How to make Care & Support Planning a 2-way Dynamic

 Wednesday 1 October 2014 (13:00 – 13:45)

Dr Alan NyeClinical Lead Shared Decision Making, AQuA

Brook HowellsProgramme Manager Shared Decision Making, AQuA

Beverley Matthews NHS Improving Quality Programme Delivery Lead for Long Term

Conditions

Bev MatthewsA nurse by background, Beverley has worked extensively throughout the NHS in a variety of clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of NHS Kidney Care an NHS Liver Care. Passionate about service transformation through developing networks and leading complex programmes. Providing strategic leadership to partners within health communities, managing stakeholders and working across agencies.

Dr Alan NyeGeneral practitioner with a special interest in rheumatology, he also is the Director of Pennine MSK Partnership, which is a clinically owned accountable care organisation delivering rheumatology, orthopaedics and chronic pain services in Oldham. Clinical lead for shared decision making (SDM) at AQuA . In 2012 AQuA was commissioned to deliver NHS England’s programme to implement SDM across the country. He is president of the primary care rheumatology society

Brook HowellsProgramme Manager with the Advancing Quality Alliance (AQuA), assisting clinical teams from a number of NHS trusts across the North West. Currently workinig with the Shared Decision Making and Self-Management Support Programme, supporting the challenge of improving culture such that clinicians and patients work more collaboratively and in partnership with each other. She has previously facilitated improvement projects with the Collaboration for Leadership in Applied Health and Research Care (CLAHRC) for Greater Manchester.

Meet the Speakers

How to make Care & Support Planning a 2-way Dynamic

• Have a different kind of conversation.• Make a partnership approach the ‘business as usual’ for

individual/care professional interaction.• Hear the views of care professionals who have front-line

experience of implementation.• Know how to encourage patients, carers and the public

to alongside (in equal partnership) with clinicians and managers.

• Understanding the paradigm of shared decision making.

Learning Outcomes

Bespoke Support

The approach:• Identify sites guided by intelligence from the LTC Dashboard and local

advice• Support local health economies to understand their baseline position

through the self assessment Diagnostic Tool• Provide coaching support to start identifying interventions that will

drive change and develop the local action plan.• Agree bespoke support package with memorandum of understanding• Developing a facilitators network of local champions• Use evidenced based improvement methodologies to facilitate

change• Embed measurement and evaluation expertise throughout the

delivery• Development of implementation guide in real time

Tools and Resources

LinksLong Term Conditions Dashboardwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-house-of-care-framework.aspx#

Long Term Conditions House of Care Toolkitwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx LTC House of Care Personal Levelwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/personal.aspx LTC House of Care Local Levelwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/local.aspxLTC House of Care National Level www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/national.aspx

#LTCyearofcare #LTCframework #NHSIQFollow Team @NHSIQ @Bev_J_Matthews @Catherinestro17

LTC Learning Forum

Wednesday “Lunch & Learn” Webinar Series&

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Virtual Learning Network Wednesday “Lunch & Learn”

• 45 minute “real time” Webinar sessions • Topics agreed and learning outcomes

identified• Faculty of Speakers identified• Speakers support package being

developed• Marketing of series to commence

September 2014

Open invitation

Bite Size Learning Master-Classes

• Pre-recorded 20 minute Master-classes• Master-class either as stand alone

sessions or pre-requisites for Wednesday “Lunch & Learn” Webinars

• Faculty of Speakers identified• Speakers support pack developed• Marketing to commence September

2014

Open invitation

 How to make Care & Support Planning a

2-way Dynamic

 

Dr Alan NyeClinical Lead Shared Decision Making, AQuA

Brook HowellsProgramme Manager Shared Decision Making, AQuA

Shared Decision Makingand Self-Management Support

Dr Alan Nye, Clinical LeadBrook Howells, Programme Manager

The AQuA SDM andSMS Programmes

• 2012-13: National SDM Programme– 33 teams– Maternity, MSK and Renal settings

• 2013-14: AQuA SDM/SMS Collaborative– 28 teams– North West rather than national– Incorporating Self-Management Support (SMS) as well as Shared Decision

Making– Focusing on long term conditions

• 2014-16: SDM/SMS in Transition, Health Foundation funded Closing the Gap in Patient Safety Programme– 7 teams recruited– Network of interested people in development

• Collaboration and partnership working

• Patient-centred care

• Personalised, individual choices/treatment

• Sensitivity to preferences

• Sharing information and responsibility

• Good health[care] beyond clinic visits

What is it all about?

Social; interactions with family, friends,

workmates

Psychological; reactions, thoughts,

feelings

Biological; bodily symptoms

“It’s about clinicians “letting go” and allowing patients to make a different choice to the one they may have made.”

Chris Goldsmith, Renal Consultant,

Aintree University Hospital NHS Foundation Trust

Feedback from 2012/13 SDM Collaborative

• Better consultations• Clearer risk

communication• Improved health

literacy• Improved confidence

and self-efficacy• Improved health

behaviours• Reduced costs

• Fewer unwanted treatments

• More appropriate decisions

• Greater compliance with ethical standards

• Greater equality of care• Safer care• Improved patient

experience

The Benefits

Courtesy of Angela Coulter, Informed Medical Decisions Foundation

Where are we now-unwarranted variation

“In the past we would often have known the patient’s preferences, circumstances or values because we had worked with them over a long period of time as their GP. Nowadays however, patients do not always see the same clinician because the practices are so large or because there are trainee GPs in the practice, so perhaps we do need to be asking them what their preferences and values are.”

General Practitioner, NHS Trafford

Feedback from 2012/13 SDM Collaborative

RecognisedChallenges

PatientsWorking with patients of cultural/ethnic minorities, differing expectationsPatients often need time and support to self-manage outside of appointmentsDenial

Service structure

Insufficient elf-management support commissioned to change culture?Getting protocols working between providersLack of choice in treatment available locally

Staffing structure

Staff skill mix/capacity to provide service/support developmentsTime to educate patients, talk to people and offer a range of information

Skills/ knowledge

Using the most up to date evidencePeer v professional led self-managementCommunication skills

Nature of change

Breaking old patterns of practiceImproving efficiency in small thingsInstitutional practicesMeasuring change to see the impact is positive

How is it done?

• Supporting patients to get involved

• Structuring conversations differently

• Providing evidence-based, balanced information

• Asking patients what they’d like more of

Supporting and encouragingpatients to get involved

Leaflets, posters, animations, postcards…

A prompt for patients to ask three basic, but important, questions about what options are available to them

Useful prompts for clinicians too.

Agenda setting

Information gathering

Decision making

• Experience of illness

• Social circumstances

• Attitude to risk

• Values

• Preferences

• Diagnosis

• Cause of disease

• Prognosis

• Treatment options

• Outcome probabilities

Adapted from The King’s Fund (2013)

RestructuringConversations

Patient’s Input Professional’s Input

Agenda Setting

The Model for SDM(Elwyn et al 2012)

ChoiceTalk

OptionTalk

Decision Talk

Decision Support Brief (inside) &

Extensive (outside)

Good Decision

D E L I B E R A T I O N

Prior Preferences

Informed Preferences

J Gen Intern Med. 2012 October; 27(10): 1361–1367.

Informing, comparing,deciding on options

D e l i b e r a t i o n

Choice Talk

 

OptionTalk

Decision Talk

GoodDecision

Decision SupportBrief – during Long – External

 

Prior Preferences Informed Preferences

“C O D”

Adapted from The Model for SDM by Elwyn et al and MAGIC programme (2012)

“In terms of using with patients: I recently had a discussion with a patient about a very difficult and complicated decision regarding the possible use of a second course of strong immunosuppression for a long term condition. The choice/option/decision structure was very helpful as a way both to approach the consultation and to reflect on the discussion in my letter to the patient afterwards.”

Renal Consultant

Feedback from 2012/13 SDM Collaborative

“It’s a great idea and should be of real benefit to patients once rolled out to all clinical areas of the NHS.” “It was fairly easy to implement into our practice because we were already using SDM, although not formally or in a measured way.”

Stephen Bunting, Physiotherapy Extended Scope PractitionerAintree University Hospitals NHS Foundation Trust

Feedback from 2012/13 SDM Collaborative

Measuring involvementwith decisions

Elwyn et al, 2013Legare et al, 2010

Measuring impactof involvement

Apr-12

Jun-12

Aug-12

Oct-12

Dec-12

Feb-13

Apr-13

Jun-13

Aug-13

Oct-13

Dec-13

05

101520253035404550

Percentage of DNAs forAdolescence Diabetic Clinic

DNA% Average

Perc

enta

ge o

f m

onth

ly D

NA

s

Jan Feb Mar Apr May Jun Jul Sep Oct Nov Dec05

10152025303540

Median Length of Stay

March - April 2013 Sept-Oct 20130

50

100

150

200

250

300

350315

173

253

132

No of reported problems with equipment on handover

LWSMH

Monitoring relevant key performance indicators to assess the impact of Shared Decision Making

“I feel SDM is something we think we have always done, but when considering SDM probably never have shared choices fully. I think this gives a good template to guide discussions.It has improved working together with the vulnerable team. It has improved discussion with the women who have engaged with the SDM ProjectThe women have been really receptive to it. I feel that they have responded well to being involved in decision making. I feel this is particularly positive with the vulnerable women that we work with.”Blackpool Maternity Team

Feedback from 2012/13 SDM Collaborative

Further Resources

• Training and advice from facilitators experienced in working with over 50 clinical teams;– Introductory workshops– Half day training workshops– Train the Trainer Programme

• Case studies of staff and patient experience

• www.advancingqualityalliance.nhs.uk/sdm• Brook.Howells@srft.nhs.uk• Alan.Nye@nhs.net

Useful ResourcesAQuA SDM www.advancingqualityalliance.nhs.uk/

Programme Budging for Shared Decision makingwww.advancingqualityalliance.nhs.uk/wp-content/uploads/2013/04/PENNINE-MSK-CASE-STUDY-FINAL.pdf

Making shared decision making a reality: A Coulter & A Collins (July 2011) www.kingsfund.org.uk/publications

SDM Programme measuring shared decision making a review of evidence www.rightcare.nhs.uk/wp-content/uploads/2012/12/Measuring_Shared_Decision_Making_Dec12.pdf

Wednesday Lunch & Learn SeriesComing next

Date Webinar Hosted by

15 October @ 12noon Co-morbidity and cost implications

Dr Umesh Kadam

22 October @ 1pm Commissioning for Outcomes

Bob Ricketts

To register email catherine.strong@nhsiq.nhs.uk