What matters in acute care? Values and decision making in the acute medical unit

Abstract

An acute medical unit (AMU) requires a broad range of decisions to be made under time pressure, where consensus is not always easily attainable. In such circumstances, having a clear and workable framework of values is of heightened importance in order to judge what course of action is best. Within the NHS, a multi-value framework and a single-value framework have both been proposed in the last 10 years. However, it remains unclear what values currently guide the work of an AMU. Data from a 16-month ward-based ethnography in an AMU in the north of England, supported by 27 semi-structured interviews, were analysed thematically in order to characterise a framework of values in decision making. Within an AMU, people figure out what is best according to three values simultaneously: welfare, choice and effectiveness. These values operate as an irreducible triad, with implications for holism and realism in healthcare.