Theories and values of positive practice

For this assessment criterion, you will be required to critically evaluate the principles, theories and values of positive outcomes-based practice relating to the well-being of individuals. Key terms that you will need to understand are:

• Person-centred practice is an approach to healthcare that encompasses several values that focus on the individual receiving services or treatment rather than their condition. These values include respect, dignity, independence, choice, compassion and collaboration.
• Outcomes-based practice is an approach that focuses on the impact that health and care services have on an individual’s life and well-being, as defined by the individual themselves and their carers.
• Active participation is an approach that supports individuals to have full involvement in their care, relationships, activities and other areas of everyday life.

As you can see, all of these approaches are underpinned by recognising that each individual receiving health and care services is considered a unique human being with their own values, goals and characteristics and that services should take this into account when developing care packages.

Person-centred practice

There are several approaches and tools that can be used to support person-centred practice. However, before moving on, it may be worth reviewing person-centred values.

Personalisation

The Personalisation Agenda began in the mid-2000s with the government’s white papers ‘Our Health, Our Care, Our Say‘ (2005) and ‘Putting People First‘ (2007).

The underlying premise was that individuals receiving care services should have choice and control over how those services and shaped. This led the way for personal budgets and direct payments. A personal budget is a set amount of money that is allocated to an individual by the local authority to pay for their care needs. The individual then has the choice of whether the local authority has control of the money, it is paid to a service provider or it goes directly to themselves (or another person that they choose, such as a carer or family member).

Dimensions approach

Dimensions Activate is a research-based, outcomes-focused model that was developed to improve care in a personalised way.

They also promote other person-centred thinking tools such as one-page profiles and relationships and provide person-centred training in collaboration with Helen Sanderson Associates.

Building Blocks Framework

In 2007, the World Health Organisation (WHO) proposed a framework for describing health systems in terms of six primary components or ‘building blocks’. These are:

1. Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources.
2. A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive).
3. A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.
4. A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and they are scientifically sound and cost-effective use.
5. A good health financing system raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.
6. Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design and accountability.

You may find it useful to look at your own service in terms of these six components; the service, the staff, the information systems, physical resources, finances and leadership.

Common Core Principles

Skills for Health and Skills for Care joint-published Common Core Principles to Support Self-Care in 2015 to provide guidance through the transition of perceiving individuals that use care and support services “from passive recipients to active and equal partners who bring their own expertise about their lives“.

There are seven principles:

1. Person-centred practice that engages, supports, encourages and facilitates involvement and helps individuals to make decisions that are right for them.
2. Effective communication enables individuals to identify their strengths, assess their needs, and develop and gain the confidence to self-care.
3. For individuals to make well-informed decisions about their self-care they must have access to appropriate information and understand the range of options available to them.
4. Developing skills and confidence in self-care requires access to a range of learning and development opportunities, formal and informal.
5. New technology is an important aspect of enabling people to self-care.
6. Individuals are enabled to access support networks and participate in the planning, development and evaluation of services.
7. Risk-taking is a normal part of everyday life, so supported risk management and risk-taking is an important element of maximising independence and choice.

Does your service embrace these principles or are there areas that you could improve?

Links between outcomes-based practice and person-centred practice

As previously discussed, person-centred practice encompasses the needs, wishes and preferences of an individual receiving care services by working with person-centred values such as choice, independence and respect.

Outcomes-based practice focuses on the impact that care and support services have on an individual’s life and well-being. In health and social care, outcomes should be based on the individual’s unique needs, wishes and preferences, thereby considering the individual’s needs, wishes and preferences.

As an example, imagine two individuals that have had a fall and broken their leg. One is an older man in their eighties, the other is a young lady in their twenties. From a clinician’s perspective, the outcome would simply be to treat the injury so that both individuals can make a full recovery. However, when taking a person-centred approach and speaking to the individuals, the preferred outcome for the older man may be to be able to walk to the shops again, whereas the younger woman may want to be able to play football for her team again as soon as possible. These differing outcomes may mean differences in the way treatment and aftercare are provided.

Active participation

As previously discussed, active participation is an approach that enables individuals receiving care and support services to be actively involved in their care as well as all other aspects of their lives. This means promoting the person-centred values of rights, choice, respect, partnership-working and independence.

Some of the benefits of promoting active participation can be found here.

Ways of working with individuals to ensure choice and control

All individuals receiving care and support services should have choice and control over any decisions that affect them.

This can be achieved in many ways. Primarily, when an individual is referred to your service, you should get to know them and collaborate with them to produce a care plan that meets their unique needs, wishes and preferences. You should also recognise that everyone’s needs, wishes and preferences change over time so the care plan should be regularly reviewed to ensure that it is still working or if changes need to be made.

When individuals must make choices about their care, you should provide them with impartial information about the risks, benefits and potential outcomes of each choice so that they are able to make their own informed decision.

As mentioned previously, the introduction of personal budgets and direct payments has enabled individuals to have more choice in how their care and support is delivered.

Integrated service provision

Integrated, seamless care is concerned with reducing the discontinuity of care that occurs when individuals move between different services. This could, for example, be a result of an individual leaving the hospital and being transferred to outpatient care, transitioning between children and adult care services or moving from health services to care services.

This requires health and care professionals to work in partnership and share information to support positive outcomes for the individual.

As well as providing integrated services with external organisations and agencies, you may also consider how effective your internal systems are for providing individuals receiving care and support services seamlessly. Do different departments within your organisation communicate well with one another or even staff members within the same team? Does handover between shifts work well or are service users being asked the same questions by several members of staff?