Implementing the PIE (Person, Interaction and Environment) programme to improve person-centred care for people with dementia admitted to hospital wards: a qualitative evaluation

Background
Improving person-centred care for people with dementia in hospitals is a UK policy priority. The PIE (Person, Interaction, Environment) programme comprises cycles of observations of care by staff, identification of areas for improvement and plans for practice change and evaluation. The aim of the research reported here was to describe and evaluate PIE implementation in three UK NHS regions.

Methods
A qualitative design was adopted in ten case study sites (wards). Site selection was based on readiness for change criteria. Following a training workshop, PIE cycles were introduced into each ward. Data collection comprised observation, interviews, documentary analysis and an events log. Normalisation Process Theory provided a guiding framework for analysis.

Results
PIE was fully adopted in two study wards over 18 months, which resulted in sustained practice change and increased awareness of person-centredness. Partial implementation of PIE took place in a further two wards but progress stalled before significant action. The remaining six wards failed to implement PIE. Factors influencing implementation were: salience of PIE, collective team involvement, fit with strategic priorities, adequate resources, effective clinical leadership, good facilitation and organisational stability.

Conclusions
PIE has the potential to help staff improve person-centred care for people with dementia admitted to hospital wards. However, the evidence is limited to ten wards of which only two fully implemented the programme.
Implications for practice
• A programme for improving person-centred care for people with dementia in acute hospital wards requires sustained commitment from both the organisation and the ward.
• Successful practice change depends on multiple key factors, including effective clinical leadership and good facilitation.
• Contextual factors at various levels of an organisation need to be considered.
• Use of the PIE tool has the potential to enable staff’s attention to focus on person centred care for older people with dementia in acute settings.