An introduction to values based practice ATBH September 2016 Oxford

Transcription

1 An introduction to values based practice ATBH September 2016 Oxford Bill Fulford, Ashok Handa and Ed Peile Ashok Collaborating Centre for Values-based Practice St Catherine s College, OxfordWednesday 25 th November 2015

2 Outline 1. Values and values-based practice 2. Values-based surgical care 3. Education in values-based practice 4. Summary

3 Outline 1. Values and values-based practice 2. Values-based surgical care 3. Education in values-based practice 4. Summary

4 First Exercise - what are values? 1. Write down three words (or very short phrases) that mean values to you 2. Then compare with your neighbour

5 Principles Needs Wishes Preferences Hopes Ambitions Concerns Virtues Etc! What are Values?

6 What are Values? Values are individually diverse

7 Resources for working with values Ethics Medical humanities Decision analysis Health economics Etc

8 Values-Based Practice adds to these.. a process that supports balanced decision making on diverse values within frameworks of shared values

9 David Sackett s definition of evidencebased medicine the integration of ~best evidence ~clinical experience ~patient values

10 By patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.

11 Outline 1. Values and values-based practice 2. Values-based surgical care 3. Education in values-based practice 4. Summary

12 Surgery of Old School Dress Behaviour Patronage etc 12

13 Pitfalls

14 What surgery is about: every man should know his limitations

15 What surgery is NOT about: feeling lucky today punk?

16 Background Bill Fulford and meeting at St Catherine s College Reflection on surgical practice 3 categories of decisions in clinic/ward/emergency department Plans for surgical seminar series

17 Surgical seminars 7 seminars to date Content of 3 word and forced choice exercises Case based discussions Inter-professional teams Patients and patient groups actively involved

18 Surgical seminar outcomes Feedback very positive Teams keen to have follow up seminars Other follow ups Seminars for Trainees in School of Surgery HETV Educators forum Dec 2015 Embedded in Oxford UG curriculum further speciality seminars in 2016 Online seminar learning materials Specialist Nurse seminars (Midwives, Nurse prescribers, Macmillan) Association of Radiography Educators Pharmacists Physicians Assistants

19 How VBP has changed my practice

20 How VBP has changed my practice What would you do doctor? Pre-VBP: answer based on my values

21 How VBP has changed my practice What would you do doctor? Pre-VBP: answer based on my values What s important to you? Post-VBP: answer based on patient s values

22 Outline 1. Values and values-based practice 2. Values-based surgical care 3. Education in values-based practice 4. Summary

23 Where does V-BP fit in the curriculum? Communication Skills IPL Clinical Skills Medical Professionalism Ethics & Law Science

24 Interprofessional Collaboration The process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients clients, families and communities to enable optimal health outcomes. Elements of collaboration include respect, trust, shared decision-making, and partnerships Canadian Interprofessional Health Collaborative.

25 Requirements for effective teams Clear team goals Shared team commitment Role clarity Interdependence Integration between team members A necessary attribute is an understanding of values, knowledge and skills of team members Reeves et al (2010)

26 Competency-based model Common Complementary Collaborative Barr (1998)

27 Norms and values Collaboration involves shared norms (Thompson 2009) Norms are the rules of behaviour arising from the ideology of the team members which reflects their values. Normal behaviour is right and proper: Abnormal behaviour is inappropriate. (Thistlethwaite 2012)

28 V-BP helping patients Individually and collectively More altruistic healthcare More of a voice in healthcare planning and policy Balanced decision-making more likely to have better outcomes.

29 The lights of creative altruism in healthcare

30 The two-feet principle The best clinical decisions are based both on the best available scientific evidence and on the values relevant to the individual patient situation

31 Evidence and values in obstetrics Healthcare providers have the responsibility to ensure the safest, most cost-effective method of delivery for women and babies accepting that very occasionally women will request an elective c-section in the absence of conventional obstetric indications. RCOG October 2011

32 Values aware Not everyone thinks like I do. Values communicate I won t find out about other people s values unless I explore this sensitively

33 Modelling Communication: ICE StAR Ideas Concerns Expectations Strengths Aspirations Resources

34 Conclusions from Weston Project Research Case History discussions are effective for multidisciplinary team learning, focusing discussion on the common concern: patients

35 Consensus and Dissensus Ways of coping with difference. Consensus: reach an agreed position: a basis for subsequent decision making across all relevant cases. Appropriate for E-BP Dissensus: more than just agreeing to disagree. In values-based decision making, values are not dropped or excluded but remain in play to be balanced sometimes one way and sometimes in other ways in different situations. This is dissensus.

36 Outline 1. Values and values-based practice 2. Values-based surgical care 3. Education in values-based practice 4. Summary

37 V-BP Starting point: A MUTUAL RESPECT FOR THE DIVERSITY OF VALUES Objective: BALANCED DECISION-MAKING WITHIN A SHARED FRAMEWORK OF VALUES

38 Teaching and Learning V-BP Way forward when values are complex /conflicting. PATIENT - CLINICIAN - ORGANISATION/SOCIETY Appreciating diversity of values Developing awareness -what matters to patients? Increasing effectiveness of communication Developing clinical reasoning skills Clinical decisions based on values and evidence Learning with colleagues :Consensus & Dissensus

39 To learn more about V-BP processes, come to the Friday afternoon workshop!

40 Collaborating Centre valuesbasedpractice.org