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Research priority 2: How can occupational therapists ensure that person-centred practice is central to how they work? Start by rethinking the person

The second priority identified in the James Lind Alliance (JLA) Priority Setting Partnership is: ‘How can occupational therapists ensure that person-centred practice is central to how they work?’ The JLA Priority Setting Partnership identified that person-centredness can be difficult to achieve in some areas of occupational therapy practice, despite being considered a fundamental principle of the profession. The JLA listened to service users and their families in setting the priorities and noted that the people who access occupational therapy services do not always agree that they have experienced person-centred practice. In this editorial, we hope to provide some insights into how the profession might achieve this aim in the many contexts that shape practice. We do so by considering the place of a person-centred philosophy in the practice of occupational therapy. We want to explore where the person is placed in the theory and practice of the profession and suggest that there is a need for critical debate about the centrality (or not) of the person in occupational therapy practice. It would not be unusual for some readers to be affronted by the suggestion that occupational therapy might not be person-centred, as all healthcare professionals would probably argue that our core values are personcentred, and it is how we practice. We are not suggesting that this is not the case, but we do need to reflect on where occupational therapy practice is ‘at’ and what is privileged as professional practice. Over the last 20 years, there has been a movement towards what is generally described as a focus on ‘humanising healthcare’. In part this has been a kickback against new public management and the idea of healthcare as a commodity focusing on throughput, and outcomes that concentrated on efficiency, productivity effectiveness and financial modelling. In response to this dominant culture and some significant examples of healthcare failings (e.g. those identified by The Bristol Hospitals Inquiry and The Francis Inquiry), evidence emerged highlighting the pressing need to listen to people, to privilege care experience and to develop more collaborative and inclusive healthcare practice environments. The intent was to recognise that these systems comprise people trying to act with purpose and meaning, but when these same people work in contexts that are depersonalised, their practice can become ineffective. Listening to practitioners and the people they work with can prevent this from occurring and helps improvement by enabling changes to be made to the contexts and cultures of practice (Harvey et al., 2018; Rycroft-Malone et al., 2018). In that context, there has been a drive to adopt a more person-oriented approach to the way health and care systems are designed. This has been a multi-professional agenda including occupational therapy, with advancements evident in theory and methodology, as well as evaluation and research methods. There has also been a lot of superficial engagement with efforts to show the symbols of personcentredness (language and artefacts) without working with deeper assumptions about what matters in practice (McCormack et al., 2010). Some of the challenges associated with engaging more deeply with person-centred ideas lie at the level of discourse. Despite the existence of several definitions of person-centredness and person-centred practice, there continues to be a dominant belief that it is difficult to define and operationalise – a critique that Dewing and McCormack (2017) argued is embedded in professional silo mentality and an unwillingness on the part of some professional groups to accept inter-professional definitions of practice. Further, the literature clearly demonstrates sloppiness in the use of language between person-centredness, patient-centredness and client-centredness (to name a few!), something that McCormack (2022) identified as a significant problem in person-reported outcome measurement. This difference is not merely one of terminology. Patient and client-centredness have their origins in renegotiating power imbalances in Research priority 2: How can occupational therapists ensure that person-centred practice is central to how they work? Start by rethinking the person