Reducing tokenism in patient and public involvement by integrating the Gothenburg person-centred care framework, relational bridges and impact log – a co-produced position paper

Abstract

Background

Patient and public involvement (PPI) is widely promoted in health research, care services and governance. It is increasingly framed as a matter of rights, dignity and accountability. Despite strong policy support, PPI remains conceptually diverse, unevenly implemented and persistently vulnerable to tokenism, with PPI contributors often reporting unclear influence and weak feedback. Recent literature has highlighted the need for stronger ethical anchoring of PPI beyond standards, frameworks and reporting requirements.

Main argument

This position paper explores how tokenism in PPI can be reduced by adapting established steps from the Gothenburg person-centred care (PCC) framework, grounded in Paul Ricœur’s “little ethics”, to involvement practices beyond the clinical encounter. We propose person-centred PPI (PC-PPI) as a practice-oriented approach comprising three core collaborative steps: (1) Initiating the partnership through shared narrative, (2) Working the partnership through explicit negotiation of decision rights, and (3) Safeguarding the partnership through documentation and follow-up, as well as three organisational readiness domains that function as ethical minimum requirements for reflective self-assessment for all involved.

Contribution

PC-PPI shifts the focus from general levels of influence to specifying and documenting meaningful decision rights for concrete activities, supported by practical tools such as a relational bridge framework and an impact log. The feedback loop supports contributor empowerment during the involvement process by making influence visible, explainable and contestable over time. Organisational readiness domains further clarify that PC-PPI cannot rely on willingness alone, but requires sustained ethical, structural and accountability support.

Implications

By translating person-centred ethics into concrete steps and organisational practices, PC-PPI offers a pragmatic way to reduce tokenism while remaining adaptable to context, resources and ongoing learning. The approach has implications for professionals, organisations, and policymakers seeking to move from formal PPI requirements towards auditable, ethically grounded partnership practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40900-026-00920-6.

Plain language summary

Why this paper?

Service users, patients, carers, and community representatives can actively contribute to healthcare improvement and research. This is also called patient and public involvement (PPI). However, PPI is not always experienced as meaningful. People may be invited too late. They may have little influence. They may also receive little or no feedback about how their input was used. This can be discouraging.

What we did:

We explored how PPI could be done in a more transparent way. We drew on ideas from person-centred care (PCC), where similar ethical challenges have been addressed. We adapted these ideas to PPI and call this approach person-centred PPI (PC-PPI).

What we propose:

PC-PPI has three practical steps:

1. Listening carefully to develop a shared understanding of what is most important,

2. Negotiating decision rights for each activity,

3. Documenting how input is used and feeding this back over time.

We also describe three areas where organisations need to be ready. This includes support for both PPI contributors and professionals, e.g. through preparation or skills training. Organisations need routines for fair and accessible participation. They also need clear systems for accountability.

Why this matters:

PC-PPI aims for partnership. It does not promise that every suggestion will be adopted. Instead, it commits to transparent processes that make involvement clear, fair and visible. PPI contributors can see how they made a difference. Organisations can demonstrate transparent decision-making through documentation and follow-up. We hope this approach helps reduce tokenism, strengthens trust and supports more meaningful partnerships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40900-026-00920-6.

Background

Patient and public involvement (PPI) has become a central expectation in health and social care research and policy across many jurisdictions. It is promoted as a means to enhance democratic legitimacy, improve the relevance and quality of research and services, and support people’s rights to influence decisions that affect their health and everyday lives. International policy and ethical frameworks emphasise that people with lived experiences should be actively engaged in shaping health services and research [1–3]. In this article, we use the term PPI contributors while recognising that people may identify in different ways, including as patients, survivors, carers, health service users, consumers, advocates, community representatives, or members of the public.

Despite strong policy support, PPI often remains tokenistic [4, 5]. Tokenism in PPI refers to the formal inclusion of patients, family carers or public representatives in activities without granting them real influence to shape decisions, thereby using PPI to signal legitimacy (e.g., to satisfy funder expectations) rather than to genuinely share power [4, 5]. Whether arising from structural constraints or from forms of involvement lacking genuine opportunities for influence, the practical consequences for contributors are similar: late invitations, unclear roles and decision rights, limited influence, and weak feedback mechanisms [6, 7].

PPI has become a very broad field spanning over a variety of settings and contexts. Recent syntheses consistently show that PPI remains conceptually diverse, unevenly implemented and reported with substantial variation in terminology, rationales and outcome measures [8–11]. As a result, cumulative learning remains difficult about what counts as “good” involvement and how impact should be understood [9, 10, 12]. PPI literature has further highlighted a lack of explicit ethical anchoring in existing standards and frameworks, alongside persistent uncertainty in practice about the ethical responsibilities associated with involvement [13, 14]. While levels or principles of involvement have been frequently described, they have been less successful in specifying how influence should be made visible, negotiated and fed back [8, 9, 12].

In parallel, person-centredness has developed as a complementary paradigm in clinical practice, grounded in ethics, evidence-based practice, and an action-oriented ethics by Paul Ricœur where responsibility is realised in what we actually do together in everyday care [15, 16]. The Gothenburg framework [17, 18] conceptualises person-centred care (PCC) and partnership through three integrated core steps: (1) listening to the person’s narrative to initiate a partnership; (2) co-creating goals and plans to implement the partnership; and (3) documenting to enable follow-up and to safeguard the partnership. The framework has been operationalised across multiple clinical settings and is increasingly reflected in clinical guidelines and regulation [19–21].

Yet the relationship between PCC and PPI remains under-theorised [22]. While both discourses emphasise recognition of lived experience, participation, voice, and redistributing influence in relationships characterized by asymmetry, they have largely evolved in parallel. PPI is often organised as a separate activity, typically at project or committee level, without explicit grounding in the ethics of personhood that underpin PCC. Conversely, PCC initiatives may focus on the clinical encounter without systematically involving citizens and communities in wider service design and governance. As a result, there is a risk that organisational and policy-level involvement structures do not reflect the same ethical commitments promoted in clinical practice.

The Gothenburg framework reduces the risk of tokenism by embedding patient involvement in concrete clinical practices. The linkage between active listening to develop a shared understanding, co-creating goals and plans, and documenting decisions for follow-up limits opportunities for symbolic participation without influence.

This position paper builds on these insights to reflect on how similar ethical commitments can be applied to patient involvement beyond the clinical encounter. We draw on the Gothenburg framework and Paul Ricœur’s “little ethics” to propose person-centred PPI (PC-PPI) as a practice-oriented heuristic that makes influence, decision rights and feedback visible and accountable over time.

How this position paper was developed

This article was co-developed through a reflexive, collaborative process involving researchers at the University of Gothenburg Centre for Person-Centred Care (GPCC) and a patient lead author (JB). The author team brings together experiential and disciplinary perspectives, including lived experience of illness and caring, patient organisation leadership, and long-standing research and implementation work in person-centred care. The writing process included iterative discussions with former and current patient and family carer representatives from the GPCC Person Council, who are involved in a wide range of health research, care service improvement, governance, advocacy and support initiatives. Insights were also gained through GPCC’s ongoing improvement work with its Person Council, including the implementation of impact logs (led by JB), as well as through webinars and PPI literature. Additional file 1 provides an overview of key discussions, reflections and activities that informed the development of this position paper and illustrates how experiential and professional perspectives contributed to shaping this article. The GRIPP2 short form [23] is provided in additional file 2.

The purpose of this collaborative process was not to evaluate an intervention, but to articulate practice-oriented guidance grounded in lived experience and everyday challenges in PPI. The section on organisational pre-conditions for PC-PPI should be understood as a provisional synthesis of shared reflections, intended to support discussion and further development.

Ethical lens: person-centredness, just institutions and PPI

The Gothenburg framework for person-centred care is grounded in Paul Ricœur’s “little ethic” (Fig. 1): striving for “the good life, with and for others, in just institutions” [24]. This formulation is particularly relevant for PPI because it links interpersonal ethics (“with and for others”) to institutional questions of justice and power (“just institutions”).

Fig. 1.

Paul Ricœur’s “Little Ethic” illustrated in a simplified form. Ricœur formulates the ethical aim as striving for “the good life, with and for others, in just institutions.” Specific ethical actions are enacted in striving to do good even in situations of great uncertainty, while being tested against norms (rules and laws) and situated within institutions that raise questions of justice and power. Practical wisdom (phronesis) mediates between ethical aims, moral norms and concrete situations, particularly when values or obligations come into tension

Ricœur starts from the premise that every human being is a capable person, able to act, interpret, express preferences and take responsibility in relation with others. Person-centred care focuses on recognising existing capabilities and supporting their development through partnership, rather than reducing people to diagnoses or passive recipients of care. Age, illness, disability or social vulnerability may limit specific capabilities, but they do not erase personhood.

Because healthcare systems are characterised by structural asymmetries [25], patients commonly face a three-fold disadvantage: an institutional disadvantage due to their low position in hierarchical healthcare structures, an existential disadvantage due to illness and vulnerability, and a cognitive disadvantage due to limited access to technical and biomedical knowledge. These layers of disadvantage also affect PPI contributors who participate in health governance, policy or research processes, where expert-driven cultures and procedural norms often make it difficult to influence decisions and participate on equal terms. PPI therefore requires explicit attention to asymmetry, and to the practical wisdom (phronesis) needed to step outside one’s own frame of reference, recognise blind spots and build shared understanding through narratives, promises and practices that unfold within institutional contexts. Institutions are “just” not only when they distribute resources fairly, but when they recognise persons as capable contributors with system knowledge beyond experiences (as illustrated and described in detail by Dumez and L’Espérance (2024) [26]), enable their voices to be heard and create conditions for mutual recognition, solidarity and accountability over time. At the same time, just institutions must balance responsibilities not only to those directly involved, but also toward others not present in the encounter – the anonymous other. As reflections on practicing person-centred ethics have shown, this balancing of ethical conviction and institutional obligation can be challenging in practice [27].

The Gothenburg framework translates Ricœur’s ethics into concrete clinical steps that support partnership. We propose that these steps can also support ethical PPI, helping teams move beyond symbolic invitation toward shared responsibility and just institutional practices.

In the following two sections, we build on this ethical lens to outline person-centred PPI (PC-PPI) as a set of three collaborative and integrated steps (transferred from the Gothenburg framework to PPI) and three organisational readiness domains. The steps describe how PPI contributors and professionals can work together in practice, while the readiness domains specify what organisations need to put in place to make such collaboration possible and sustainable. Together, these elements reflect Ricœur’s little ethics as ethical commitments are translated into everyday ways of working that recognise people as capable contributors and make partnership and accountability visible over time.

Translating the Gothenburg framework to PPI

Translating the three integrated steps from the Gothenburg framework to PPI yields practical guidance (Fig. 2) that can be applied across a variety of contexts, e.g. health quality improvement, service design, governance, policy, and research. The steps are intended as a small set of core practices that should normally all be present, while allowing for adaptation in how they are enacted depending on context, available resources and the nature of the decisions being made.

Fig. 2.

Guidance for person-centred PPI, building on the Gothenburg PCC framework. Step 1 is to initiate the partnership through actively listening to each other as narratives unfold. The goal here is to develop shared narratives while embracing and holding the tensions between different perspectives. In step 2, the partnership is implemented by explicitly negotiating decision rights for each activity. Instead of a participation ladder, we suggest visualizing relational bridges and, if needed, define and draw in additional bridges. This allows for flexibility in practice as a negotiated bridge may depend on capabilities, culture, and opportunities to learn. In step 3, to safeguard and sustain the partnership, actions, decisions, and points raised are documented in an impact log that is used continuously for follow-up to close the feedback loop (arrows)

Step 1: Initiating the partnership through active listening

A person-centred PPI process begins with deliberate active listening and shared narrative development. PPI contributors and professionals jointly explore issues that are most important to be addressed, as well as motivations, concerns and expected contributions. This work acknowledges diverse sources of knowledge, builds a shared understanding of purpose, vocabulary and expectations, and it should also surface supports needed for meaningful and equitable participation. Co-creating the meeting agenda can be a concrete way of supporting early involvement, by allowing PPI contributors to influence what issues are prioritised and how discussions are framed from the outset.

Step 2: Working the partnership through explicit negotiation of decision rights

Within this step, all participants may share information, respond to consultation requests, make plans to get involved in activities, make decisions and/or agree on leading specific actions. This requires early and explicit clarification of decision rights and responsibilities for each activity. The relational bridges illustrated in Fig. 2 offer a simple way to articulate this in practice, as they build on established participation frameworks [28–30] and respond to previous critiques [31, 32]. For example, Wilcox (1994) emphasized that participation should be seen as a negotiated process rather than a linear hierarchy [32]. It is also important to note that more than one participation level (if not all) may be present within a single meeting, depending on activity, context and stage of process. Transparent reasoning enables PPI contributors to negotiate roles, contributions and decision rights in relation to their capabilities. The aim here is not to maximise influence in every situation, but to make influence explicit, fair and justified [33].

Step 3: Safeguarding and sustaining the partnership through documentation and follow-up

Safeguarding ensures that partnership can be maintained over time. Shared documentation in form of an impact log (illustrated in Fig. 2) anchors accountability by creating a transparent record of how consulted advice influenced decisions, which decisions were made together and/or which actions were agreed on. The impact log format suggested here builds on existing resources [34–36] and is provided as template in additional file 3. Regular follow-up maintains momentum and supports ongoing learning in real time. Ideally, communicating updates from the impact log becomes a standing agenda item for subsequent meetings. This is particularly important when involvement takes the form of consultation (Fig. 3), where the risk of tokenism is greatest [28]. This way of safeguarding also protects the integrity of the partnership if circumstances change (e.g., if people’s capacities vary or if organisations cycle through shifting pressures and priorities).

Fig. 3.

Safeguarding the partnership over time (person-centred consultation). Professionals consult PPI contributors to receive advice and insights that may then influence decisions made by professionals. Giving feedback to PPI contributors on how their advice and insights influenced decisions is essential to safeguard the partnership. PPI contributors may also approach professionals for their advice and insights on issues of interest to them. This would help creating a more balanced partnership even at the stage of pure consultation

Together, the three steps form a structured yet flexible set of guidance for integrating person-centred principles into PPI and for building trust over time. Interpersonal trust is commonly conceptualized as a willingness to be vulnerable based on expectations of another party’s benevolence, ability and integrity [37]. Initiating the partnership through shared narrative signals benevolence, as contributors see their concerns and motivations recognized. Working the partnership through clear structures and shared responsibility demonstrates ability, while safeguarding through transparent documentation and follow-up affirms integrity.

Documentation also protects PPI contributors from invisibility as their work becomes part of an auditable chain of decisions. Ongoing follow-up, reflection, and adaptation allow teams to respond to changing circumstances, enabling PPI contributors to rely on the process despite uncertainty and supporting the development of trust over time.

Pre-conditions for PC-PPI: organisational readiness domains for self-assessment

During our efforts to implement PC-PPI in practice at GPCC (see Additional file 1 for details), we have identified three interrelated organisational readiness domains so far: ethical-capability readiness, structural-material readiness, and governance-accountability readiness. While this is an ongoing learning process, we consider these domains not as aspirational ideals but ethical minimum requirements that make PC-PPI auditable, reduce the risk of harm and of reproducing existing power imbalances, regardless of good intentions. The readiness domains can be used as a basis for reflective self-assessment over time as PC-PPI is implemented incrementally while considering organisational context and available resources.

Ethical-capability readiness

(Supporting all parties to participate as capable persons)

PC-PPI requires reciprocal capability building. Preparing PPI contributors alone is insufficient. Professionals and organisations must also develop the ethical, relational, and practical capabilities needed for genuine partnership, aligning closely with existing standards and guiding frameworks for PPI, e.g. the European CEN standard for patient involvement EN 17398:2020 [38], UK standards for public involvement [39], Canadian Institute for Health Research’s guiding principles [40] and the Australian Commission on Safety and Quality in Health Care - Partnering with Consumers standard [41]. Without such reciprocity, involvement risks becoming extractive or symbolically inclusive, even where formal involvement structures are in place.

For professionals, ethical-capability readiness includes:

• Skills in narrative elicitation [42–44] and teach-back techniques [45] to establish shared understanding,

• The ability to produce and work with plain-language materials [46],

• Training in facilitation [47] and engagement with trauma-informed practices [48] – ideally before PPI activities commence, though learning may also occur throughout activities including debriefings and emotional support for staff carrying out this work,

• Explicit engagement with epistemic injustice [44,49] to ensure that experiential knowledge is recognized as credible and relevant rather than discounted or unintentionally silenced.

For PPI contributors, capability support may include:

• Training in articulating perspectives, priorities, goals and needs [5,7], for example through peer support if there is no local or context-specific training from advocacy organisations,

• Basic orientation to relevant systems (e.g. research, health services, governance), depending on the context of PPI activities and best if co-developed with the inviting institution and team.

Rather than functioning as fixed requirements, these approaches offer examples of capabilities that can support shared understanding, respectful engagement and partnership in PPI. However, where such capabilities are not supported on both sides, influence remains unequal even when formal opportunities for involvement exist. In such circumstances, PC-PPI is difficult to sustain ethically over time.

Structural-material readiness

(Reducing avoidable inequities in participation)

PC-PPI also depends on structural and material conditions that make participation possible and fair. Structural-material readiness includes:

• Funding that allows professionals to set aside protected time for PPI,

• Funding that allows for compensation and reimbursement of PPI contributors,

• Accessibility arrangements (e.g., transport, digital inclusion, flexible formats, assistance, childcare),

• Standardized administrative routines (e.g. recruitment, compensation, insurance, conflict of interest) and organisational support for professionals [50],

• Practices that prevent the reuse of narratives outside the agreed context without renewed consent (preventing story-mining and re-traumatisation).

These pre-conditions aim to help organisations reflect on whether PPI contributors can participate without incurring personal, financial or emotional costs that professionals do not bear. From a self-assessment perspective, structural-material readiness concerns whether existing organisational arrangements reduce or reproduce avoidable inequities in participation.

Governance-accountability readiness

(Making influence visible, traceable and contestable)

Finally, PC-PPI requires organisations to have arrangements in place that make partnership accountable over time and that make PPI contributors’ influence visible and traceable. Governance-accountability readiness includes:

• Scheduled reviews of progress,

• Agreed indicators of partnership quality,

• Independent routes for PPI contributors to raise concerns about tokenism or exclusion,

• Clear leadership responsibility for responding to findings.

Without such arrangements, claims about influence remain rhetorical. As a reflective fairness test, adapted from Rawls [51], organisations can ask whether the recommendations given for each readiness domain would appear reasonable if one did not know whether one would participate as a professional or as a PPI contributor and also whether one would belong to a marginalised group.

Discussion

This position paper set out to explore how tokenism in PPI can be reduced by adapting established steps from the evidence-informed Gothenburg framework, grounded in Ricœur’s “little ethics”. PC-PPI shows how ethical commitments can be translated into concrete, repeatable core practices rather than remaining aspirational. The practical knowledge and experiences of PPI contributors (including the lead patient author) were central to shaping the presented ideas while testing them in practice in the work with the GPCC person council.

Positioning PC-PPI in relation to existing PPI guidance

Existing guidance for PPI has largely focused on frameworks (often with participation levels), standards for good practice, reporting and impact evaluation [12, 23, 28–30, 36, 39–41, 52, 53]. While these contributions have improved transparency and encouraged wider adoption of PPI, they are often seen as separate elements. This paper takes the position that meaningful PPI requires a more integrated way of working with focus on the ethical and relational work needed for enacting partnership in asymmetrical settings in real time. This includes jointly specifying meaningful decision rights for each activity and documenting agreements which are then followed up and communicated back. The documentation provides a very strong basis for reporting as well as evaluation. Together with organisational readiness domains PC-PPI makes PPI more meaningful and more credible.

Tokenism as an institutional ethical failure

From the perspective of Ricœur’s “little ethics” [24], tokenism can be understood as a failure of recognition and justice. When PPI contributors are invited late, lack clarity about their influence, or receive no feedback, institutions are not treating people as capable partners [4–7]. PC-PPI addresses this by linking the ethics of the capable person directly to organisational structures. Early involvement through shared narrative, explicit negotiation of decision rights, and systematic documentation and feedback all work to reduce the space in which symbolic participation can occur unnoticed.

To clarify how striving for PC-PPI can address commonly reported features of tokenistic involvement, Table 1 contrasts characteristics of tokenistic PPI, as discussed in the literature [4–7], with striving for PC-PPI. The table is intended as an interpretive synthesis rather than an empirical comparison.

Table 1.

Characteristics of tokenistic PPI versus striving for person-centred PPI

Characteristics of tokenistic PPI	Striving for person-centred PPI
Late or reactive invitation	Earlier involvement (before decisions and actions)
Agenda set by professionals	Influence on or co-creating the agenda to shape priorities
Unclear decision rights	Negotiating decision rights and making them explicit
Influence assumed or overstated	Influence becomes more transparent, justified and contestable
No feedback after meeting	Impact is documented and systematically followed up
Reliance on willingness	Organisational routines and accountability

The impact log as an empowerment-enabling practice

A distinctive contribution of PC-PPI is the use of an impact log as a routine element of partnership rather than as a retrospective evaluation tool. Many existing PPI impact assessment tools and frameworks focus on documenting outcomes, often primarily for organisations, funders or academic audiences [12, 23, 36]. While valuable for learning and reporting, such approaches do not necessarily support empowerment during the involvement process itself.

The impact log differs in that it functions as a shared, forward-facing record that makes influence visible to PPI contributors as decisions unfold. By documenting how input is considered, taken up, adapted or not acted upon, and by feeding this back, contributors gain insight into how their participation shapes decisions and why certain recommendations do not translate into action. From an empowerment perspective, this visibility is ethically significant [6, 7]: influence becomes explainable rather than symbolic, and disagreement or non-uptake is depersonalised and open to discussion rather than experienced as disregard. In this way, the impact log operationalises ethical commitments to recognition and accountability by making influence transparent, traceable and contestable in practice.

Scaling PPI

PC-PPI also has implications for how PPI is scaled. Scaling is often framed as a quantitative challenge: how to involve more people, in more processes, more often. Drawing on Ricœur’s focus on institutions as sites of justice [24], this position paper suggests reframing scalability as an institutional challenge: how practices of recognition, negotiation and accountability can be embedded in organisational routines without losing their ethical content in practice.

In PC-PPI, the legal framework (e.g., rules on consent, confidentiality, documentation, patient rights and organisational duties) functions as a minimum, enforceable baseline: it defines responsibilities, safeguards, and procedural requirements for involvement. Ricœur’s action ethics adds a complementary yet fundamental ethical layer: it asks not only what is permitted, but what is right to do in the concrete situation, guided by the ethical intention to strive for “the good life, with and for others, in just institutions.” In practice, law can secure formal participation, while person-centredness demands relational quality: recognition, mutual responsibility, and prudent judgement when values conflict or when rules are silent. The productive tension is that law limits arbitrariness and protects rights, while action ethics prevents involvement from becoming merely procedural or tokenistic by insisting on accountable, respectful partnership in practice.

Standardised advisory structures, national panels or digital participation platforms may increase reach, but risk reproducing tokenistic patterns if ethical commitments are not operationalised and supported by organisational readiness. The collaborative steps and readiness domains proposed here offer a heuristic for this balancing act. They specify what needs to be stable and auditable (e.g. early involvement, negotiated influence, documented feedback) while leaving room for contextual interpretation, learning and adaptation.

Organisational readiness and ethical minimums

A key contribution of PC-PPI is the articulation of organisational readiness domains as ethical minimum requirements for reflective self-assessment rather than aspirational ideals. Organisations can introduce PC-PPI incrementally, assess where ethical risks remain, and prioritise improvements without claiming credibility prematurely. Framing it as ongoing learning is particularly important in resource-constrained settings, where the absence of structural or governance support can otherwise place disproportionate burdens on PPI contributors.

Scope and limitations

PC-PPI focuses on how involvement is enacted and governed rather than on who is involved. Questions of representativeness, diversity and inclusion are crucial but require additional strategies beyond the scope of this article. Similarly, PC-PPI is offered as practice-oriented guidance rather than as a validated intervention. Further empirical work is needed to examine how the collaborative steps and readiness domains function across contexts and to explore their effects on PPI contributor experience, decision-making and organisational learning.

Implications for practice and policy

For professionals, PC-PPI offers concrete entry points for strengthening involvement, even in everyday activities such as agenda setting, role clarification and follow-up communication. For organisations and funders, it provides a way to move beyond formal PPI requirements towards auditable, ethically grounded practice. For policymakers, the model suggests that meaningful involvement cannot be mandated solely through standards or reporting requirements, but depends on sustained investment in organisational capability, documentation and accountability.

In conclusion, PC-PPI reframes PPI as an institutional ethical practice rather than a procedural add-on. By translating person-centred ethics into concrete steps and organisational readiness domains, it offers a pragmatic way to increase transparency and reduce tokenism, while remaining adaptable to context, resources and ongoing learning.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

PPI

Patient and Public Involvement

PCC

Person-Centred Care

PC-PPI

Person-Centred Patient and Public Involvement

GPCC

Gothenburg University Centre for Person-Centred Care

Author contributions

Conceptualisation: JB (lead), AW (supporting), JÖ (supporting), IE (supporting), Methodology / Approach development: JB (equal), SW (equal), HG (supporting), AW (supporting), Investigation / Practice-based exploration: JB (lead), JÖ (supporting), AW (supporting), HG (supporting), IB (supporting), EF (supporting), SW (supporting), IE (supporting), Resources: AW (lead), Visualisation: JB (lead), SW (supporting), AW (supporting), JÖ (supporting), HG (supporting), IB (supporting), EF (supporting), IE (supporting), Writing – Original Draft: JB (lead), Writing – Review & Editing: JB (equal), SW (equal), HG (equal), AW (supporting), JÖ (supporting), EF (supporting), IB (supporting), IE (supporting), Supervision: AW (lead), JÖ (supporting), IE (supporting), Guarantor: JB (equal), AW (equal).

Funding

This work was funded by the University of Gothenburg Centre for Person-Centred Care.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

N.A.

Consent for publication

All authors reviewed and approved the final manuscript.

Competing interests

The authors declare no competing interests.