Different for a reason
Many organisations talk about having people-centred, evidence-based decision making and reflective practices, but the reality is these values and processes are often side-tracked and buried under organisational demands, top-down targets and process-driven structures. The Care Aims Framework offers a unique framework to re-engage with the fundamental ethics that should be at the heart of clinical, caring and educational organisations, to achieve better outcomes for patients, children and families and to improve job satisfaction for practitioners.
The Care Aims philosophy and approach is significantly different from that prevailing today in the vast majority of health, education and care services:
- The Care Aims Framework focuses predominantly on decision making and not on behaviour
- The Care Aims Framework focuses on clarity of outcomes, and the distinction between intended and desired outcomes
- The Care Aim Framework creates a framework for truly person-centred reasoning
- The Care Aims Framework focuses almost entirely on ethics
- The Care Aims Framework recognises that evidence-based practise is iterative, and that reflection is essential to enable the necessary review and revision
A comparison with prevailing culture in medical services
Expand the box below to see the distinctions between the Care Aims Framework and the dominant culture in acute and outpatient medical care.
Analysis of Prevailing Medical Model vs Care Aims| PREVAILING PHILOSOPHY AND APPROACH IN ACUTE AND OUTPATIENT MEDICAL CARE | CARE AIMS PHILOSOPHY AND APPROACH | |
|---|---|---|
| CLINICAL REASONING FRAME | Uses a Problem‐based frame for decision‐making around admission, assessment, treatment and discharge. Overall population needs are considered at a very broad level e.g. number of beds. | Uses a Duty of Care frame around admission, assessment, treatment and discharge based on risk, predicted clinical effectiveness and clinical need. Takes a whole‐population approach to these decisions. |
| RISK ASSESSMENT | Uses condition‐risk as the predominant frame for risk assessment | Uses impact/forseeable imact for the person as the frame for risk assessment |
| CLINICAL INTERVENTION AND APPROACH | Direct intervention is the preferred approach with limited investment in pre‐referral activities | Supporting self‐help and universal services through consultancy is the preferred approach to a request for help from a referrer or member of the public |
| EVIDENCE‐BASE FRAME | Use efficacy as their main reference for clinical effectiveness | Acknowledges efficacy as the first point of evidence but uses a predominantly effectiveness approach to evidence‐base |
| APPROACH TO CLINICAL OUTCOME | Predominantly uses process measures and measures of patient status at the end of care to evidence clinical outcome. Where clinical outcomes are being measured they are not predicted first, so a status measure against baseline will be the most common approach. | Uses prediction of change within an identified time‐scale to support evaluation of clinical outcome and clinical effectiveness. Uses different measure for each predicted outcome (i.e. each Care Aim) and the focus is on the degree to which the outcome has contributed to reducing or avoiding the impact on the patient. Uses PROMS and other related outcomes to evidence outcome of universal and targeted work. |
| DEGREE TO WHICH CARE IS PERSON‐CENTRED CARE | A lot of care is process driven using ICPs or other task‐based guidelines. Very few of the ICPs use any impact‐based reasoning in the decision‐making required to plan care. | The approach is entirely person‐centred to support reasoning around impact and outcome. The 8 Care Aims do not make sense unless the focus is person‐centred. Whilst it recognises the need for ICPs this is at a task level and not a reasoning level and it supports departing from the ICP if it is not reducing the impact. |
| CASELOAD/ WORKLOAD MANAGEMENT | Prioritisation is based on condition‐risk with the highest condition‐risk clients prioritised over any other patients. Consideration of clinical effectiveness is limited when prioritising cases. Throughput or discharge are normally not a problem as patients are usually managed in relatively uniform packages of care. | Uses clinical effectiveness and level of need (resource) as the basis for prioritising cases and managing throughput. |