Leprosy
Mailing List – March 30th, 2008
Ref.: “COPE” (client-orientated,
provider-efficient)
From: Awcock D., Phnom Penh,
Cambodia
Dear Dr Noto,
I refer to Dr Ruth Butlin’s LML message dated
March 21st 2008. The
editorial and article from the BMJ do indeed make interesting reading
and illustrate very clearly just how complicated the issue of
participation has become.
I am not too concerned about the terminology
–whether the people involved are patients, users or clients, or
clinicians, providers or staff - these are matters of individual
preference or particular circumstance.
What I think should concern us more is the extent to which
apparent confusion about the purpose and process of participation
limits the usefulness and cost-effectiveness of studies such as the
one so honestly described in the article.
Many staff have a very clear idea of 'what it is like to
be a patient here', and they act on that knowledge where necessary and
appropriate, but others have no idea at all. In my experience it is
sometimes necessary to both give patients a voice and teach staff to
listen. I have found that
a framework called COPE can be helpful where patients are generally
not very assertive or articulate.
COPE stands for client-orientated,
provider-efficient and is a self assessment tool that can be adapted
to a specific location and type of activity. The assessment is carried out
by staff with the involvement of patients and their own managers. This means that the assessment
addresses the needs of the staff (for training, resources, new
policies, encouragement, whatever) as well as the needs identified by
patients. No issues that
concern patients or staff have to be excluded because they are outside
the control of the staff. And the record of the assessment provides
the evidence that it has been done and in what ways if any it was
beneficial.
I have used COPE in a variety of settings and seen it
lead to significant improvements in the patient experience and the job
satisfaction of the staff but sometimes it doesn't work because it is
the wrong tool for the particular situation or time. For anyone interested, more
information can be found on the website www.engenderhealth.org including a free downloadable handbook.
Yours sincerely,
David Awcock
Cambodia
