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 AwcockCambodia
