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A multi-site evaluation of the Person, Interactions & Environment (PIE) programme to improve person-centred care for people with dementia admitted to acute hospital wards

Objectives and brief methodology

Care quality is unacceptably low for people with dementia in acute hospitals. Commonly reported negative ill-effects are on patients’ general physical health, symptoms of dementia such as becoming more confused and less independent, increased length of hospital stay and admission to residential care (1, 2). A more sensitive and proactive ward approach to meeting the complex needs of people who may have dementia is required. Person-centred care has been identified as an essential component of high quality acute care and is viewed as being particularly important for people with dementia, yet has proven challenging for ward teams to define or implement in practice.

As part of a national audit of care received by people with dementia in general hospitals (England and Wales) 2011, we developed a qualitative observational tool called ‘PIE’ (to look at the ‘Person’, their ‘Interactions’ with staff and the immediate ‘Environment’). This was successful in describing the quality of care and identifying areas for action within and across hospital wards, particularly in terms of communicative practices with people who may have dementia. However, translating action planning at ward level to effect practice and organisational change was not examined; and neither was the effect on the care experience of patients, their families/ caregivers and staff, or on patients’ health outcomes.

The ‘PIE programme’ thus comprises of the qualitative observational tool and a linked process for making change, with the overall objective of improving person-centred care for people who may have dementia in hospital wards. It is introduced to hospital staff via a one-day workshop and intended for use in a quarterly practice development cycle for ward teams to identify and make step-by-step changes in ward communicative practices with patients so that they gradually become more person-centred. The PIE programme will be implemented in five NHS Trusts (11 wards) over 18 months to develop person-focused communication practices and to explore how or whether this actually effects change. It is hypothesised that person-focused communicative practices will lead to improvements in person-centred care and associated health outcomes for people with dementia. The research questions are:

  1. Does the PIE programme change ward staff’s understanding and awareness of person-centred care for people with dementia?
  2. Does the process of change initiated through the PIE cycles of observation, action planning, action and review change team members practices and behaviour in ways that are consistent with person-centred care over 18 months?
  3. How does the process of change occur? What are the factors that facilitate or hinder change?
  4. Is there evidence that the PIE programme is effective in improving care for people with dementia admitted to acute wards, as experienced by those patients and/ or observed by their relatives/ caregivers?
  5. Is there preliminary evidence of effectiveness of the PIE programme in improving organisational and clinical outcomes for people with dementia?

The study will perform a mixed method, multiple case study design, using a ‘before and after’ approach. This is aimed at securing an in-depth understanding of the process of implementation and outcomes of the PIE programme in the real life setting of acute hospital wards with a substantial proportion of older people among its patients. The outcome will be a freely available evidence-based tool and manual, including training materials and implementation process, designed to enhance person-centred communication and care for people with dementia in acute hospital wards with wide applicability across the NHS.

  1. Alzheimer’s Society. Counting the cost. Caring for people with dementia on hospital wards. London: Alzheimer’s Society; 2009.
  2. Crome P, Woolley R, Young J. “Editorial: Dementia Care Deficiencies: potential for better care for patients in hospital.” Neurodegenerative Disease Management. 2011 1(4): 263-266.
  3. Royal College of Psychiatrists’. Report of the National Audit of Dementia Care in General Hospitals 2011. Editors: Young J, Hood C, Woolley R, Gandesha A, Souza R. Commissioned by HQIP.


01/02/2013 – 30/04/2016

Participant Criteria

Patients who staff consider to have an on-going problem with their memory, cognition or communication which may be undiagnosed or as a result of another condition e.g. stroke or depression will be identified. The eligibility criteria have been designed in recognition that dementia is poorly diagnosed and that people who may have impaired communication skills as a result of another condition may also benefit from the intervention.

Patient recruitment and on-going engagement for the current projects

Formal research consent will be sought from patients (and/ or their significant other) who meet the inclusion criteria to collect information about their care experiences via case studies. This will be up to six patients (and their next-of-kin) at each data collection period (198 in total).

The total patient group (with and without dementia) for whom we will compile a descriptive ward profile and obtain anonymous data on quantitative outcomes of interest is approx. 3,432.

Funding agency

This summary is funded by the National Institute for Health and Care Research Health Services and Delivery Research Programme (project number 11/1017/18).The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.