VALUES-BASED PRACTICE Figure 1: The 10-part process of values-based practice.


The 10-part Process of Values-based Practice is the ‘engine’ of values-based practice. Building on the premise of mutual respect, the process elements of values-based practice are what support its outputs in balanced decisions on individual cases within frameworks of shared values. The process of values-based practice includes ten key elements covering four key clinical


skills, two aspects of professional relationships, three close links with evidence-based practice, and a dissensual basis for partnership in decision making.


CLINICAL SKILLS The four key clinical skills for values-based practice are awareness, reasoning, knowledge and communication skills.


1 Awareness of values includes awareness of the diversity of individual values, awareness of clinicians’ own values as well as the values of others, and awareness of positive values


(StAR values, ie strengths, aspirations and resources) as well as negative values (such as needs and difficulties).


2 Reasoning about values in values-based practice is aimed at expanding our values horizons rather than (directly) deciding what is right. Reasoning so directed may employ


any of the established methods of ethical reasoning (such as principles reasoning, case-based reasoning (or casuistry), utilitarianism, deontology and virtue ethics).


3 Knowledge of values as derived from research and clinical experience has the important limitation that it can never ‘trump’ the actual values of a particular individual. That said,


knowledge in values-based practice, as in any other area of medical knowledge, includes both tacit (or craft) knowledge and explicit knowledge; and it includes the skills for knowledge retrieval.


4 Communication skills include skills for eliciting values and skills of conflict resolution. In eliciting values it is important to explore strengths (StAR values, ie strengths, aspirations


and resources) as well the standard ICE (Interests, Concerns and Expectations). So in values-based practice ICE becomes ICE-StAR.


PROFESSIONAL RELATIONSHIPS The two aspects of professional relationships important for values-based practice are person- values-centred practice and extended multidisciplinary team work.


5 Person-values-centred practice is practice that focuses on the values of the patient while at the same time being aware of and reflecting the values of other people involved


(clinicians, managers, family, carers, etc). This is important in tackling two particular problems of person-centred care, problems of mutual understanding and problems of conflicting values.


6 Extended multidisciplinary team work is team work that draws not only on the diversity of skills represented by different team members but also on the diversity of team values:


this is important both in identifying the values in play in a given situation and in coming to balanced decisions about what to do.


EVIDENCE-BASED PRACTICE AND VALUES-BASED PRACTICE The relationship between evidence-based practice and values-based practice is defined by three principles.


7 The two feet principle is that all decisions whether overtly value-laden or not, are based on the two feet of values and evidence: clinically, this translates into the reminder to


‘think facts, think values’.


8 The squeaky wheel principle is that we tend to notice values only when (like the squeaky wheel) they cause trouble: clinically, this translates into the reminder to ‘think values,


think facts’.


9 The science-driven principle is that advances in medical science and technology in opening up new choices (hence diversity of values) drive the need equally for


values-based practice as for evidence-based practice: clinically, this translates into the reminder that above all in high-tech medicine it is vital to ‘think both facts and values’.


PARTNERSHIP Partnership in decision making, as the 10th element of the process of values-based practice, depends on both consensus and dissensus.


Consensus is when differences of values are resolved with one or another value being adopted (as in the adoption of a framework of shared values).


Dissensus is where differences of values remain in play to be balanced sometimes one way and sometimes in other ways according to the particular circumstances presented by different situations.


Source: The Collaborating Centre for Values-based Practice in Health & Social Care, 20162 JUNE 2017 . 13


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