Supporting clinicians to develop the confidence, capability and capacity to support people to self-manage: Part 1 - Doing it yourself
My self-management support journey started six years ago when I attended the Practitioner Development Programme for Clinicians which was part of The Health Foundation’s Co-creating Health programme.
Since that time I have had the opportunity to work with a number of teams and health economies to support workforce development and trial different models of training delivery and learning. One consistent observation is the challenge for clinicians to make the shift from expert advisor, manager and problem solver to a model which also incorporates a coaching and developmental role. Supporting patients to self-manage and to change their health behaviour requires work forces to be confident and capable in their own behaviour change, to truly be able to explore and understand things from the person’s perspective and to explore their own attitudes and beliefs.
This is a complex area and there are a number of skills, tools and enablers that can support clinicians to develop these capabilities. There are also some very practical approaches that I have noticed in training programmes that give key opportunities to enhance this learning.
As an alternative to using simulated patients for interactive role play during training sessions I have become aware of the power of participants working in pairs with their own material and working on areas of change that are important to them. Having the opportunity to be actively listened to and facilitated to talk about the change they want to make using open questions, reflection and empathy and to be facilitated through importance and confidence scaling and SMARTER action planning and goal setting has been hugely powerful. Working in pairs with coaching feedback allows people to experience the tools and techniques from both the clinician’s perspective and also the person’s.
Feedback on this approach is extremely positive and clinicians regularly report that participating in these exercises has enabled them to think about their challenges in a different way, generating new thoughts and ideas that they have not had before. They regularly report feeling more confident and motivated to start working towards the change they have been considering and have identified their first step forward and an action plan. There are a variety of areas that people chose to work on in the training sessions that are important to them. For some these are health related issues such as weight loss, getting more exercise or managing stress, for others it may be about practical issues such as moving house or managing family dynamics. For the overwhelming majority they find the experience enabling and very helpful.
Workforces in health and social care are under enormous pressure, they often struggle with many of the same challenges that people living with long term conditions and those contemplating changing their health behaviours also face. I have observed that creating a learning environment which helps staff to develop and experience the impact of these approaches from both perspectives has multiple benefits, both within the clinician-person interaction and individually. Many clinicians have said that this approach has facilitated them to utilise the skills in their work and day to day lives and that this has increased their confidence to use them within clinical practice.
Additionally managers and team leaders describe the positive impacts of utilising a self-management support approach within their leadership roles, for example using collaborative agenda setting for staff meetings and appraisals, SMARTER action planning and goal setting for departmental initiatives and importance and confidence scaling together with exploring ambivalence as a structure to support teams to explore difficult choices and challenges.
If we are going to achieve our ambitions of delivering excellent person centred care through workforces who are skilled in self-management support and health behaviour change these skills need to be developed and used regularly. They must become the norm not the exception and part of core workforce skill sets. We need to capitalise on every opportunity to do this both within the learning environment, our day to day work and our organisational models of working.
A very wise person once said to me when I nervously started out on my journey as a self-management facilitator and workforce trainer ‘what are you worrying about, you’re doing it aren’t you?’