co-creating health: a collaborative approach to self management support
TRANSCRIPT
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Co-creatingHealthSupporting self-management8 July 2010
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The pillars of the HealthFoundations approach
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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.
Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.
Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.
Encourage. We work across every level of the healthcare system tocreate advocates for our approach.
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The pillars of the HealthFoundations approach
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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.
Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.
Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.
Encourage. We work across every level of the healthcare system tocreate advocates for our approach.
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The pillars of the HealthFoundations approach
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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.
Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.
Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.
Encourage. We work across every level of the healthcare system tocreate advocates for our approach.
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The pillars of the HealthFoundations approach
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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.
Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.
Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.
Encourage. We work across every level of the healthcare system tocreate advocates for our approach.
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Our aim
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To improve the quality of care bytransforming the dynamic
between people who use servicesand those that provide them
The nature of the interactioncreated by the structures, processes andbehaviours that exist within the system
Patients, clients groups,service users, carers,
families and communities
All those who work in ordeliver care services
Safe, effective, timely,person centred, equitable
and efficient
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Our starting point...
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Quality can be improved only so far by focusing withinorganisations and professional bodiesHigh quality care demands high quality interactions between thepeople using services and those that provide them
People using services need to be able to play an active role in their careand they need to feel respected, supported and cared about
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What needs to bedifferent?
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Clinicians, managers, services and systems need to:
invite and enable an active role , meet physical, psychologicaland emotional needs
approach people with compassion and respect support people in understanding their options and in making
their decisions.This requires changes in philosophy , beliefs and behaviours
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Transforming the dynamicWhich dynamic
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Shifting from an orientation in which the habits and rules of providers andprofessions come first, to one in which the world is seen through the eyesof the person: felt experience and authority
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Transforming the dynamicwhat have king Solomon and the Beckhams to say?
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Co-creatingHealth:Transforming healthservices dynamics withpeople living with a long-term condition
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Now? Service driven ...
Care pathwaysBio-medically informed treatment escalators
for individual conditionsGate -keepers on every floor
Self care support
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and reactive to crises
Please help me
Ill do my best
I amscared
****, I dont have anything
else to try
Anxiety informs the decision making process
Clinician becomes primary decision maker
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Peoples perspective?
Scheduled care planningappointments, providingproactive, structured
support
Scheduled follow upappointments,providing motivational support
Scheduled carepathway, providingspecificinterventions
Shared decisionmakingDecision aids
Life with a long term condition: the persons perspective
Interactions with the service: planned or unplanned
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Informed, activatedpatients
Prepared, proactive teams
Optimal functional and clinical outcomes
Working in partnershipSharing decisionsPlanning care and support
A supportive system
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Co-creating Health (CCH)Aim: to a chieve measurable improvements in the quality of life of people living with long term conditions and improve theirexperience of the healthcare system by embedding self managementsupport within mainstream health services
Co-creating Health
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Supported self-managementhappens here
Locating Co-creating Health
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supporting people on their journey of activation
Activated people; pro-
active teams
Understanding haverole; confident and
capable in role
Supported self-managementhappens here
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Agenda setting agreeing a joint agenda
Goal setting Small and achievable goals Builds confidence and momentum Clinical?
Goal follow-up Proactive Soon Regular reinforcement
Becoming active partners
Making change
Maintaining change
Co-creating healththe three enablers
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Advance Development Programme
Self-management Programme
Service Improvement Programme
Co-creating healththe three on-site programmes
Clinicians with the knowledge, skillsand attitudes required to provideeffective self-management support
People with a belief in the efficacy of self-management and the confidenceand skills to undertake it
Health systems that encourage andfacilitate self-management by patientsand self-management support byclinicians
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Advance Development Programme Skills to work in partnership Motivational support Co-facilitated
Self-management Programme Health literacy Collaborative decision making skills Self-management techniques and
confidence Co-facilitated
Service Improvement Programme Intensive change management support Quality improvement methodology
Co-creating healththe three on-site programmes
Clinicians with the knowledge, skillsand attitudes required to provideeffective self-management support
People with a belief in the efficacy of self-management and the confidenceand skills to undertake it
Health systems that encourage andfacilitate self-management by patientsand self-management support byclinicians
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Informed, activatedpatients
Prepared, proactive teams
Optimal functional and clinical outcomes
Working in partnershipSharing decisionsPlanning care and support
A supportive system
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Co-creating Health
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WandsworthTeaching PrimaryCare Trust &South WestLondon and StGeorges MentalHealth NHS
Torbay Care Trust& DevonPartnership Trust
CambridgeshirePrimary CareTrust &CambridgeUniversityHospitals NHSFoundation Trust
NHS Ayrshire andArran
Calderdale andKirklees PrimaryCare Trusts &Calderdale andHuddersfield NHSFoundation Trust
Bristol PrimaryCare Trust &North Bristol NHSTrust
Southwark Healthand Social Care &Guys and StThomas NHSFoundation Trust
Islington andHaringey PrimaryCare Trusts & TheWhittington NHSHospital Trust
3 years plus 2 People living with 4 conditions 8 sites
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It takes just that little bit longer the first time but how amazing it is to
find that when people are managing themselves and doing that bit
more for themselves how much less they need to see you as aclinician. People do need to see you less .... Theres a real bonus to
clinicians seeing patients in front of you have light bulb moments and
go Oh I see and actually Ive sat here and said very little, its quite
empowering for the doctor because its wonderful to see.
General practitioner
Co-creating Healththe difference
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We are used to the traditional way where you visit a patient and say
okay today were going to do da.. da.. da.., and the patient saysokay you are the boss, youre the nurse, and most of the time
were wondering why is it not working ... now its the reverse and
you are saying, okay, what do you want us to do today.
Community matron
Co-creating Healththe difference
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In the past, I used to go to the doctor and say What are you
going to do to fix my problem?, but now Im saying like, Im
not sure these particular painkillers are working the way we
hoped, can we try something else?
Person living with a long-term condition
Co-creating Healththe difference
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I found out about the Self Management Programme ... It changed the way I thought
about myself and my depression in particular - because that was what was crippling
me... The skills that I learnt ... was the real key for me ... One of the big issues I hadwas finding a rheumatologist that was sympathetic to my symptoms. And, being on
the SMP, it actually raised the issue that I could negotiate this with my GP. I didnt
realise how receptive she would be. But it gave me the confidence to raise the issue
with her, and also, helped me realise how important it was for me to actually find aspecialist that I felt comfortable with.
Person living with a long-term condition
Co-creating Healththe difference
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Co-creating Healthchanging roles
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CLINICIAN
Believes knowledge creates behaviour
change
Gives expert advice and prescription
Seeks compliance with cliniciandetermined goals
Scientific focus on condition
Lead part
Reactive
CLINICIAN
Believes supported self-efficacy plus
knowledge create behaviour change
Provides enabling support
Seeks exploration of persons goals
Empathetic focus on person
Supporting role
Proactive
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Co-creating Healthchanging roles
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PATIENT
Believes clinicians role is toimprove health
Passive recipient of care
Supporting role
Reactive
PERSON
Believes supported self-efficacyplus knowledge create behaviourchange
Determines and enacts goals
Lead part
Proactive
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Co-creating Healthchanging models
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Conventional model
SYSTEMTraining: clinicians trained incommunications skills to enable themto get agreement to cliniciandetermined goalsInformation flows: results sent toclinician to share with patient during
consultationAppointments system allows for onlyfixed time 1:1 consultation
Engagement: individually-based,representative
Co-creating Health model
SYSTEMTraining: clinician trained in skills tosupport people to determine and enacttheir own goals
Information flows: person receivesresults in advance of consultation
unless they determine otherwiseAppointments system allows differenttypes of consultation e.g. group,telephone e.g. emailEngagement: community-based,participative
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Being differently Roles
o Clinician from expert to enablero Patient from expectant to
empoweredo Managers from regulators to
liberators
Wayso Quality improvement
Co-creating healthsome challenges
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Being differently Roles
o Clinician from expert to enablero Patient from expectant to
empoweredo Managers from regulators to
liberators
Wayso Measurement from audit to quality
improvement
Leadership for change differentlyLeadership for change Clinical leadership: social modelling Project leadership: keeping on track Executive leadership: supporting the
vision
Training in QI techniques
Co-creating healthovercoming challenges
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Being differently Roles
o Clinician from expert to enablero Patient from expectant to
empoweredo Managers from regulators to
liberators
Wayso Measurement from audit to quality
improvement
Leadership for change differentlyLeadership for change Clinical leadership: social modelling Project leadership: keeping on track Executive leadership: supporting the
vision
Training in QI techniques
incentiverhetoric reality
motivation
Co-creating healthinternalising change
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Embed the approach within the existing condition
Identify successful approaches to making the model self-sustaining
Demonstrate successful approaches to securing the wider uptake of the approach
Spread approach to other conditions, clinical communities and/orsettings
Co-creating Healthgoing forward
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Presentation title set in header
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Presentation title set in header
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Co-creating Healthto see differently is to do differently
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Transforming the dynamicworking together to do things differently
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www.health.org.uk
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Song of Songs
Transforming the dynamicking Solomon and the Beckhams
I am my beloveds andmy beloved is mine