Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Abstract

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patientcenteredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.

Using Photovoice to Explore Patient Perceptions of Patient-Centered Care in the Veterans Affairs Health Care System

“…Application of participatory methodologies, such as photovoice, to patient-centered care is a new concept [23], and we found it to be useful in multiple ways. First, photovoice provided an innovative platform to broadly understand the Veteran patient perspective related to patient-centered care.…”

“…One study to date has used photovoice to explore patients' perspectives of clinical care processes. The authors explored perceptions of patients with brain injury, and concluded that using photovoice in clinical settings was effective in improving patient-provider communication and patient engagement [23].…”

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

“…15 We developed and implemented a decision aid using a patient-centered care framework to facilitate SDD after PCI. 15,18 The patient-centered SDD program at BJH required prospectively identifying risks of bleeding, 19 mortality, 20 and AKI, 21 with a patient-specific determination of a safe contrast limit 22 at the point of care, before PCI. We used the American College of Cardiology's NCDR (National Cardiovascular Data Registry) CathPCI Registry models to identify the risks of bleeding, mortality, and AKI [19][20][21] and developed a method for estimating the safe contrast limits.…”

Graphic Narratives, Trauma and Social Justice

“…Digital storytelling and personal mapping approaches, for example, are newer visual methods that disrupt conventional modes of knowledge production, and deepen understandings of the complex operations of social inequalities and struggles for social justice (Hidalgo, 2015;Nanackchand & Berman, 2012;Ulmer, 2017). No matter which visual approaches are used, scholars argue for their value as modes of communication that enable vulnerable groups to articulate difficult and complex personal experiences in ways that text-based approaches often frustrate, opening possibilities for enhanced social recognition and claims for justice (Lorenz & Chilingerian, 2011;Ogston-Tuck, Baume, Clarke & Heng, 2016).…”