- Brainstorm everything that is important that the decision should live up to.
- Ask people to offer full ideas in answering the question “Whatever our answer, it is important that…”
- All considerations should first be named and listed, regardless of degree of importance (so all responses should be accepted).
- Prioritize this list.
- Review the list and confirm the ordering.
- Discuss the justification for the prioritization: why is it reasonable to prioritize and balance in this way?
- Identify values about which there was disagreement and discuss how to address these.
- The resulting list will be the criteria against which the quality of different options will be judged.
Tips for Success
- Make explicit what matters in the situation.
- When a consideration is identified as important, explore whether it is important for its own sake or because it gives us something else of more importance.
- If the latter, be sure to capture both the instrumental and the intrinsic value on the list. For example, if it is important that “all team members clearly chart conversations with a patient about what is important to them while they are in hospital”, is this because it is important, “to minimize exposure to legal liability,” “to ensure consistency of care,” “to best respect the autonomy of the patient,” or “to assist family to understand the perspective of their loved one”? All of these may be important, but some will likely be more important based on the context. So all of the considerations in quotes above should be listed.
- Avoid one word values that are open to interpretation.
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Key Values in the Healthcare Encounter
There are a number of things that are generally recognized as very important in the experience of providing healthcare. These include that…
- We make decisions based on the values and beliefs of the patient
- Our decision advances the well-being of the patient, from their perspective
- We do not penalize patients for attributes that are beyond their control
- We do not cause physical harm to our patients
- We do not cause emotional or psychological harm to our patients
- We do not cause harm to others involved in the situation
- The decision reflect the values and beliefs of family members
- We help families to help us understand the perspective of the patient
- We involve members of the family in the manner the patient does or would want
- We honour the integrity of the care team
- We pay particular attention to those who are vulnerable
- We do not abandon the patient
- We support the key relationships in the patient’s life.
How to Prioritize Values
Possible ways to do this exercise include…
- If the group is small enough, collectively give each value statement a score between 1 and 5, where 5 is crucial.
- Write each value statement on a whiteboard or flip chart, and have everyone write their score beside each.
- Give each participant 5 colours of stickers/dots, identify each one with a value between 1 and 5, and ask each participant to place one dot beside a value statement, then tabulate.