Report on Shared Decision Making and Self-Management Support AQuA Collaborative Programme 2013/14

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The aim of the AQuA Shared Decision Making and Self-Management Support Collaborative programme was to achieve a 10% improvement in the number of patients actively engaged in their care and treatment.  This report describes the work undertaken by 22 teams taking part in the programme and their learning.

 In particular it identifies three crucial elements to successful and sustainable implementation of shared decision making and self-management support: support at Board level so the implementation and training of staff are part of standard operations; training and support for individual clinicians to challenge the common misconception that “we are doing this already”; and empowering patients through the use of resources such as Ask 3 Questions and agenda setting tools.  The report also identifies the importance of measurement.

The programme had three elements:

Leadership and culture: with the aim that senior managerial and clinical leaders understand, practice and support shared decision making and self-management support, providing the primary drivers for both the uptake and continuation of improved patient engagement with care and treatment. Each team had a named programme lead, clinical lead, data lead and executive sponsor who were responsible for describing the experience of achieving clinical and cultural change with healthcare professionals and patients.

Tools and techniques: with the aim that, where appropriate, clinicians and patients are using SDM/SMS tools and techniques.  AQuA identified potential tools and techniques to support SDM/SMS in a wide range of care settings and clinical areas. 

Staff delivery: with the aim of building capacity among staff to effectively use shared decision making and self-management support across all identified pathways.  Tools, techniques, training and leadership were provided as pre-requisites for this programme. Teams then took individual responsibility for the use of SDM and SMS in practice.

Learning from the programme included

Approach
• Use multi-stage application process to select teams that were prepared to invest the time and energy embedding SDM/SMS 

• Complete planning canvasses to avoid misunderstandings 

• Use dedicated data submission links for each team to facilitate data submission 

• Emphasise aim of measurement for improvement to maintain data submissions and allow teams to reflect accurately on results 

• Complete patient questionnaires immediately post-consultation 

• Networking and collaboration between teams increases over time 

• Use dedicated facilitators to support teams in training, implementation and programme management

 • Set realistic and meaningful ‘So What’ targets within each setting 

• Invest time upfront to ensure greater understanding of ‘So What’ measures to allay concerns that the metrics were not ‘clean’ and could be influenced by many factors 

• Factor declining attendance into programme design with shorter events (rather than whole days) in the latter stages of the programme 

Leadership and culture 
• Identify strong clinical and high-profile advocates for SDM/SMS to promote improvement - embed regular team catch-ups with these advocates 

• Identify senior sponsors who actively engage with team leads and support progress 

• Teams must have common purpose and approach linked to organisational priorities 

• Provide resources to support teams 

• Facilitators must keep SDM/SMS on the agenda even during busy times 

• Facilitators need to understand previous and current experience in improvement methodology and pace change accordingly 

Techniques and approach
• Take time out from service commitments to train and practice learned communication styles and techniques when engaging with patients 

• Use of the Mental Capacity Act (MCA) has had a considerable impact on approach to utilising SDM/SMS 

• Motivational interviewing works well for healthcare professionals and patients 

• Agenda setting and Ask 3 Questions tools are essential to support SDM and SMS 

• Include staff and patients in co-design of tools to ensure broad perspective 

• Patient push for SDM and SMS facilitates wider adoption of tools and increases commitment to individual accountability 

Staff delivery 
• Use the A3Q resources and participate in the SDM/SMS AQuA facilitator-led training 

• Ensure executive and organisational support for SDM/SMS

 • Ensure patient/user involvement including Patient Ambassadors and patient group input 

• Allow local peer leads to provide the ‘case for change’ 

• Use agenda setting tools • Develop and use brief decision aids 

• Incentivise SDM/SMS through CQUIN payments Patient demand/engagement

• Proactively encourage patient engagement from the outset 

• Improve contact methods with (and persistence in contacting) potential Patient Ambassadors as part of the original programme 

• Ensure clarity on the use of trained Patient Ambassadors within clinical teams 

• Use a greater pool of patient nominations to increase overall participation in the programme 

• Use existing, well-established forums as these patients are most keen to contribute 

Sustainability 
In organisations where SDM/SMS has been effectively sustained there are a set of common traits:
• Organisational SDM/SMS advocate with executive support 

• Clear ‘line-of-sight’ between organisation values/aims and case for SDM/SMS 

• Continuous measurement and review of data that ‘means something’ to the organisation

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