Time to enrich evidence based practice?
In the realm of health and care, organisations such as the National Health Service England (NHSE) and the Care Quality Commission (CQC) play pivotal roles in setting standards, monitoring performance, and ensuring quality of care. While their emphasis on evidence-based practice and rationalistic approaches is crucial for maintaining high standards and accountability, it can inadvertently discourage the use of intuition and deep wisdom among healthcare professionals. This essay explores this hypothesis, examining how current practices might inhibit holistic understanding and proposing strategies to mitigate these limitations.
The Dominance of Rationalistic Approaches
Evidence-Based Practice
Evidence-based practice (EBP) is a cornerstone of modern healthcare, emphasizing the use of the best available research evidence to guide clinical decision-making. While EBP has led to significant advancements in patient care, its stringent requirements can overshadow the nuanced, experiential knowledge that practitioners develop over years of practice. The emphasis on quantifiable data and standardised protocols can limit the flexibility and responsiveness required in complex, dynamic care environments.
Regulatory Oversight
The CQC’s role in inspecting and rating healthcare services ensures that standards are met and patients are protected. However, the focus on compliance with specific criteria can create a culture of box-ticking and risk aversion. This environment may stifle innovation and discourage healthcare professionals from relying on their intuition and experiential knowledge, which are often crucial in making quick, nuanced decisions in patient care.
Intuition and Deep Wisdom in Healthcare
The Value of Intuition
Intuition in healthcare refers to the ability of practitioners to make judgments and decisions based on tacit knowledge and subtle cues that may not be immediately evident through rational analysis. This skill, often honed through years of experience, allows for a more responsive and personalised approach to patient care. For example, a nurse might sense a patient’s deteriorating condition based on minor changes in behavior or appearance, prompting early intervention that might not be supported by immediate clinical data.
Deep Wisdom and Holistic Care
Deep wisdom in healthcare involves a profound understanding of the human condition, integrating emotional, psychological, and social dimensions of care. This wisdom often manifests in the ability to provide compassionate, empathetic care that addresses not just the physical but also the emotional and spiritual needs of patients. It requires the integration of both scientific knowledge and humanistic understanding, fostering a more holistic approach to health and well-being.
The Inhibitive Environment
Bureaucratic Constraints
The bureaucratic nature of organisations like NHSE and CQC can impose rigid structures that prioritise adherence to protocols over personalised care. Healthcare professionals might feel pressured to conform to standardised procedures at the expense of their intuitive insights, leading to a more mechanistic approach to patient care.
Fear of Litigation and Blame
The litigious environment in healthcare further exacerbates this issue. Fear of litigation and professional blame can drive practitioners to adhere strictly to guidelines and protocols, even when their intuition suggests an alternative approach might be more beneficial. This culture of fear undermines the confidence of healthcare professionals to trust and act on their deep wisdom.
Mitigating the Suppression of Intuition and Deep Wisdom
To create a more balanced approach that values both evidence-based practice and the intuitive, experiential knowledge of healthcare professionals, several strategies can be implemented:
1. Promote Reflective Practice
Encouraging reflective practice can help healthcare professionals integrate their experiences with evidence-based knowledge. Reflective practice involves regularly reviewing and analysing one’s experiences to gain insights and improve future practice. This can be facilitated through structured reflection sessions, journaling, and peer discussions.
2. Encourage Clinical Supervision and Mentorship
Clinical supervision and mentorship programs can provide a supportive environment for healthcare professionals to discuss and develop their intuitive skills. Experienced mentors can guide less experienced practitioners in recognizing and valuing their intuitive insights, fostering a culture that respects and integrates deep wisdom.
3. Integrate Holistic Assessment Tools
Incorporating holistic assessment tools that consider psychological, social, and spiritual factors alongside clinical indicators can support a more comprehensive approach to patient care. These tools can help practitioners capture and use subtle, non-quantifiable aspects of patient health, encouraging the use of intuition in clinical decision-making.
4. Foster a Culture of Open Dialogue
Creating an organisational culture that values open dialogue and diverse perspectives can help mitigate the suppression of intuition. Encouraging team discussions where all voices are heard, including those based on intuitive insights, can lead to more innovative and responsive care practices.
5. Develop Emotional Intelligence
Developing emotional intelligence can enhance healthcare professionals’ ability to recognise and respond to their own and others’ emotions. This training can help practitioners develop greater empathy and insight, which are essential components of deep wisdom and holistic care.
6. Balance Protocols with Professional Judgment
While protocols are necessary for ensuring standardisation and safety, it is important to balance them with professional judgment. Organisations can revise policies to allow more flexibility for clinical discretion, acknowledging that strict adherence to protocols may not always be in the best interest of individual patients.
7. Support Research on Intuitive Practice
Supporting research on the role and impact of intuition in healthcare can provide empirical evidence of its value. This research can help shift organisational attitudes towards recognizing and integrating intuitive knowledge as a legitimate and beneficial aspect of clinical practice.
Conclusion
Organisations like NHSE and CQC, through their emphasis on evidence-based practice and regulatory oversight, can inadvertently discourage the use of intuition and deep wisdom in healthcare. This inhibition limits the holistic understanding and responsiveness required for effective patient care. By promoting reflective practice, encouraging mentorship, integrating holistic assessment tools, fostering open dialogue, providing emotional intelligence training, balancing protocols with professional judgment, and supporting research on intuitive practice, healthcare organisations can create a more balanced and integrative approach. Such strategies can help reclaim the value of intuition and deep wisdom, enhancing the overall quality of care and supporting the well-being of both patients and healthcare professionals.
An interesting essay around a key aspect of health care i.e. learned experience which creates a basis for intuition – balanced by the need for hard evidence to avoid risk. I think another aspect here is the need to suspend judgement i,e. not be judgemental. This is more likely to encourage discussion and sharing of experience and insights, although it must always be underpinned by patient safety.
Judgement is certainly something to be used with great care and to be developed wherever possible. But recognising that our judgements are based on very limited experience and insight is a good start.
HI Mike,
I really like the simplicity of the hypothesis and as you know I am fully supportive of looking at how systems have developed in such a way that we are losing the essence of care. What struck me was the current push for ‘standard work’ v’s the need to remember that no one person is standard. I think this also lays out a very different requirement for leader development and almost a need as we have discussed to understand and develop a pedagogy which is grounded in the person, their understanding of self, their ability to ‘listen’ to their intuition and more importantly their ability to act
I am certainly getting further into this territory Sue. And a real need to balance the hegemony of utilitarian ethics with an ethic of care and a rights based approach to service provision.