Quality Enhancing Strategies
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Transcript of Quality Enhancing Strategies
Quality Enhancing Quality Enhancing StrategiesStrategies
John Gavazzi, Psy.D., ABPPJohn Gavazzi, Psy.D., ABPP
Positive EthicsPositive Ethics
Ethics as a movement away from Ethics as a movement away from the punishment and anxiety-the punishment and anxiety-producing components of ethicsproducing components of ethics
Fulfill their highest idealsFulfill their highest ideals
A means to help interpret and apply A means to help interpret and apply ethics standardsethics standards
CompetenceCompetence
Remedial:Remedial:Acquiring and maintaining Acquiring and maintaining minimal formal qualificationsminimal formal qualifications
Positive:Positive: Striving for highest standardsStriving for highest standards
Includes self-awareness andIncludes self-awareness and
self-careself-care
Emotional competenceEmotional competence
Informed ConsentInformed Consent
Remedial: Remedial: Fulfilling legal responsibilitiesFulfilling legal responsibilities
Emphasis on signed consentEmphasis on signed consent
Positive:Positive: Working to maximize client Working to maximize client participation with goalsparticipation with goals
Understand issues related to Understand issues related to multiple relationshipsmultiple relationships
Benefits of Positive EthicsBenefits of Positive Ethics
Broadens a psychologist’s understanding Broadens a psychologist’s understanding of ethics in a broader contextof ethics in a broader context
Sensitize psychologists to ethical Sensitize psychologists to ethical implications of decisions on a daily implications of decisions on a daily
basisbasis
Benefits of Positive EthicsBenefits of Positive Ethics
Appreciate the moral values on which the Appreciate the moral values on which the APA code is basedAPA code is based
Assist psychologists in balancing Assist psychologists in balancing competing ethical demandscompeting ethical demands
Help psychologists to address systemic Help psychologists to address systemic social problemssocial problems
An Acculturation ModelAn Acculturation Model
One Application of Positive EthicsOne Application of Positive Ethics
Acculturation Acculturation
A A processprocess to change the cultural behavior to change the cultural behavior of an individual through contact with of an individual through contact with another culture. The process of another culture. The process of acculturation occurs when there is an acculturation occurs when there is an adaptation into an organization or society.adaptation into an organization or society.
Ethical Culture of PsychologyEthical Culture of Psychology
Our system of common beliefs, shared Our system of common beliefs, shared meanings, norms and traditions that meanings, norms and traditions that
distinguish psychologists as professionals.distinguish psychologists as professionals.
It is a learned set of skills, bases of It is a learned set of skills, bases of knowledge and ethical beliefs, as knowledge and ethical beliefs, as
described in our ethics code. described in our ethics code.
Acculturation as a ProcessAcculturation as a Process
Can be a complex processCan be a complex process
Some parts of a psychologist’s practice Some parts of a psychologist’s practice and lifestyle may be easily acculturated and lifestyle may be easily acculturated while others notwhile others not
Process that may continue throughout the Process that may continue throughout the education or career as a psychologisteducation or career as a psychologist
Ethical AcculturationEthical Acculturation
Identification with personal value systemIdentification with personal value system
(high vs. low)(high vs. low)
Identification with value system of Identification with value system of psychologypsychology
(high vs. low)(high vs. low)
Acculturation Model of ethical Acculturation Model of ethical trainingtraining
IntegrationIntegration SeparationSeparation
AssimilationAssimilation MarginalizationMarginalization
Higher in Higher in Professional EthicsProfessional Ethics
Higher in Higher in Personal EthicsPersonal Ethics
Lower in Lower in Personal EthicsPersonal Ethics
Lower in Professional Ethics
MarginalizedMarginalized
Matrix:Matrix: Low on professional ethicsLow on professional ethics
Low on personal ethicsLow on personal ethics
Risks:Risks: Greatest risk of harmGreatest risk of harm
Lack appreciation for ethicsLack appreciation for ethics
Motivated by self-interestMotivated by self-interest
Less concern for patientsLess concern for patients
AssimilationAssimilation
Matrix:Matrix: High on professional ethicsHigh on professional ethicsLow on personal ethicsLow on personal ethics
Risks:Risks: Developing an overly Developing an overly legalistic legalistic stancestance
Rigidly conforming to Rigidly conforming to individual individual rules while missing rules while missing broader broader issues issues
SeparationSeparation
Matrix:Matrix: Low on professional ethicsLow on professional ethics
High on personal ethicsHigh on personal ethics
Risks:Risks: Compassion overrides goodCompassion overrides good
professional judgmentprofessional judgment
Fail to recognize the Fail to recognize the unique unique role of psychologistsrole of psychologists
IntegratedIntegrated
Matrix:Matrix: High on professional ethicsHigh on professional ethics
High on personal ethicsHigh on personal ethics
Reward:Reward: Implement values in context Implement values in context of professional rolesof professional roles
Reaching for the ethical Reaching for the ethical ceilingceiling
Aspirational ethicsAspirational ethics
Quality Enhancing StrategiesQuality Enhancing Strategies
High quality psychological services High quality psychological services occurs at the intersection of our occurs at the intersection of our personal and professional lives.personal and professional lives.
Paraphrase from “The Courage to Teach”Paraphrase from “The Courage to Teach”
Parker J. PalmerParker J. Palmer
Link to Moral PrinciplesLink to Moral Principles
BeneficenceBeneficence: Welfare of the patient: Welfare of the patient
NonmaleficenceNonmaleficence: Avoiding harm: Avoiding harm
AutonomyAutonomy: Respect for patient : Respect for patient
decision-makingdecision-making
Quality Enhancing StrategiesQuality Enhancing Strategies
As the legal risks, the possibility of As the legal risks, the possibility of treatment failure, or patient treatment failure, or patient
complexity increases,complexity increases,
the greater the level of attention should the greater the level of attention should be given to quality enhancing be given to quality enhancing
strategies.strategies.
Quality Enhancing StrategiesQuality Enhancing Strategies
ConsultationConsultation
Empowered CollaborationEmpowered Collaboration
DocumentationDocumentation
Redundant ProtectionsRedundant Protections
ConsultationConsultation
Technique oriented informationTechnique oriented information
Emotional reactionsEmotional reactions
Reduction of emotional turmoilReduction of emotional turmoil
Thinking through solution togetherThinking through solution together
ConsultationConsultation
Write down issues in advanceWrite down issues in advance
Need to be open and honestNeed to be open and honest
Be willing to admit mistakes or clinical Be willing to admit mistakes or clinical errorserrors
Empowered CollaborationEmpowered Collaboration
Empowered collaboration builds upon Empowered collaboration builds upon informed consent and attempts to maximize informed consent and attempts to maximize patient involvement in all essential elements patient involvement in all essential elements of treatmentof treatment
The patient becomes more actively involved The patient becomes more actively involved in the process of psychotherapy. Greater in the process of psychotherapy. Greater commitment leads to better outcomes.commitment leads to better outcomes.
Empowered CollaborationEmpowered Collaboration
Empowering psychologists respect a Empowering psychologists respect a patient’s autonomy and decision making patient’s autonomy and decision making skills about the goals of treatment, process skills about the goals of treatment, process of treatment, and life choices.of treatment, and life choices.
Examples of tough decisions and Examples of tough decisions and ambivalent patientsambivalent patients
Documentation: Legal PurposesDocumentation: Legal Purposes
Required by insurers, State Board of Required by insurers, State Board of Psychology, APA Ethics Code, etc.Psychology, APA Ethics Code, etc.
A record of treatment for future providersA record of treatment for future providers
Useful risk management toolUseful risk management tool
Documentation: Quality EnhancingDocumentation: Quality Enhancing
Dialogue with self and patient regarding Dialogue with self and patient regarding process and goals of treatmentprocess and goals of treatment
Means to identify pertinent clinical issuesMeans to identify pertinent clinical issues
Procedure to document progressProcedure to document progress
Redundant ProtectionsRedundant Protections
Multiple layers of information in order to Multiple layers of information in order to provide the highest level of careprovide the highest level of care
Another health care providerAnother health care provider
Psychological testing or screening devicePsychological testing or screening device
Family member or significant otherFamily member or significant other
ConsultationConsultation
Redundant ProtectionsRedundant Protections
Lack of progress in treatmentLack of progress in treatment
Patient who presents as complexPatient who presents as complex
High risk for self-abuse, self-harmHigh risk for self-abuse, self-harm
Why Redundant Protections?Why Redundant Protections?
Avoid errors in judgmentAvoid errors in judgment
Obtain essential informationObtain essential information
Promote greater chance of successPromote greater chance of success
TransparencyTransparency
Implement quality enhancing strategies with Implement quality enhancing strategies with as much transparency as possible.as much transparency as possible.
VignettesVignettes
Important IssuesImportant Issues
What factors make this a potentially difficult What factors make this a potentially difficult patient or situation for you?patient or situation for you?
What would your emotional reaction be to What would your emotional reaction be to the content of this scenario?the content of this scenario?
Important issuesImportant issues
How would you use a consultation?How would you use a consultation?
In what ways would empowered collaboration In what ways would empowered collaboration be of use?be of use?
Are there any issues related to documentation?Are there any issues related to documentation?
Can you think of any redundant protections?Can you think of any redundant protections?