I was at a study day today which was all about values based practice (VBP). For those not in the know, VBP is all about patient choice, consent, information and being at the centre of holistic care. It’s the gold standard of patient care. So, why is it so hard to demonstrate? And, why is it not just part of what happens on a daily basis? Should it be explicitly mentioned in our continuing professional development? I don’t profess to have the answers but we certainly had some good discussion today.
Part of the problem, we concluded, is the culture in hospital departments, and naturally I’m generalising here. We discussed the fact that there are actually people out there who don’t introduce themselves to patients, don’t make eye contact, don’t explain what they’re going to do and why, don’t mention the risks of undergoing procedures. They take pride in not getting involved with patients. They do their job and that’s it. If these same “professionals” also happen to the departmental opinion makers then the culture of non-communication prevails and propagates.
We moved on from discussing culture to discussing CPD. The questions was asked “can’t there be some overt requirement to include values based practice in CPD?”. The hope was to encourage or more likely, force the silent minority to think more deeply about what they’re not saying to patients. I’d love this, and implement it tomorrow, if I thought it would work. Although I’ve no empirical evidence, I strongly suspect that those who decline to take part in effective communication with patients are also probably those who say they do CPD but “keep it in their heads”. The ones who tell me that they just “aren’t very good at recording it”. The ones who admit to me in front of students and their manager that they use the fingers crossed method of CPD – they don’t record any and just keep their fingers crossed that the regulator doesn’t want to see their profile. Regulators and professional bodies can make all the edicts they like but it won’t affect the practice or CPD of those who do not wish to engage.
The only thing that will encourage better communication and values based practice is if individuals get something out of it. Something overt or something that they don’t even realise they’re getting, but definitely something that gives benefit. For example, if those who carried out values based practice got praise form their peers, respect from students and colleagues or even recognition from their manager that they’re doing a good job, they’d keep doing it. More subtly, if everyone else is doing VBP, and the naysayers join in consciously or unconsciously, they’ll get a feeling of being part of the crowd. They won’t be out in the cold wilderness of unbelonging.
So, we should all be doing our bit for values based practice and be seen to communicate, show respect and understanding and encourage and praise good practice. If we do, then maybe one day the gold standard will be just a little bit closer to being reached.