1 - Values-based practice in health care: setting the scene

Summary

‘If there is any merit in this idea at all, the VDM (values-based decision making) offers a hugely exciting prospect for greater tolerance and understanding between human beings.’

(Seedhouse, 2005, page 47)

Values-based health and social care practice is an approach that aims to involve both patient and professional in decision making and management, taking into account both parties’ views. It may be seen as complementary to what are claimed as the more scientific aims of evidence-based practice, which some practitioners and patients consider has reduced rather than enhanced the possibility of patient partnership. There is an emphasis in the health professional literature, particularly from medicine, on evidence-based practice often without a mention of values. In this chapter I will explore the nature of both values-based and evidence-based practice in general, while chapter 2 considers values as they affect teamwork and collaborative practice.

Definitions of values

One definition of values is that they ‘operate as standards by which our actions are selected’ (Mason et al., 2010, page 71). Also succinctly ‘a value is a belief upon which man acts by preference’ (Allport, 1961, page 454). In relation to patients, values are ‘the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient’ (Thornton, 2006, page 2). Fulford et al. (2012), in the first volume of this series, use the term ‘values’ to include ‘anything positively or negatively weighted as a guide to health care decision-making’. Values-based care or values-based practice (VBP) similarly has a number of definitions (Box 1.1).