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Title: Engaging clinicians in cocreating health
Author: Phillips, Andrew
ISNI:       0000 0004 6057 3767
Awarding Body: University of South Wales
Current Institution: University of South Wales
Date of Award: 2016
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This thesis contributes to the wider debate on Prudent Healthcare and Relational Practise. The study aimed to determine how to engage clinicians in cocreating health by developing a framework for cocreating health to support the patient-clinician interaction and to identify the factors in its successful implementation in health services. The interaction between patients and clinicians is at the heart of health care. They are the first point of contact and a familiar interaction with the health service for most patients. Within UK health services there are three hundred million consultations held every year. Consultations happen in a variety of contexts, locations and with many different clinical professions. The overwhelming majority of these interactions follow a set pattern, the rules of engagement, which governs how patients are examined, histories established, symptoms described, test results discussed, progress monitored, treatment options given and decisions made. However, the traditional medical model of consultation can reinforce a power imbalance between clinician and patient, and create paternalistic relationships that reduce patients' control, leading to their 'systematic disempowerment'. Cocreating health is about enablement, viewing patients as assets not burdens and seeks to support them to recognise, engage with and develop their own sense of resourcefulness building on their own unique range of capabilities. Cocreation means that health care services support people's individual abilities, preferences, lifestyles and goals. In a cocreating health model of interaction, patients work with a supporting clinician. Such interactions consider the patient's life goals, how they plan to work towards them and what support they need to help her get there. Working in cocreation, a clinician would support patients to think about goals that are meaningful and adaptive. A number of elements of cocreating health such as self-supported management and decision support have previously been developed. However, these have generally been implemented within the context of the traditional 'medical model' of consultation. In the development of the cocreating health framework, a mixed qualitative and quantitative approach was taken to explore different aspects of cocreating health and to triangulate knowledge obtained from the different methodologies. Principles of grounded theory were used in the qualitative research. Data and insights were obtained in two phases. In the first phase, over thirty workshops were held with over five hundred participants from Welsh Government, local authorities, voluntary sector and across the NHS in Wales including policy makers, leaders of health services and clinicians. Insights from these participants combined with knowledge gained from the literature review were used to develop a cocreating health framework for testing. The initial data suggested that for clinicians, working collaboratively with patients in agenda setting was the most unfamiliar and potentially transformative element of cocreating health. Accordingly, training was arranged for one hundred and sixty four clinicians whose attitudes towards cocreating health were explored using questionnaires. In the second phase, semi structured interviews were held with thirty one participants from
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.B.A.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available