CLEVER: target setting in primary care

We should focus more on 'dealing' with the consequences of the disease than curing the disease. We need to 'care more for the person than the disease'. A paradigm shift from disease-oriented (problem-oriented care) care to care based on goals of the person (goal-oriented care) is therefore necessary.

The goal of goal-oriented care is - according to one of the very first researchers in the field, Jim Mold in 1991 - 'to achieve the highest possible level of health as the individual defines health himself'.

Achieving goal-oriented care is no mean feat

To begin with, it is not clear to everyone what goal-oriented care means. Even though the meaning of the term 'goals' is seemingly obvious, it is difficult to define what those goals should be and what those goals should be about. Are they life goals? And if so, how should we make this concrete? Are they 'other' goals? And which ones then? Then how do we get those clear?

Apart from that, goals are unfortunately still often formulated from a problem perspective (the disease) and not from a need perspective (the human being). Meritorious attempts have been made, but methodologies sometimes fall short for certain target groups in certain situations.

It is high time to develop a methodology close to the needs of persons with chronic care needs and validate it.

In September 2017, a practice-oriented research project was launched at Arteveldehogeschool, in collaboration with the field and the patients' association, with the aim of developing and validating a methodology that would enable the formulation of meaningful goals 'together with' persons with a chronic condition, multimorbidity, social distress or a combination of the above.

Over the last two years, research using a mixed-method design - combination of qualitative and quantitative methods - was conducted. In a number of successive research steps, we first attempted to clarify what goals could mean for persons with care and support needs. To this end, we conducted a qualitative study, using in-depth interviews. This study showed that participants were awake to their daily (and not so daily) activities and that their goals were mainly to be found in those activities that were meaningful to them. Those activities were always found to have a basis in the research subjects' own context, life story, emotions and values. When we took all these things into account, we arrived - according to the participants - at goals that were relevant and important to them. We could thus conclude that meaningful activities were important and a basis for identifying and formulating goals.

In the next step, we converted the insights from the qualitative research into a methodology that questions precisely those things that the participants indicated as important. In a structured way - but leaving enough room for a personal conversation style - the conversation is started with the person with a care and support need. This methodology was named CLEVER.

Clever stands for: Context, Life Story, Emotions, Fixed Values, Engagement and Relevance. The CLEVER methodology enables goal-oriented care in primary care. At the heart of CLEVER were the ACTIVITY goals that people put first in order to keep functioning in their daily lives. Indeed, these activities - which are central to this methodology - were linked to the roles that were important to them that the participants took up, to their values and norms. At the same time, the activities also determined individuals' identities. 

The CLEVER methodology allows the professional to look for relevant and meaningful activities that are no longer possible due to the chronic condition, multimorbidity and/or social problems. Or which the person thinks are no longer or will never be possible. With CLEVER, personal CLEVER goals are then determined - together with the person. These then guide the various care providers in supporting the person. However, CLEVER only reaches its full potential if the professional also turns out to be a CLEVER professional.