Creating a shared vision of great, person centred care

Who to involve

In shared decision making and self-management support, the people using services are collaborators in their own health and care and play an active role in determining the outcomes they want. If we want to ‘scale up’ to a whole system that facilitates people to determine and achieve the health outcomes that they want, we must involve the people who use services in developing and designing that system. In effect, we need to apply the principle of shared decision making to the commissioning process itself.

Organisations responsible for planning and allocating resources must engage local stakeholders, including providers, frontline staff and communities.  They all have vital insights into how to make this change work and can play a powerful role in shaping the local vision and identifying how to change and improve services to achieve it.
 

Why involve people who use and deliver services?

Commissioning intentions and service frameworks designed in partnership with stakeholders, designed with both the people who use services and those who provide them should accelerate service change because:

  • They reflect what people say matters most.  When they recognise this, people begin to trust and respect the process and the commissioning organisation
  • They ensure that everyone has shaped and shares the same vision of great care.  This ensures a common focus and purpose across the system, driven by shared values. This enables providers and commissioners to negotiate and compromise when the going gets tough
  • They guarantee that commissioners start measuring what matters and not just what is easily counted. 
 

Identifying outcomes

Commissioning is moving rapidly towards being outcomes based.  Working in this way means commissioners need to identify outcomes that they want to achieve through the services they invest in, from high level ones to the very specific.  An example of a high level outcome around shared decision making and self management support might be:

  • People feel confident and are empowered to make decisions about their treatment and care and manage their own health.

Most clinical services are likely to argue that they already seek to deliver this, and many will have a similarly worded requirement built into their contracts.  

However, work with stakeholders will enable you to ‘unpack’ what this means for the people who use services, and to create a hierarchy of outcomes beneath the over-arching statement, which can then be translated into activity and be monitored.
 
For example, for people with long-term conditions, outcomes need to be designed to capture the impact and outcome of services on people’s ability living their lives and do what matters to them; not just apply clinical measures of wellness. When outcomes are designed in this way, the emphasis shifts towards how a service enables those outcomes - not just what clinical services are provided.
 

A narrative for person-centred co-ordinated care created by National Voices sets out a series of statements that patients and service users could make if the care they experienced was person centred and coordinated. It provides an example of a development process and statements.  Similar statements could be developed with local stakeholders to sit beneath your over-arching statement.

The Esther approach’ was developed by Jönköping in Sweden to move from a service planning approach based on organisations and their functions to one that centres on the pathway of patients through the health system.  ‘Esther’ is not a real patient, but her persona as a grey-haired, ailing, but competent elderly Swedish woman with a long-term condition and occasional acute needs has inspired impressive improvements in how patients flow through a complex network of providers and care settings.  The approach has been adopted in a number of places internationally, including Scotland, Belfast, Torbay (who use ‘Mrs Smith’).
 

Transforming Participation in Health and Care includes extensive guidance and resources on how to engage with local stakeholders to create a rich understanding of what is needed and how to co-design and deliver services that meet these needs, as well as how to measure and evaluate them. 

Creating the right commissioning  (contractual?) framework

A great commissioning (contractual) framework is one that is:

  • Created and owned by stakeholders throughout the system 
  • Values-based 
  • Underpinned by a clearly articulated, shared vision
  • Outcomes-led – with outcomes measures that cover both soft patient experience outcomes as well as harder clinical outcomes.
 

It should deliver:

  • Services, which are focused on achieving the outcomes that matter to people, which encourage responsive services that behave in a very holistic way (Patients eye model).  To use the jargon, this is about moving from a ‘biomedical model’ to a ‘psycho-social’ medical model
  • Ways of nudging providers to move towards person centred, integrated working as we move towards commissioning for co-morbidities as the norm. This brings the strength of the individual components (specialisms of disease focus) and of working as a co-ordinated unit (Common spine model).   

Contracting should be underpinned by risk sharing and financial arrangements that support health and social care teams to work more sustainable ways that are better aligned with what matters to  people and families.

People Powered Commissioning: Embedding innovation in practice sets out a framework of 5 key activities: 

 
  • An outcomes based approach – where outcomes attend to patients’ priorities and to indicators of social and economic value alongside traditional (bio-medical) metrics.
  • Reflecting people’s real lives – creating systems that are coherent and responsive to those engaging with them and aligned with everyday life.
  • Incentivising and supporting collaboration – giving rise to new and sustainable partnerships, networks and alliances.
  • Market making and shaping – in which People Powered Health services can develop and flourish
  • Culture change and leadership – under the leadership of visionary commissioners.
 

QUESTION:  How have you described your vision of great person centred care and aligned contracting processes and outcomes to deliver it?

  • Do you have examples of how you worked with local stakeholders that we can use?
  • Do you have examples of outcomes that we can use?
  • What contracting mechanisms have worked for you and driven person centred change?
  • What hasn’t worked?

All resources on commissioning
 

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