how to make care and support planning a 2 way dynamic
DESCRIPTION
How to make care and support planning a two-way dynamic - presentation from webinar held on 1 October 2014 This relates to the first NHS IQ Long Term Conditions Improvement Programmes Wednesday Lunch & Learn Webinar Series. How to make care and support planning a 2 way dynamic hosted by Dr Alan Nye & Brook Howells from AQuA. This webinar discussed how to encourage patients, carers and the public to work alongside (in equal partnership) with clinicians and managersTRANSCRIPT
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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
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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
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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
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Bespoke Support
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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
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Tools and Resources
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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
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LTC Learning Forum
Wednesday “Lunch & Learn” Webinar Series&
Bite Size Master-classes
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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
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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
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Shared Decision Makingand Self-Management Support
Dr Alan Nye, Clinical LeadBrook Howells, Programme Manager
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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
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• 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
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“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
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• 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
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Where are we now-unwarranted variation
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“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
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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
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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
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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.
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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
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Agenda Setting
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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
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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)
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“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
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“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
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Measuring involvementwith decisions
Elwyn et al, 2013Legare et al, 2010
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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
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“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
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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• [email protected]• [email protected]
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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
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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 [email protected]