COLLABORATING FOR OUTCOMES: Sustaining and spreading self-management support

1. COLLABORATING FOR OUTCOMES: Sustaining and spreading self-management support International Forum on Quality and Safety in Healthcare Paris 2014

2. Presentation title set in header Conflicts of interest

3. How important is it to you that we support people to manage their own health and healthcare? 0-not at all important 10-extremely important

4. How confident are you that you/your support(s) people to manage their own health and healthcare? 0-not at all confident 10-extremely confident

5. What led you to say the numbers you said?

6. Presentation title set in header Conflicts of interest Once upon a time …

7. What is self-management support? • Self management support can be viewed in two ways: • a portfolio of techniques and tools that help patients choose healthy behaviours; • a fundamental transformation of the patient-caregiver relationship into a collaborativepartnership.” • Bodenheimer T, MacGregor K, Shafiri C (2005). • Helping Patients Manage Their Chronic Conditions. • California: California Healthcare Foundation.

8. Why support self-management? Life with a long term condition: the person’s perspective Interactions with the service: planned or unplanned NB : People may also be accessing a wide variety of other support e.g. from within their communities

9. The job …People are supported to make informed and personally relevant decisions about managing their own health and healthcare and to enact them Should I take that pill today? Am I going to stick to that exercise regime? Do I really want that heart operation?

10. The Chronic Care Model • The problems: • Lack of care coordination • Lack of active follow-up • Patients inadequately trained to manage their illnesses ‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’ Understanding have role; confident and capable in role Supporting people on their journey of activation Developed by the MacColl Institute ACP-ASIM Journals and Books

11. The teams NHS Ayrshire and Arran Calderdale and Huddersfield NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Whittington Health SW London & St George’s Mental Health NHS Trust Guy’s and St Thomas’ NHS Foundation Trust Torbay Care Trust and Devonshire Partnership Trust

12. Co-creating Health

13. An integrated approach

14. The three enablers • Becoming an active partner • Making change • Maintaining change • Agenda setting • Identifying issues and problems • Preparing in advance • Agreeing a joint agenda • Goal setting • Small and achievable goals • Builds confidence and momentum • Goal follow-up • Proactive – instigated by the system • Soon – within 14 days • Encouragement and reinforcement

15. http://personcentredcare.health.org.uk/

16. Here are some things you can talk about at your next appointment…. Blood glucose monitoring Taking medications Skin care Taking insulin Diet Depression  Losing weight Daily foot care Smoking

17. Presentation title set in header Co-production • An equal and reciprocal relationship Partnership Working together Adherence Independent

18. Bovaird’s Co-production Framework FULL CO-PRODUCTION

19. Co-production inCo-creating Health • Delivering • Shared agenda setting, shared goal setting, follow up • Co-delivery of training for patients and for clinicians • Overcoming challenges • Shaping • Emergent • PDSA cycles – My Health Plan • Researchers in evaluation • Reference group – beyond Co-creating Health

20. Presentation title set in header Conflicts of interest Once upon a holiday …

21. Presentation title set in header Changing habits: embedding in routine practice • Target whole teams and groups of clinicians in the same service • Critical mass • Reinforcement • Common language, common conversations, common approaches – from biomedical markers to patient goals • Follow up to training • Action learning sets • Buddying • One-to-one support • E-learning

22. Presentation title set in header Changing habits: peer support • Reunions • Torbay newsletter • Guy’s St Thomas’ Walking Group • Ayrshire and Aran buddying • Working with the voluntary sector • Nesta: People Powered Health

23. Presentation title set in header Changing the context • Engage influential clinical leadership • Influence Board • Support staff • Supportive systems and processes • Supervision • Audit • Part of monthly meetings • Education and training • Undergraduate education • Continuing professional development • Routes in – gold, silver and bronze

24. Presentation title set in header Following the path of least resistance • Tools, templates and IT systems • Calderdale and Huddersfield SystemOne: reminders and reinforcement • Results to patients in advance • Text follow up • Link to other initiatives • Cambridge – pulmonary rehabilitation • Ayrshire and Aran – telehealth care pathway • Calderdale and Huddersfield – Year of Care • Work across sectors and with partners • My Health Plan

25. Presentation title set in header A dose of reality • The business case • Cost vs value • What’s the matter vs what matters • And some hard outcomes

26. Presentation title set in header Some key messages • Whole system change • Interrelated elements – training and improvement • Pathways cross organisational boundaries – understanding and approach need to also • Don’t forget the voluntary and community sector • Co-production – partnership builds power

27. Presentation title set in header Some key messages • Whole system change • Strategic approach to implementation • Build into local strategies • Piggy-back on existing initiatives • Use local levers • Draw upon policy frameworks

28. Presentation title set in header Some key messages • Whole system change • Strategic approach to implementation • Adopt a targeted but flexible approach to delivery • Train teams and groups of clinicians • Have a menu of training and follow-up support for patients • Have a menu of training and follow-up support for clinicians

29. Presentation title set in header Some key messages • Whole system change • Strategic approach to implementation • Adopt a targeted but flexible approach to delivery

31. Presentation title set in header Thank you • Firefly • The Co-creating Health Sites – clinicians, managers, people living with long-term conditions • You

32. Some resources