In the third blog of our Person Centred Care series, our other Programme Manager Rachel Bryers discusses the fine balancing act between supporting patients to be autonomous in their decisions on care, with protecting their health and reducing harm.
 |
| Rachel Bryers |
‘Professional training provides a foundation for understanding the importance of Person Centred Care but it does not prepare you for the reality of managing complex decision making with patients; supporting their right to autonomy and choice, against balancing risk and fear of litigation.’
This is often the response we hear from health professionals when exploring how they can embed Person Centred Care within their practice.
As a team manager of an intermediate care service, we explored these ethical dilemmas; reflecting on our attitudes and practice when managing the complexities of risk, safety and wellbeing but most importantly ensuring that what mattered to the patient was the principal factor in decision making. This was paramount in getting to the crux of how we delivered Person Centred Care.
Tensions between autonomy and protection can be seen across all aspects of healthcare and more must be done to guide and support health care professionals with these challenging and testing conversations.
Recognising our paternalistic approach, albeit with our best intentions for the patient, is fundamental. When a patient makes a decision that we are not comfortable with it is difficult to support their wishes; more so when we feel it isn’t the option that will most optimise their health and reduce the risk of harm.
Health professionals want to be able to provide the care that responds to patient’s priorities but tell us they feel stifled, disempowered and scared by a system where governance and risk does not support this.
We all have different attitudes to risk, values and preferences, and should be supported to choose the option which matters to us. For health professionals, the fear of litigation and being held accountable for a decision which may prove to be unwise often results in labelling patients as ‘non-compliant’, or prompting them to sign a disclaimer form for ‘going against advice’.
How can we move away from this culture, to one which gives us ‘permission’ to support the patient’s choice by standing alongside the patient, listening and understanding what matters to them and feeling confident to act on it; with the support of our organisation?
Clinicians who have a better understanding of The Mental Capacity Act and how it underpins clinical practice can feel more protected and equipped to support complex decision making.
When a patient chooses a course of action that the clinician would feel uncomfortable with, it enables them to take a Person Centred approach; leading to better outcomes for patients, as defined by the patient.
An example of this can be seen in our work with North West Boroughs Healthcare NHS Foundation Trust (previously Five Boroughs Partnership NHS FT). Professionals involved in the decision making must ensure they have the knowledge and expertise to understand the implications of the Mental Capacity Act in clinical practice, as not adhering to the legal framework of the Mental Capacity Act could be regarded as wilful neglect.
In my current role as an Improvement Facilitator working with health professionals to support Person Centred Care in practice, it is clear that more support and guidance is needed to understand their role in decision making.
You can share your thoughts with Rachel on Twitter via @Rachel_Bryers or @AQuA_NHS, or feel free to leave a comment below.
In our next blog we hear from one of our members, Norah Flood, Assistant Director Clinical Networks, North West Boroughs Healthcare NHS Foundation Trust, on the importance of early adopters of Person Centred Care.
No comments:
Post a Comment