As the notion of person-centredness of health services and systems is becoming more established in national and international policy declarations and commitments, there is a need to better understand and clarify the use and usefulness of relevant strategies and approaches that seek to improve the position of individuals, their families and communities in the health system.

This book takes as a starting point the various roles people take in health systems, while recognizing that these roles overlap and may be performed simultaneously (see Chapter 1). Indeed, as Coulter (2002) suggested, the 21st-century health service user is at once “a decision-maker, a care manager, a co-producer of health, an evaluator, a potential change agent, a taxpayer and an active citizen whose voice must be heard by decision-makers” (p. 6). Viewed through this lens, a greater person focus can contribute to advancing equity, efficiency and the responsiveness of health systems.

Overcoming care fragmentation remains among the key challenges facing health systems globally (Nolte & McKee, 2008; Saini et al., 2017; Schoen et al., 2011). This has become particularly acute against the background of a changing disease burden and the rising number of people with multiple health problems. Policy-makers have recognized this challenge and countries are exploring new approaches to health care delivery to enhance the coordination of care and so better meet the needs of those with chronic and multiple health problems and optimize service use (Nolte, Knai & Saltman, 2014; Wodchis et al., 2015; World Health Organization Regional Office for Europe, 2016). The focus has tended to be on the service provider side, with the introduction of innovative care models such as through strengthening multidisciplinary team work, the use of care coordinators or case managers, co-location of different providers, and shared pathways, among other developments (Nolte & Knai, 2015).

As we have seen in the introduction to this book, there remains a lack of consensus about the actual meaning of patient or person ‘centredness’ in the context of health systems. There is considerable overlap with concepts such as ‘empowerment’ and ‘participation’. Some view empowerment as a core principle or dimension of patient-centred care (Docteur & Coulter, 2012; International Alliance for Patients’ Organizations, 2006), while others define centredness as a foundation or prerequisite for achieving empowerment (Castro et al., 2016; Lhussier et al., 2015).

A wide range of reviews have been carried out over the past two decades to better understand patient- and person-centred care and related concepts.

As we have seen in Chapter 2 of this book, the terminology and interpretations of person-centredness vary across disciplines, professionals and stakeholders. A common theme underlying the diverse understandings is the ethical premise that people as patients and service users, and, by extension, family members, members of the community and citizens more broadly, should be treated as persons, with respect and dignity, and that care should take into account their needs, wants and preferences. However, expectations regarding the outcomes of enhanced person-centred care vary among stakeholders. Thus, managers and decision-makers might anticipate increased efficiency and wider system level effects, while others emphasize more effective engagement at the interpersonal level. Different understandings and perspectives will significantly impact on the translation of principles into practice, and on the perceived or demonstrated effectiveness of relevant initiatives and strategies.

There is now widespread acceptance, in political and policy declarations, that the individual citizen should be at the heart of the health system (OECD Health Ministerial Meeting, 2017; World Health Organization, 2016; World Health Organization Regional Office for Europe, 2015). A person-focused approach has been advocated on political, ethical and instrumental grounds and is believed to benefit service users, health professionals and the health system more broadly (Dieterich, 2007; Duggan et al., 2006; Richards, Coulter & Wicks, 2015). However, and in contrast to the political and policy emphasis placed upon ‘person focus’, there is continuing debate about its actual meaning in the health care context vis-à-vis concepts such as ‘patient-centred’, ‘user-centred’, ‘family-centred’ or ‘people-centred’ care, or indeed ‘personalized’ health care, as well as the strategies that are available and effective to promote and implement ‘person focus’