Client as Driver of Care

In our current healthcare systems the client is often viewed as the silent person to whom all the health professionals provide their views on what the client should be doing to improve his/her health.

However, this above approach is from a different era. Today one-third of the world’s population has at least one chronic disease that people live with every day. As people age they often experience additional chronic diseases and may also have social issues that together create their need for individualized approaches by healthcare teams in partnership with clients. It is this group of clients who often ‘fall into the cracks’ of current health care while also increasing the costs for their care.

The way most health professionals have been socialized into their professions and approaches to care set by health systems rarely result in health professionals seeking out how these people are actually living with their diseases on a daily basis. the emphasis is more on how they are enacting the treatments prescribed by the health professionals. While important they are not always having the same level of importance to the client. However, when the client is feeling his/her health issues that they sought help with are being resolved.

Treatments or actions health professionals suggest may therefore, not be viewed by the client to improve their health unless that information is integrated into his/her capacity to carry them out as part of their daily actions. Hence, today it is the client who needs to be the driver of his/her care and health professionals assuming a facilitator role in providing their knowledge, skills and expertise to assist clients in their self-care. This suggested shift in roles reflects the fact the clients live with their conditions on a 24/7 basis. Health professionals only interact with clients at episodic intervals that are often short in time. Does it not make sense then, that we re-think how our interactions should occur?

To further support the above shift three theories are shared below that seem to underpin a re-thinking.

  1. Adult Education Theory: Adults are problem focused. This means that a client is only going to work on the problem that they are seeking health professionals’ assist with. Anything beyond that is likely to be ignored.
  2. Naturalistic Decision Making: Kline’s work has helped to understand how members of the general public make their decisions. It is not the linear process that most health professional assume occurs. In reality it is comprised of ‘patterns’ that each client develops over their lifetime in response to challenges he/she experience. When something difference in their daily living occurs within the client he/she first responds unconsciously automatically responding using that pattern. If this alteration resolves the problem, then no further action will be taken. If not, then at a conscious level a further alteration to the normal pattern will be tried by the client. Further alterations will be trialled until he/she feels a solution cannot be found. It is only at this stage that a client seeks a health professional’s help. But rarely is the client asked about what they have already tried.
  3. Learning to be me in society learning theory: Jarvis’ presents an interesting theory about how a person responds in social interactions with others. When a client seeks health professionals help, it is a social interaction. Clients do not come without stored life long experiences, knowledge skills acquisitions, values, phobias, fears etc. to their interface. As health professionals interact with the client these areas in the mind are activated and influence how the client hears what is being discussed and then chooses to follow or not. However, in many cases due to time pressures and a predominance of focus on evidence based practice algorithms, clients are rarely considered as an expert in their own lived experience. Thus interactions with health professionals are often a downwards delivery of instruction with limited consideration of how they can be applied into a client’s daily life. Since it is how the client can adapt what is being advocated that they do is not negotiated and adapted into their daily life there is a greater likelihood that limited change in their health and social problems can occur.

If we consider these three theories, how might the way health professionals could change how they interaction with clients and how might clients consider different approaches when meeting with their health professionals?


Orchard, C.A. Bainbridg, L. (2016). Competent for collaborative practice: What does a collaborative practitioner look like and how does the practice context influence interprofessional education? Journal of Taibah University Medical Sciences. 11(6): 526-532.

Jarvis, P. (2010). Adult education and lifelong learning: Theory and practice (4th Ed.). London, UK: Routledge.

Kline, G. (2008). Naturalistic decision making. Human Factors, 50(3), 456–460. DOI 10.1518/001872008X288385

Jarvis P. (2009). Learning to be a person in society.  London, UK: Rout-ledge