How best to integrate commissioning for shared decision making and self-management support

Shared decision making and self-management support are both elements of person-centred care

They are inter-related concepts, but they are not the same.  There is much debate about their precise relationship. The Health Foundation is working with others to help build a common understanding of these concepts and other aspects of person-centred care.

Shared decision making and self-management support work from common principles

Both promote a central role for patients in determining the health outcomes that they want to achieve.  Another version of this might say: Shared decision making focuses on the process of making an episodic decision such as having an operation or taking a course of medication. Self-management support describes the actions that the health service takes to support people who live with long term conditions to become knowledgeable, skilful and confident daily problem solvers. These differences in purpose and approach in turn lead to the employment of different tools and techniques depending upon whether the conversation between a patient and a clinician or health coach is about an episodic decision or about developing a range of self-management skills

Both require creating an environment in which patients feel confident to play an active role: in which they believe they have a role and in which they have the necessary knowledge and skill.

Shared decision making requires health professionals and health coaches to use communication skills and consultation techniques to help patients think through and understand their options, what is known about the advantages and disadvantages of each and to take into account their personal preferences.  It may take more time in the short run. And it may involve developing or using materials that inform the conversation and support the decision-making process, like decision support materials. It may mean redesigning pathways so that patients have time and space to consider their options and engage their family or others in working through how a decision will impact upon their lives and the lives of their family. The patient’s health outcomes may improve as a result of the decisions they have made and the resulting treatment and care provided by the health service.

Self-management support requires health professionals and health coaches to use communication skills and consultation techniques to motivate and support people to adapt to their conditions, to learn new information to use on a daily basis and to make sometimes challenging changes to their health related behaviour.  It means providing training and support and access to support networks that enable people with long term conditions to build the knowledge, skills and confidence to manage their own health.  It means the health service adapting its systems – such as sending out test results before a person’s appointment – so people feel well prepared and thus more in control.  Being in control, or being activated is an important health outcome in its own right - but being in control also has positive effects on other health outcomes such as quality of life or clinical outcomes.

When you commission services to undertake shared decision making or self-management support, you are in effect commissioning a change in the roles and relationships within service delivery so that patients become active partners in their own health and care.  How that activation happens and how change manifests itself within the system – from the skills of the health professional through to the systems and processes used by the service – can be quite different between shared decision making and self-management support, as well as reflecting differences in individual patients and differences inherent in different places.

Thinking about the outcome you want to commission from a shared decision making encounter or a self-management support encounter is vitally important. We hope that this resource centre will help you make informed commissioning decisions.

QUESTION:  If we want to embed shared decision making and self-management support across a local health economy, is this best done through a commissioning approach that combines both shared decision making and self-management support, or should each be viewed separately?

  • What are the common areas/themes?
  • What are the differences?
  • What are the advantages and disadvantages of these different approaches?
  • What outcomes should we build into contracts and measure?
  • How might we do that?
  • Do commissioners still need to fund things like training and workforce development – or should providers do that?

All resources on commissioning

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