Transitioning to a Person-Centred Care Model: Quality Improvement in Community Disability Services

Community Living Algoma in Northern Ontario moved from routine-led, behaviour-focused care towards person-centred support. Staff reframed behaviour as communication, individualised plans and added flexible staffing, scheduling and housing transitions. Reported outcomes included greater autonomy, independence and emotional stability, fewer crises, stronger social belonging and reduced staff burnout, supported by leadership alignment and community and family engagement.

Key Points

• Care shifted from rigid routines to person-centred choices and daily decision-making.
• Staff treated behaviour as communication and co-created individual support plans.
• Flexible scheduling and housing transitions supported safer autonomy.
• Reported outcomes included fewer crises, more stability and stronger belonging.
• Better values alignment reduced moral distress and staff burnout.

Background

Person-centred care (PCC) models that emphasise autonomy, dignity and individualised decision-making are becoming more popular in developmental disability services (Agonafer et al. 2021). Community Living Algoma (CLA), a large community-based organisation in Northern Ontario, has historically taken a traditional, clinician-driven, behaviour-focused approach, relying on standardised routines, rigid care plans and restrictive interventions such as physical or chemical restraints (Wilson et al. 2017; Community Living Algoma 2025). This model prioritised efficiency and risk management over the preferences and goals of supported individuals, representing a clear area for quality improvement.

Over the past decade, CLA has undertaken a system-level quality improvement initiative to transition toward a PCC model. This approach shifts organisational processes to centre the individual’s choices, needs and aspirations, supporting meaningful participation in care planning, goal setting and daily decision-making (Leemreis et al. 2020). Evidence across healthcare settings shows that PCC enhances quality of life, autonomy, satisfaction and reduces reliance on restrictive practices (Kuipers et al. 2019; Yu et al. 2023). Implementing PCC has also been associated with improved organisational outcomes, including stronger staff engagement, reduced burnout and more sustainable service delivery practices (Gustavsson et al. 2023).

Despite these benefits, there is little empirical evidence on the operational and managerial challenges associated with implementing person-centred care in community-based developmental disability services. To effectively implement PCC principles, organisations must address workforce training, policy updates and service redesign (Janerka et al. 2023). Understanding these implementation processes is essential to supporting successful QI efforts.

This article presents the findings of a pilot qualitative study that investigated the experiences of staff and supported individuals during CLA's transition to person-centred care. The study highlights key takeaways and considerations for healthcare managers, service providers and organisational leaders looking to implement or maintain similar models of care. By examining both client and staff perspectives, the study provides practical insights into strategies for promoting change, increasing workforce engagement and improving care quality in developmental disability services.

Methods

This pilot study employed a qualitative design to explore lived experiences during CLA’s shift to person-centred care. Semi-structured interviews were conducted with staff (n=9) and supported individuals (n=3), purposefully recruited for their long-term involvement in the organisation and their capacity to reflect on practice before and after the key changes. All participants provided informed consent before the interview, with supported individuals participating only with care-team approval.

Interviews examined organisational changes, evolving staff roles, support planning and how new practices affected daily life and autonomy. All interviews were audio-recorded, transcribed and anonymised, with participants informed that their unique experiences might still be recognisable. Participation was voluntary, with the option to withdraw at any time. Pseudonyms are used throughout to maintain confidentiality. Ethics approval was granted by the Algoma University Research Ethics Board (REB CODE 03_202324).

Data were analysed using a modified Grounded Theory approach (Charmaz 2006) to identify operational and experiential patterns related to CLA’s transition to person-centred care. Coding was iterative and comparative, with insights from supported individuals used to corroborate and enrich staff perspectives. Given the pilot scope, analysis remained exploratory, and triangulation across participant groups enhanced the credibility and practical relevance of the findings for organisational learning and service improvement.

Findings

Early Feelings and Practices

Early care practices at CLA were rooted in a more traditional, behaviour-focused approach, according to many staff members. At the time, physical and chemical restraints were commonly used to manage behaviours, with staff reporting as many as four or five restraints per shift. A staff member shared an example of restraints used:

“3 person restraints and somebody in an exclusionary timeout room with steel doors and 3 quarter inch plywood and it took 3 of us to help this person get into that room.”  (Alex)

Before the implementation of person-centred care, staff followed a more standardised approach to care, often without questioning its effectiveness or the impact it had on the individuals they supported. The use of restrictive measures, such as isolation rooms, and the focus on controlling behaviours were seen as normal practices, as staff adhered to behaviour support plans prescribed by doctors and psychologists. Many staff members recognised that their approach was based on what was considered best practice at the time. They had followed established protocols without questioning their effectiveness:

"We accepted things for the way they were ... we never questioned it. We just did what we were trained to do."(Cameron)

The staff members recalled having to adhere strictly to institutional routines, which often took precedence over the unique needs of the individuals they supported. One staff member reflected on this experience, explaining: 

"It was sort of like we had this routine that we wanted to follow ... not their personal day." (Sam)

Day programmes, where many individuals spent their time, were described by staff as being segregated and primarily designed for convenience rather than engagement. This led to situations where many people attended programmes they did not genuinely want to be part of. It became evident that supported individuals had minimal autonomy over their daily activities. This lack of choice was further illustrated when a supported individual recounted their experience of living in a group home:

“I had to sign a consent form to let the home know where I’m going to.”(Jamie)

Reflecting on past practices, staff members expressed disbelief and regret. One staff member conveyed their incredulity, mentioning that they couldn't believe the kinds of things they did in the past. Another staff member shared the challenges faced by both employees and the individuals they supported:

"I have to say it was brutal for us as well as for the people supported. It wasn't a good working environment."(Morgan)

Transition Experiences

The shift to individualised, person-centred support was initially met with fear and uncertainty from both staff and families. A staff member shared:

“When we first started talking about change... there was a lot of fear. Maybe fear with families, fear with staff, you know, are people going to be safe?” (Alex).

Over time, empowering individuals to build independence gained acceptance. For example, a young person learning to take public transit gradually earned family trust through positive community experiences.

As staff began listening more to the individuals they supported, the transition gained momentum. One young person, previously under 24-hour supervision and exhibiting significant aggression due to restricted independence, experienced a decrease in outbursts after staff shifted control over medication and finances back to them. A staff member reflected on the importance of truly listening to those they support:

“We were listening to them, right? Listening to what they want. Which is how things should have been done all along. We should be listening to people. We shouldn't be deciding what is best for people because we think that's best…You learn from things and how they go.” (Alex)

New Approaches and Feelings

Staff emphasised the ongoing shift toward a person-centred approach, valuing the opinions and preferences of those they support. Rather than simply caretaking, the focus is now on enabling individuals to make their own choices and live as they wish. One staff member highlighted the importance of respecting and prioritising these choices:

"It's about learning to value the opinions and what the people we are supporting want and to remember that we're here to support them, not to babysit them."(Casey)

CLA is transitioning away from being a landlord by offloading group homes and relocating individuals to community-based housing. This approach allows individuals to choose their living arrangements. A staff member noted the increased flexibility and personal choice that comes with this change, including adjusting support staff to better meet individual needs:

"We have the flexibility to move the staff around, which is nice. So, in essence, it affords the person an opportunity to choose who their supports are, if it’s not working.” (Jordan)

One individual receiving support, who used to live in a group home and described it as feeling like a jail, shared their appreciation for the opportunity to live independently:

“I'm in a good place … I live in my own house and I’m renting from a landlord. I have one bedroom and one office and there’s a kitchen, dining room and living space upstairs and then the bathroom is off of the kitchen.”(Avery)

A key aspect of the new approach is viewing all behaviours as forms of communication. Rather than using restraints, staff interpret behaviours to understand underlying needs and messages, demonstrating a commitment to truly understanding the individuals they support. One staff member reflected on this approach:

"We still believe in the premise that all behaviours are about some form of communication ... we just have to keep digging deeper and deeper and not giving up."(Taylor)

The agency has learned to deliver better support by moving to more individualised plans. This involves planning with people, one person at a time, considering their interests and preferences, and providing support when and where it is needed. One staff member described this shift:

"When we move to more individualised supports, we planned with people one person at a time; what things are they interested in? What do they want to do? How do they want their day to look?"(Alex)

Additionally, this new approach allows individuals to have more control over their schedules and activities. They are not limited to a strict 8 to 4 support schedule but can receive support when it is most beneficial for them, including evenings and weekends. Another staff member explained:

"They didn't have to have support from 8 to 4 … they could have support in the evening, they could have support on the weekends, when is it that you want support and need support and what do you need. Some people didn't need to be supported and supervised 8 hours a day."(Alex)

These approaches enhanced individualised support, giving people greater autonomy and involvement in daily life. Staff shared that the journey towards these new approaches has involved a shift in mindset and continuous learning. They highlighted the importance of seeing the positive changes in individuals as they are given more autonomy and independence.

Pandemic and Staffing Challenges

The COVID-19 pandemic disrupted CLA’s progress toward person-centred care, shifting focus from individualised support to immediate needs. High turnover and new hires, while bringing fresh perspectives, challenged consistency in established practices. Staff noted that rebuilding a personalised approach was delayed, and connections with those they supported were weakened. One staff member expressed concern:

"The connection piece is what's missing now … they're so worried about covering overtime that they're training them [new hires] at like nine locations. And they're not really connecting with the people we support." (Riley)

Many new hires joined during or after the pandemic, altering how staff approached their work. Staff emphasised the need to rebuild connections and restore a more personalised approach in supporting individuals.

Community Engagement and Family Involvement 

Findings suggest that community engagement and family involvement are central to creating a supportive future for individuals with disabilities and enhancing the person-centred care approach. Ensuring safety while promoting independence is a key concern. Staff recognise that individuals can thrive when integrated into their communities with appropriate support systems. As one staff member explained:

"It’s important that people are safe...we try to protect them...but I think as we've gone along and seen that people can be successful, it does help open people up."(Alex)

Staff members strongly believe that community acceptance plays a crucial role in easing individuals into the community and allowing them to succeed. A welcoming and inclusive environment helps individuals with disabilities feel more integrated and supported, which is essential for promoting person-centred care. CLA staff work hard to ensure that individuals feel included and part of their community. This effort was recognised by a supported individual:

"The way they [staff] help people see us is that we're not on the outside of the community, like people being supported. They help people see it as, 'oh, they're just amazing.' I’m someone else living in society … They don't know that they’re staff unless you say to the other person, 'Yes, this is my staff, and I'm being supported.'" (Avery)

Looking ahead, there is a desire for CLA to continue supporting individuals in building natural support systems and meaningful community connections, reducing reliance on professional caregiving alone. As one staff member shared:

"I'd love to see people more connected to their community. They need to have natural support, staff can’t be it … when staff walk away, they have nobody. It’s a community issue … the community needs to be accepting of everybody"(Alex)

Family involvement is also highlighted as a cornerstone of person-centred care. Emphasising that family should remain a constant source of support ensures continuity and emotional support for individuals. One staff member stressed the importance of early engagement and support for families, highlighting how proactive efforts can strengthen bonds and provide stability:

"I would probably like to see the engagement at a younger level. Supporting families at a younger level, supporting families in the home in the moment, not waiting, for being proactive at an early stage, enable stability… it strengthens families, it keeps families together."(Taylor)

Discussion

Reframing Care Around the Client Experience

The transition to person-centred care at CLA fundamentally shifted the organisation from routine-driven, behaviour-focused practices toward an approach grounded in the lived experiences of the people supported. Staff described how supports were redesigned to align with each person’s preferences, histories, communication styles and daily rhythms, an approach that contrasted sharply with the earlier era of rigid routines, segregation and widespread use of restraints. This aligns with recent PCC scholarship emphasising that high-quality care depends on preserving selfhood, autonomy and relational continuity (Tieu & Matthews 2023). As staff moved away from standardised plans and began listening more deeply to individuals, care interactions became more predictable, emotionally safe and responsive.

A key component of this reframing involved reinterpreting behaviour as communication. Rather than using control-oriented strategies, staff sought to understand what unmet needs or frustrations were being expressed. This shift increased clients’ influence over their support arrangements and expanded opportunities for self-determination. The organisation also learned to privilege flexibility over uniformity. Staff were encouraged to modify schedules, adjust staffing and reshape routines based on what each individual needed on a given day. These operational adaptations, which were largely absent in earlier models, helped create conditions for independence and stability.

From an organisational standpoint, reframing care required structural adjustments such as flexible staffing, decentralised decision-making and increased discretion at the frontline. These adaptations made it possible for staff to act on their relational knowledge and tailor supports in real time. In this sense, CLA’s model resembles precision care: interventions are shaped around a person’s unique circumstances rather than imposed as universal protocols. In a field facing complex challenges, significant support demands and workforce constraints, this approach provides a feasible, long-term strategy to reduce crises and promote better outcomes for clients

Organisational Change Requires Both Top-Down Direction and Bottom-Up Insight

The findings show that CLA’s transition to person-centred care depended on coordinated action from both leadership and frontline staff. Leadership provided top-down direction by articulating a clear vision for change, supporting measured risk-taking and creating structures, such as phased implementation, flexible scheduling and housing transitions, that allowed staff to experiment with new approaches safely. These actions were critical in reducing early fear among staff and families, who initially questioned whether greater autonomy could be implemented safely. Similar concerns are well documented in organisational change research, which notes that transitions affecting roles, routines or power structures often generate anxiety, resistance and doubts about accountability (Khaw et al. 2022). The pandemic experiences reported by staff illustrate that PCC is vulnerable to operational pressures, and recovery requires intentional efforts to rebuild connections and reinforce PCC practices, potentially requiring management to retrain and support staff.

At the same time, the successful implementation of PCC relied heavily on bottom-up expertise. Frontline staff used detailed knowledge of individuals to reframe behaviours as communication, co-create support plans and adjust routines to meet personal preferences. Staff highlighted that planning with individuals often involved choices about activities, support staff and living arrangements, emphasising collaboration rather than unilateral decision-making. This type of work demands considerable emotional and cognitive effort, attention, patience and careful observation to interpret signals accurately and respond appropriately. These practices transformed organisational mandates into meaningful, workable support, demonstrating that sustainable change depends on the insights, judgment and dedication of those closest to day-to-day care.

The findings make clear that person-centred care at CLA is shaped not only by organisational practices but also by the broader environments in which people live. Leadership provided direction and frontline staff operationalised PCC, yet families and community acceptance influenced how confidently individuals embraced increased autonomy. Staff noted that while community support strengthened trust in the model, they emphasised the need for greater family engagement and additional natural supports, as many individuals remained highly reliant on paid staff. Sustaining PCC therefore, required alignment between leadership, frontline practice and the social networks that enable belonging, independence and meaningful participation in community life (Tomaselli et al. 2020).

Quality-of-Care Outcomes

The findings show that CLA’s transition to person-centred care produced clear and observable improvements in individuals’ quality of life, independence and overall stability. Participants described how increased control over living arrangements, daily schedules and personal decisions allowed supported individuals to experience a stronger sense of ownership over their lives. Moving from group homes to independent or community-based settings enabled people to shape their routines in ways that reflected their preferences rather than organisational expectations. For many, this shift translated into greater pride, satisfaction and confidence in managing their day-to-day lives.

A notable outcome was increased emotional stability and a marked reduction in crisis-driven incidents. Staff reported that individuals who once experienced frequent outbursts or frustration became calmer and more regulated as they gained more influence over their environment and choices. Changes such as having input into finances, medication routines or support timing reduced previously overwhelming triggers. These improvements reflect how autonomy and trust can directly contribute to safety and stability.

The shift also enhanced people’s sense of belonging and connection. Individuals spoke about feeling seen and valued in ways they had not experienced under earlier service models. Staff similarly observed that people participated more actively in activities, community outings and relationships once they felt respected and included. Community acceptance played an important role in reinforcing these gains; when neighbours, service providers or local businesses treated individuals as full community members, people expressed greater confidence and comfort navigating public spaces.

Staff also described feeling less emotionally exhausted as the model evolved. Greater alignment between their professional values and daily practice reduced moral distress and contributed to lower burnout, an organisational benefit widely recognised in quality improvement literature (Edvardsson et al. 2011; Gustavsson et al. 2023).

Limitations and Future Research

As a pilot study, the qualitative design and modest sample size limit transferability. Perspectives from a single organisation may not reflect the experiences of other agencies with different cultures, resources or regulatory environments. The study primarily captured staff views, with fewer contributions from families or community partners; future research should incorporate these perspectives to enrich understanding of system-level dynamics.

Longitudinal studies examining implementation fidelity, organisational efficiency, staff retention, client quality of life and cost implications would strengthen the evidence base for PCC in developmental disability services. Comparative research across multiple organisations would also help identify which management practices most effectively support sustainable change.

Conclusion

The CLA pilot demonstrates that person-centred care can generate measurable improvements in service quality, including increased independence, reduced behavioural incidents and stronger emotional and social well-being. These outcomes were enabled through targeted quality-improvement strategies such as flexible staffing deployment, streamlined individualised support planning and strengthened collaboration with families and community partners. Allowing staff to respond to client needs in real time and embedding autonomy into daily routines enhanced both client experience and workforce engagement.

Importantly, the findings show that successful PCC implementation is not achieved through philosophy alone. Sustainable improvement requires deliberate alignment between leadership priorities, frontline workflows and organisational processes. This pilot offers actionable insights for managers, highlighting how operational redesign, data-informed decision-making and relational practices can directly support safer, more responsive and more empowering models of care within community-based developmental disability services.

Conflict of Interest

There were pre-existing relationships between some members of the research team who conducted interviews and the interviewees. This was essential to the nature of the study, as we believed that supported individuals would be more open with members of their care team than they would have been with a stranger. It was made explicit that nothing they shared would affect their current or future care plans.