual shift in the delivery and orientation of health services, but this needs to be expanded to incorporate broader relationships and interactions (Nolan, at al., 2001), as demonstrated in relationship-centred care. It is through recognising and contributing to these relationships that we can genuinely meet the needs of the consumer and their community.
About the author
Dr Peart is a Research Fellow, Addiction Studies, Monash University, working closely with Turning Point’s Telephone and Online Services. Dr Peart is a health services researcher with clinical and management experience in a range of health and social service settings. Her research interests include access to care, person-centred care, and using qualitative methods to understand the experience of care.
Beach, M. C., Inui, T., & Relationship-Centered Care Research Network. (2006). Relationship-centered care. Journal of General Internal Medicine, 21, S3-S8. doi.10.1111/j.1525-1497.2006.00302.x
Byrne, L., Wang, L., Roennfeldt, H., Chapman, M., Darwin, L., Castles, C., Craze, L., & Saunders, M. (2021). National lived experience (peer) workforce development guidelines. National Mental Health Commission. https://www.mentalhealthcommission.gov.au/Mental-health-Reform/Mental-Health-Peer-Work-Development-and-Promotion/Peer-Workforce-Development-Guidelines
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136. doi.10.1126/science.847460
McWhinney, I. R. (1989). A textbook of family medicine. Oxford University Press.
Nolan, M., Keady, J., & Aveyard, B. (2001). Relationship-centred care is the next logical step. British Journal of Nursing, 10, 757. doi.10.12968/bjon.2001.10.12.12336
Peart, A., Lewis, V., Brown, T., & Russell, G. (2018). Patient navigators facilitating access to primary care: A scoping review. BMJ Open, 8. doi.10.1136/bmjopen-2017-019252
Safran, D. G., Miller, W., & Beckman, H. (2006). Organizational dimensions of relationship-centered care: Theory, evidence, and practice. Journal of General Internal Medicine, 21, S9-15. doi.10.1111/j.1525-1497.2006.00303.x
Soklaridis, S., Ravitz, P., Adler Nevo, G., & Lieff, S. (2016). Relationship-centred care in health: A 20-year scoping review. Patient Experience Journal, 3, 130-145. doi.10.35680/2372-0247.1111
Tresolini, C., & the Pew-Fetzer Task Force. (1994). Health professions education and relationship-centered care. Pew Health Professions Commission.