Shaping the Future One Conversation at a Time

Ross GrieveThistle Foundation

Connecting

• In pairs

Introduce yourself to someone you don’t know and..... one scottish word !!??

Connecting

• In pairs

Say another hello and.....

What stood out for you from this morning ?

Meeting the Person ( not the condition, problem, issue)

• Change pairs

Talk about anything other than why you are here today and in particular.....

What matters to you?What’s important to you?

What matters

• What is it that matters to human beings?

• What do humans need to experience wellbeing?

Enabling conversations in health and care

Share information in ways people

understand

Adapted from Lhussier, Eaton et al. Health Expectations, 2013

Increase knowledge skills

and confidence to live day-to-day

Plan and review ongoing care and

support. Person as active participant

Supportto

self-manage

Care and Support planning

Shared decision making

6

What matters to an individual informs these discussions

What matters to us ?Joy in Work… seriously??

Purpose

Human Needs

Swensen, Kabcenell, Shanafelt. J Healthcare Management.61:2;105-127 2016Maslach, Leiter. World Psychiatry. 2016;15(2):103-111. (Vigor, Dedication + Absorption)

Camaraderie

A great place to work!

Control

Conversations with colleagues about what matters…

In 3s

• Imagine you wake up tomorrow and you are at your best

• Describe• What difference would it make ? • who would notice and what might they notice ?• what else might they notice ?

In 3s

• “think of a person who knows you best ( and likes you !)”

• what would they say that they most appreciate about you?

• (listener - respectful curiosity - get detail)

Deepening our Reflective Practice: EARS

• E – elicit– Tell a story of how you’ve impacted someone’s life through nursing – What happened ? … (briefly)

• A – amplify– What difference has that made ?– Who’s noticed ? What have they noticed ?

• R – reinforce– How did you do that?– What have you learned?– What does this say about you ?

• S - start again– What else is better?

• (S - or next Signs of change)– what might the next signs of progress be ?

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How do you look after yourself,stay kind to yourself, attend to your

needs ? • 10 - as well as you can be

, given your life situations• 0 – opposite• X - where we all are just

now• How come you are an x

and not lower? (what are you doing to keep you as well as you are keeping just now?)

• What else, what else?

Scaling - What keeps you well?

• 10 - as well as you can be , given your life situations

• 0 – opposite• X - where we all are just

now• How come you are an x

and not lower? (what are you doing to keep you as well as you are keeping just now?)

• What else, what else?

The Times, 3rd Sept 2015

“We’re all living longer….to an unhealthy old age”

There is a difference betweenincreased lifespan

andincreased healthspan

The Guardian

29th May 2018

• Severe obesity rates double during primary school.

Nearly twice as many year six children classed as severely obese as those in reception

• The data reveals 22,646 of 556,452 children (4%) aged 10 and 11 are in the highest body mass index (BMI) category, nearly double the 14,787 of

629,359 children aged four and five (2%) classed as severely obese.

House of Care Metaphor

What’s different about the conversations we have ?

Shifting our mindset:from expert fixer to facilitator/enabler

What % of consultation time is taken by the practitioner talking?

80%

22

On average, how long does it take for us to interrupt?

“My employer is paying for the surgery. I’m having a speed bump installed between my brain and my mouth.”

12-18 seconds

Shared Decision Making

Your ideal definition of Shared Decision Making would be ?

• A - the person agrees with the plan you have made for them

• B - the Health Care Professional (HCP) agrees with and supports the patients plan

• C – it’s the conversation between a person and the HCP to reach a health care choice together

• D - it’s about using a decision aid to help you make the right decision

Your ideal definition of Shared Decision Making would be ?

• A - the person agrees with the plan you have made for them

• B - the Health Care Professional (HCP) agrees with and supports the patients plan

• C – it’s the conversation between a person and the HCP to reach a health care choice together

• D - it’s about using a decision aid to help you make the right decision

Shared Decision Making

Information sharing

• What % of consultation time is taken by the practitioner talking

• What % of the information given to people is understood?

1. Kessels RP. Patients’ memory for medical information. J R Soc Med. May 2003;96(5):219-22. 2. Anderson JL, Dodman S, Kopelman M, Fleming A. Patient information recall in a rheumatology clinic.

Rheumatology. 1979;18(1):18-22.

Half of what a person is told is forgotten¹ and half of what they

remember is misunderstood²

Information sharing

• What % of consultation time is taken by the practitioner talking

• What % of the information given to people is understood?

• Of the information that is understood, what % is acted on ?

Teachback

Teach-back

To be sure I know you’ve understood me, can you show me how you’ll use the inhaler?

To be sure I know I’ve explained myself properly, can you show me how you’ll use the inhaler?

In the following statements , notice where the responsibility lies if the person does not understand:

“Just so I can check I’ve explained

things clearly can you tell me what

you’ve understood”

“There’s a lot to take in. What are you going to say to your partner when you get home?”

Teach-Back Technique

EPE: Elicit, provide, elicit

• Elicit - permission to discuss a topic • Elicit - already existing knowledge• Elicit - permission to offer information• Provide - offer additional information if

required ( use making it Easy techniques)

• Elicit - understanding ( using teachback)

• Explore - self efficacy (confidence in ability to applyknowledge)

Self efficacy

• In 4s• Next best question ( p121)

• I know I need to change but every time I try, the change lasts for a while and then I slip back again. Sometimes I think “ what’s the point?”

Supported Self Management

Your ideal definition of Self Management would be ?

• A - the act of managing or controlling oneself , tact or diplomacy

• B - the ability to apply knowledge and skills to solve problems and manage aspects of one’s own life

• C - it’s about supporting people living with a LTC to develop tools, skills and support they need to improve their own wellbeing

• D - putting people in the driving seat of decision making

Your ideal definition of Self Management would be ?

• A - the act of managing or controlling oneself , tact or diplomacy

• B - the ability to apply knowledge and skills to solve problems and manage aspects of one’s own life

• C - it’s about supporting people living with a LTC to develop tools, skills and support they need to improve their own wellbeing

• D - putting people in the driving seat of decision making

Shifting our Mindset:Choose the person you want to work with

42

People are already motivated andself managing….to some extent.

Focus and build on what matters and what people already know and are doing

Becoming actively

involved in self

management

What matters to HCPs.Eg. Education, addressing illness beliefs/ misconceptions, health behaviour changes . Compliance with medication, self monitoring etc

What matters to me. Eg. mood, anxiety, isolation, coping, confidence, feeling in control, getting back to doing things, seeing people

Focus on small changes that matters most to the person increases possibility of changing aspects of managing the condition that matter to HCPs

What might you ask next?

• It’s been a real challenge getting my confidence back since leaving hospital ?

• How have you managed to to get the confidence that you’ve got back since leaving hospital ?

What might you ask next?

• I want to get out and about more

• Where have you been getting out to just now ?

• How have you been managing to do that?

What might you ask next?

• Since I’ve had the stroke, I know it’s important I stop smoking and live a healthier life

• What do you know about stroke ?

• Why is it important you stop smoking?

• What does living a healthier life look like to you?

What might you ask next?

• Most mornings I wake up exhausted

• How do you manage ?• What’s different about the

days you wake up and , you’re not so exhausted

Care and Support Planning

Review

Planning for small changes

Information sharing

Strengths based Inquiry

Scene setting and agenda

setting

Conversation framework

Shared Decision making

Support forSelf Management

Care and Support Planning

Person not necessarily ready to have a “what matters to you” conversation

Brief Interventions

Review

Planning for small changes

Information sharing

Strengths based Inquiry

Scene setting and agenda

setting

Conversation framework

• Outcome. person’s story: who’s bothered about what; what impact any difficulties are having; what is it that person wants to improve / make better/ do that they can’t currently do

• What’s working (Listening and asking strengths based, exploratory questions)

• The conversation as an intervention (Elicit - Provide - Elicit ( EPE))

• Co-producing a plan to achieve well-being outcomes (which may or may not include providing input/treatment to fix a problem)

• Review .What’s been better ( EARS)

Person Centred Care and Personal Outcomes

• A Personal Outcomes Approach is all about connecting to the person on the basis of ‘what matters to them’ as opposed to ‘what's the matter with them’.

• Then using what matters to help people:– identify what they hope to get from your support– make informed decisions about their care/ treatment– make life changes which supports self management

• It is an asset based approach as it asks important questions about hope and expectation, coping and resilience, person’s own knowledge, what the person is already doing that is helping them move towards where they want to be and using this information to make decisions and plan support/ treatment .

Preparing people to engage

• Website• Brochures• Referral• Letters• Method of appts• Admin/ receptionist • Agenda setting sent out

before meeting• Environment• Explaining your role

Letters• Punitive/ Service led :

“Please note, if you do not attend and we have not heard from you within 10 working days we will automatically discharge you from the Service and your consultant / referrer will be informed . This is because we need to make every effort to reduce wasted appointments as these lead to longer waiting times for others”

• Person Centred:

• We have been asked if we can arrange a meeting with you to discuss whether Physiotherapy can support you to improve how you are managing your health condition and the impact your condition may be having on your life.

• We have suggested an appointment as shown below. We understand that it might not be easy to see us on this day and time, so please call us to rearrange if it doesn't suit. If you choose not to come and see us, we’d be very grateful if you could call to let us know.

Care and Support Planning. Helping you live and stay well with your long term health condition

Name: ......................................................................................................... Your appointment: ...................................................................................... This leaflet is to help you get the most out of the conversation with your health care practitioner by thinking now about what is most important for you to discuss, so that you can work out ways to improve your health and wellbeing. Bring it along with you and you can use it to write down a plan.

Things I might want to discuss or ask about

( Circle any which are important to you)

understanding my health condition better

knowing how to manage my condition or symptoms

feeling more in control or feeling more confident

playing a more active role in improving my own health and wellbeing

improving sleep and energy levels

getting active or eating healthier

managing stress

the impact living with my condition has on my life and on others

how I’m feeling about things

feeling isolated

options around my treatment or

care

my medication or side effects

aches and pains or other symptoms

Other life issues such as

money worries, work, driving,

benefits, travel, sex life

What’s MOST important to me to discuss at my next appointment

Sending out agenda setting

forms