Professor David Seedhouse.
Professor of Health and Social Ethics.
Auckland University. New Zealand
Behavioural Nurse Therapist and Project Co-ordinator for the Values Exchange. South Staffordshire and Shropshire
Healthcare NHS Foundation Trust, United Kingdom
Senior Nurse for Quality and Standards (and medicines management lead) South Staffordshire and Shropshire
Healthcare NHS Foundation Trust, United Kingdom
freelance journalist, New Zealand
In 2006 South Staffordshire Healthcare NHS Foundation Trust, now South Staffordshire and Shropshire Healthcare NHS Foundation Trust, was awarded an ‘NHS Oscar’ at the Health Service Journal Awards. The Trust scooped first prize for ‘improving care with e-technology’ for its dedicated use of a new web based programme called the Values Exchange. Professor of Health Ethics, David Seedhouse designed the programme and is continuing to oversee its use by the Trust. The immensely powerful clinical management tool requires no installation or infrastructure investment and is simply managed from a single screen. The vision for the programme is that by 2009 it will be embedded universally throughout the NHS as part of normalised hospital management.
Values Exchange Project
The Values Exchange uses a common conceptual framework within which any health or social issue can be debated by any number of participants. It helps participants explore their beliefs systematically and fully appreciate others’ points of view. Using webbased technology, the Values Exchange has made ‘putting patients first’ a reality, engaging staff and patients in equal partnership. Staff, patients and/or directors are given access to particular cases, confidentiality being assured with robust Internet security. Proposals about topical issues are addressed by answering questions at 5 interactive screens. Background information is instantly available to everyone who joins in. Respondents are able to present their reasoned positions in a detailed manner using free text boxes. As feelings about a particular case are entered, the programme offers feedback - prompting users to define ambiguous terms and alerting them to conflicts within their reasoning. Graphic representations of values (which can be manoeuvred by the user to illustrate his/her opinion) add focus to responses, enable immediate understanding of viewpoints, and avoid miscommunication. The Values Exchange system automatically organises responses into trends that reveal the impact of values on practice and clearly displays results according to desired demographics. Over 30 reports are instantly available to the user once they complete a ‘considered response’ for a specific case. Cross-case comparisons can be carried out and chosen topics can be addressed by all clients of the Values Exchange at ‘Grand Central’.
Objectives of Values Exchange
The Values Exchange gathers detailed information about people’s views while avoiding or defusing undesired conflict and controversy. It makes decision-making completely transparent, creates a comprehensive ‘audit trail,’ and involves participants at a depth otherwise impossible.
Over the past 18 months, nearly 20 clinical teams and service users have been able to use the system to debate a whole range of issues. These have included specific organisational issues such as anticipating the smoking ban when staff and service users were canvassed for their opinion on the banning of smoking in all Trust grounds as well as the buildings. The Trust recognised that as a health provider we have a responsibility not to promote smoking. However after quite an extensive consultation it was agreed that, given the nature of the services we provide, appropriate smoking shelters should be provided within the grounds. This outcome is now part of the Trust’s Smoking Policy.
The system has also been used to discuss whether growth attenuation therapy should be approved in the UK and to deal with day-to-day clinical issues. These have included issues related to consent to treatment, capacity to decide where to live, decisions about sexual orientation, the use of physical, chemical or mechanical restraint, and whether an at-risk client should be admitted as an involuntary patient for assessment and treatment.
Contribution to Healthcare
Professionals carers both paid and unpaid are often placed in the position of making decisions on behalf of people who lack the capacity to make informed choices. This may include people who have a learning disability, people who have dementia, people who have enduring mental health issues and people who have a brain injury. The Values Exchange has made a real difference to patient care by helping to find casespecific optimal outcomes and provides a valuable forum for professionals and carers to discuss difficult, but very real issues. Patients and professionals can debate the same case independently, meaning patients have an in-depth, formalised way of making their opinions known. In other cases it has been found that it is more appropriate for a small number of people to form small working groups to debate specific case issues. The Values Exchange caters for this by managing access to secure cases. The comments staff have recorded in specific case reviews show that the opportunity to express their thoughts and concerns freely about cases that have a high emotional content is valued by those who are involved.
Values Exchange and IT
Use of the Values Exchange reflects the national IT agenda. The national programme aims to create an IT management capability that allows the NHS to capitalise on the power of IT to integrate data and processes across organisational and physical boundaries. The Values Exchange has played a large role in mainstreaming IT within South Staffordshire and Shropshire Healthcare NHS Foundation Trust. Staff have quickly become used to web-based idea sharing, cutting down face-to-face meeting time and allowing members to analyse cases and digest reports in their own time. Different ethics committees can link up remotely for key cases - sharing learning and insight (The Healthcare Trust collaborates closely with Staffordshire University). The Values Exchange can be readily integrated with Electronic Patient Records and users require minimal or no training.
By providing greater co-ordination and direction, the Values Exchange is helping the NHS to fulfil its duty to involve patients and the public in service planning, operation and development. The system costs less than £16.000 (23.600 euros) to create, pilot, manage and establish and offers various avenues for potential collaboration.