Understanding values-based practice to achieve positive outcomes for patients
04 July 2024 (Last updated: 4 Jul 2024 13:55)
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Professor Ashok Handa is a vascular surgeon and director of teaching in surgery at the University of Oxford. He is also Director of the Collaborating Centre for Values-based Practice in Health and Social Care, a centre that brings together people and organisations working in values-based practice to develop the practice through shared learning.
The centre was founded a decade ago after Ashok met Bill Fullford (a philosopher and psychiatrist), learned about values-based practice and adopted it in his own clinical practice. Today it facilitates collaborations and works to develop more effective ways of working with values in health and social care.
In alignment with the BAOMS annual conference theme of ‘The Patients' Voice’, his afternoon keynote at the BAOMS annual conference underlined without taking the time to discuss a patient’s values or by assuming that they would like a particular outcome, we can let them down.
Ashok started with an exercise to remind the audience that we all make assumptions in everyday life, asking us to each write three words that feed into values and then share these with the person next to us. The range of responses revealed how different people will come up with different answers to the same question. In some cases people had interpreted the exercise differently, giving their own values while others wrote what they think values are.
Ashok says: “So many of our decisions are based on our exclusive values and our value culture, yet we often make assumptions that people think like us. Values are heterogeneous and as medics we have to be aware that people may make decisions that are alien to us because their values or value system is different.”
He continues: “When presenting options to a patient, they may ask me what I would do because they assume that I know best. In these situations, I tell them that in this room I am an expert in vascular surgery, they are the expert on them, and we need both of us to make a decision that is best for them, given their values, circumstances and needs.”
Ashok proceeded to ask people to imagine themselves in a patient’s shoes and choose between two treatment options. Years of asking groups of people this question have demonstrated there is a trimodal ‘normal’ distribution of answers, and the pattern of distribution persists with small and large audiences. More importantly it elucidates that given the same evidence, different people will make different choices.
One case study during his presentation stood out as a clear example of values based practice: a woman with severe knee pain and arthritis presents to a medic who assumes she would like to be relieved of pain and proposes a total knee replacement. During discussion, the medic realises that her priority is gardening and shares that with the surgery she would not necessarily be able to kneel and garden so together they agree on a course of physiotherapy and anti-inflammatory medication which leaves her able to continue with her passion while managing her condition.
Ashok concluded by underlining that listening to what matters to patients alongside using the evidence base for options available gives a higher chance of achieving an outcome that a patient is happy with.
He says: “Until ten years ago I thought I was doing a good job, but then I discovered values based practice. Now I have learned more and combined values-based with evidence-based practice, and I believe this is delivering better outcomes for patients. It is true that I take longer in my clinics than any of my colleagues, but I don’t spend my evenings and weekends responding to complaints.”
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