It’s all about the conversation!

By Suzanne Traynor @Traynors
Associate Professor Mental Health (Practice) at Middlesex University & My Care Academy.

A recent symposium ‘Keep Us Safe’ was held by Camden and Islington NHS Foundation Trust and Barnet, Enfield and Haringey NHS Mental Health Trust. Although the focus was on staff safety we reflected on patient and staff safety throughout the day. #KeepUsSafe18

Having presented a session on Values-Based Practice (VBP), the themes of this framework resonated in conversations that were taking place in the workshop sessions throughout the day.

What is Values-Based Practice?

“The theory and skills of effective healthcare decision making where different (and hence sometimes conflicting) values are in play.”  (Woodbridge & Fulford, 2003)

The point of VBP is to support balanced decision making within a framework of shared values. However, shared values are not something we can assume will ‘happen’ within our care of service users unless we consciously consider the different elements against our own values as well as fully understanding the values of others.

Values-based practice can be divided into the following elements:

• Clinical skills
• Values and evidence
• Professional relationships
• Partnerships
  

The Clinical skills element reminds us of the need to reflect on our own values as individuals and teams and the framework prompts us when working with service users as to what values are being discussed – the teams or the service user? Within this element we also consider:

• Awareness of values as well as diversity of values
• Reasoning about values as well as widening our values horizons
• Knowledge of values which includes knowledge gained by experience as well as research
• Communication skills including the skills needed to identify and understand the values of service users.

Values and evidence, and the link to evidence-based practice are defined by three principles. All decisions will be made with consideration to evidence-based practice and values-based evidence – the two feet principles. “Think values, think facts”. The ‘squeaky wheel’ principle occurs when we notice values that we have not considered or understood.

Professional relationships in VBP involves person-values-centred practice and needs to include the extended multidisciplinary team. This means practicing in a way that focuses on the values of the service user and takes into consideration the different values of the team as well as acknowledging conflicting values.

Partnerships in decision making will acknowledge consensus of values within a shared framework but also dissensus when differences of values are in play when clinical decisions are being made.

One of the elements that resonated for me was the need for all staff to be confident and competent in having conversations with service users. On one level this seems so obvious but within the context of VBP its importance is elevated as these ‘conversations ‘are the basis to ensuring that the voice and values of the service user are heard and considered as part of the conversations regarding their care.

You may find it helpful to reflect on your own values as well as your team values.

Action: During your next team handover or case review, listen carefully and reflect on the following:

• Are the values of the service user being considered within the narrative?
• Are you hearing the service users’ values?
• Do you know what the service users’ values are?
• Whose values are being expressed – certain team members?
  

“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 service the patient”. (Fulford 2008)

If you would like to know more about Values-Based Practice the following would be a good starting point:

Fulford, K.W.M. (2008) Values-Based Practice: A New Partner to Evidence-Based Practice and a First for Psychiatry?  Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190543/

Gask, L. (2018) Patching the soul, Blog, Accessed on 3/11/18 at: https://lindagask.com/2017/10/15/talking-values/

Morgan, A., Felton, A. Fulford, B., Kalathil, J., Stacey, G. (2016) Values and ethics in mental health. London: Macmillan Publishers Ltd

National Survivor User network (NSUN) https://www.nsun.org.uk/

NEF (New Economics Foundation) Slay, J. and Stephens, L. (2013) Coproduction in Mental health: A literature review. Available at: https://b.3cdn.net/nefoundation/ca0975b7cd88125c3e_ywm6bp3l1.pdf

The collaborating centre for values-based practice in health and social care.   https://valuesbasedpractice.org/

Woodbridge, K., Fulford, B., (2003) Good practice? Values- based practice in mental health. Mental Health Practice. 7,2,30-34