Who to involve

The clinical team is essential, but you also need to involve others to plan, implement and embed shared decision making in the care pathway.

If you are planning to implement shared decision making across multiple teams, you will need the support and involvement of a wide range of stakeholders.  Different groups and individuals need to be involved in different ways depending on the role you want and need them to play.

Spend time planning so you can get the right people on board from the start:

  • map out who you need to engage – you can use our stakeholder mapping tool to help you
  • work out what motivates each group and adapt your communication style and techniques to suit each audience – you can use our engagement template to help assess who to work with and how
  • develop a communication plan to ensure you cover all the elements – you can use our communications plan template to help
  • don’t underestimate the amount of communication required, especially in the early stages.
  • recognise not everyone will engage at the same rate
  • listen to the groups you are trying to engage – their points may be valuable and not a sign of resistance

Engaging with key groups

Engaging clinical teams who are implementing shared decision making

  • Identify any multidisciplinary teams already interested in shared decision making with whom you could test implementation within your organisation
  • Be prepared to learn about yourself: what you and your project team members wish to gain from the project may be different
  • Identify and engage all healthcare and other staff such as admin involved in the decision pathway from the outset from all care settings (eg acute, community, primary care). Remember that a multi-disciplinary team extends beyond core clinical staff.
  • Identify and engage middle managers and lead clinicians that can influence the changes needed for improvement.
  • Create specific team time for discussing implementation. This includes non-clinical staff such as the admin team who may have a role to play.
  • Map the current pathway and look at the current cultures and practices which could block or boost successful and sustainable implementation.
  • Get to know team members and identify what aspects of the programme appeal to each team/clinical lead. Build an action plan including communication and team resources around this.
  • Be tactical about working with more receptive colleagues to start with – don't give an impression of leaving anyone out of the implementation plan.
  • A small amount of example is worth more than a mass of advice and recommendations, so collect case studies and stories to demonstrate what you are trying to achieve.
  • It can be difficult for clinical teams to find time to meet together to discuss shared decision making activity so ask teams to help you set realistic time horizons and get permission to 'hang about' in clinical settings. Core teams need to demonstrate a flexible and intensive commitment to work around the time constraints faced by clinicians.
  • Identify the clinical teams' training requirements before the project begins. Does the clinical team understand Shared Decision Making and the evidence for improvement in patient services?
  • Do they believe they can do more and better shared decision making with project team support? (including extended skills training).
  • Do they have knowledge and experience of quality improvement methodology – PDSA cycles, rapid feedback, action learning?
  • Involving the clinical teams in the development of locally appropriate measures increases the motivation to use a measure.
  • Engage teams in the development process for decision support tools. It increases engagement and buy-in and helps overcome some of the barriers associated with implementing new tools.

Engaging with wider multidisciplnary teams

  • Wider multi-disciplinary teams may not be involved initially, but you may need their support later on.
  • Build relationships with the wider multi-disciplinary teams – let them know what you are doing and keep them up to date with progress.
  • Anticipate concerns and challenges, i.e. 'we're doing it already' or 'we've no time': have some answers prepared.
  • Think of every meeting/activity with colleagues as an opportunity to brief them and keep them engaged with progress and how they can be involved and help.
  • Be aware of their priorities and be prepared to show how shared decision making can support their work eg updates at directorate level meetings.

Engaging patients, families and their advocates as part of the project team

  • Working closely with patients – as partners in decisions about treatment and care; as part of the implementation team; as advocates for shared decision making – will accelerate your progress and learning.
  • Shared decision making requires changes in the behaviour of clinicians and patients, which is more likely to occur if there is strong and consistent organisational support at all levels. Having patients as a visible part of the organisation delivers a powerful message about unity of purpose as well as an opportunity to influence more widely.
  • There are big differences between representation, consultation, participation and partnership: patients can contribute at all levels – but partnership should be your aim.

Examples of patient involvement from the Health Foundation's MAGIC programme

  • Members of the Patient and Public Involvement (PPI) Panels in Cardiff and Newcastle contributed to monthly meetings of the implementation group by commenting on plans and progress and by reviewing programme materials under development. They made contributions to various events aimed at raising awareness within the host organisations and also to external audiences. A patient voice was important in enhancing the credibility of shared decision making.
  • In Cardiff, patient representatives opened doors to specific interest groups, where interest was generated and patients were introduced to new ways of thinking about their part in decision making.
  • In Newcastle, PPI panel members were involved in 'patient walkabouts' in clinical areas alongside clinical and management staff.  They were able to identify better ways for clinicians and the organisation as a whole to engage with patients. 

Engaging the board and senior management

  • Make sure you can explain how shared decision making works – a helpful approach is to walk them through the shared decision making process – and ensure they understand the benefits to patients, the clinical team and the organisation.
  • Explain how the work you will do to implement it fits with other organisational priorities and initiatives and connects to and supports the delivery of the strategy of your organisation and the NHS eg QIPP, risk strategy.
  • Think through how best to report the project's progress and results, for example link the project outcomes to key performance indicators (KPIs), improving patient experience and satisfaction and aligning to quality accounts where possible.
  • Think about who at Board and clinical leadership level could provide active support for shared decision-making
  • The attention of Medical Director and Director of Nursing can be very powerful both to the Board and to the organisation, so engage them early as advocates and introduce them to the project teams.
  • Demonstrable senior leadership support, such as visits or 'walk arounds' by members of the Board or Executive Team can be a helpful way of engaging more clinicians in shared decision making.

Summary

  • Working closely with patients – as partners in decisions about treatment and care; as part of the implementation team; as advocates for shared decision making – will accelerate your progress and learning.
  • Shared decision making requires changes in the behaviour of clinicians and patients, which is more likely to occur if there is strong and consistent organisational support at all levels.  Having patients as a visible part of the organisation delivers a powerful message about unity of purpose as well as an opportunity to influence more widely.
  • There are big differences between representation, consultation, participation and partnership: patients can contribute at all levels – but partnership should be your aim.
  • Think about which patient and public representatives or groups could help you develop or support a programme for shared decision making.
  • Find out where you currently have good examples of patient involvement in your organisation and learn from them