Embedding Shared Decision Making in Provider Organisations

1. Embedding Shared Decision Making in Provider Organisations Sheila Macphail Dave Tomson Maureen Fallon

2. Embedding Shared Decision Making in Provider Organisations Welcome • Who is here? • Where is everyone at already with SDM in their organisation - ahead of MAGIC or not yet started? • How and why did you start?

3. Embedding Shared Decision Making in a Provider Organisation What have we achieved? • Widespread change • Generated enthusiasm • Collaborative working across health systems, sites and care providers

4. Embedding Shared Decision Making in a Provider Organisation What have we achieved – GP practices ? • 6 in depth practices • 30 MAGIC lite practices • Examples: • Use of tools/ different phrases used/discussion over coffee. • Beginnings of pathway change – urological referral in North Tyneside • Significant change in referral behaviour in South Tyneside

5. Embedding Shared Decision Making in a Provider Organisation What works and challenges in primary care • Leadership, learning sets, professional pride • Education - particularly skills training • Finding ways of keeping SDM on the practice agenda - facilitators • Paying the practice for time taken to deliver a QI process • Peer pressure or CCG initiatives

6. Embedding Shared Decision Making in a Provider Organisation What have we achieved –secondary care in Newcastle? • Teams engaged in SDM – increasing requests for training • More informed and trained clinical teams • Established Trust SDM group • Making inroads to less obvious areas for SDM – ITU admission, MDTs, Transplant. • Supporting a dialogue with commissioners including services commissioned at a national level • Influence on PG and UG curriculum content and delivery • Development of more tools • Incorporation into standard letter format

7. Embedding Shared Decision Making in a Provider Organisation What have we achieved –secondary care in Cardiff • Developed a consultancy model in order to “scale up” team development • Worked to support phase 1 teams • Identified additional teams (pre-existing interest and after call for expressions of interest) – not all progressed • Currently working with 10 teams in a wide variety of specialties • Ask 3 and SureScore introduced into some teams • Training provided to teams • Option grids being developed in some teams • Developed links with 1000 lives plus person centred care work stream • Ensured “involvement in decisions” is recognised as a key component in the Welsh Government Patient Experience Framework

8. Embedding Shared Decision Making in a Provider Organisation What works? • What works ? • Must have a local champion – prepared to walk the walk • Need resource with which to support the innovators • Shortened skills training with a different focus • Align with an existing priority or target – two birds with one stone • Get non-medical staff on board – specialist nurses/midwives invaluable • Ensure no extra paperwork/ bureacracy – ‘instead of’ rather than ‘as well as ‘

9. Embedding Shared Decision Making in a Provider Organisation Challenges to doing SDM ? • Challenges • We do it already • We don’t have time to do it • Our patients don’t want it • Patient involvement often overlooked • We don’t want it - It’s my job to give an opinion • Teams not as ready for change as they thought • We don’t have any tools to do it with • ‘I don’t agree with the data in the tool ‘ • Teams reluctant to engage in data collection • My manager does not value this in my practice ? • There is no financial incentive - this is designed to reduce referral and activity • I have other bigger problems to sort first? • There is limited evidence for benefit • The Trust does not value this • Clinical skills not at level required • Senior (medical) colleagues won’t do it

10. Embedding Shared Decision Making in a Provider Organisation Themes and challenges • Who owns SDM ? • Who wants SDM ? • Who measures SDM? • Who pays for SDM ? • Board priority • Service priority • Whole team approach • Leadership • Incentive • ‘Top –down’ vs ‘bottom-up’ approach

11. “I didn't know I had a choice, I thought everyone had the test. This tool has helped me to make a decision.” Source – patient feedback on screening programme