Monitoring for impact and improvement

If you have clearly articulated the outcomes services are trying to achieve in partnership with the people who use them at the outset, then you will have built a definition of the right outcomes to measure that can be used to hold the system and providers within it to account.

More than that, you should know what to measure so that:

  • Services understand where they can improve (insight data)
  • Services understand how they can improve (improvement data)
  • Commissioners understand whether services are delivering their overarching aims (outcomes data)3

There are some ‘hard’ measures that health economies can use to monitor impact. 

For shared decision making, these are most likely to be changes in rates of intervention for particular conditions. For self-management support these are most likely to be health outcome indicators e.g. reductions in HbA1c levels within the population with diabetes – or service utilisation indicators e.g. through implementing the LTC generic care model (and based on results demonstrated elsewhere) teams can measure and aim for the following outcomes:

  • Reduction on non-elective admissions (aim for 20%)
  • Reduction in length of stay (aim for 25%)
  • Reduction in readmissions
  • Improve patient experience.

See more potential ‘hard measures’ for self management support.  

Commissioning shared decision making and self-management support is more than commissioning an intervention, it is commissioning for culture change – a change in the relationship between the health professional and their patient; a change in the conversation between the health professional and their patient, and a change in the way services work to support that shift. 

This means that patient experience must be a key dimension of any measurement framework for person centred care.  Transforming Participation in Health and Care: Measuring Participation sets out a range of existing measures and tools available to help monitor and evaluate progress in individual participation and experience.  These include international tools, such as the Patient Activation Measure, and national tools such as the LTC6 Questionnaire.

The challenge of changing behaviour is significant and tricky to measure. We already know that the NHS wastes millions of pounds on medications patients don’t take.  This simple and well-worn example shows how difficult it can be to influence people’s behaviour beyond the consulting room.  Yet some of the key outcomes of self-management support – improved clinical outcomes and related changes in service utilisation – depend on what the patient does after they see their health professional. 

There is still work to be done to develop measurement processes that capture not just patient experience and outcomes, but help us to understand how well providers are enabling people to self-manage and be independent.

QUESTION:  How are you monitoring or do you plan to monitor shared decision making and self-management support locally?

  • What off-the-shelf or locally developed tools and measures are you using?
  • What challenges have you experienced and what solutions have you identified?
  • Have you any novel ideas about how we might measurement how empowered people feel?

All resources on commissioning

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