Now, more than ever, this is becoming true – not because the Forward View says it but because it’s demanded by patients, communities and the overall population the NHS serves. Simon Stevens recognised this changing relationship when he talked about the NHS as a social movement. This can’t be controlled or mandated - it’s happening and it should be embraced and celebrated as a force for good and renewal.
In a binary world, the access to information and knowledge by patients eager to share in the decision-making process regarding their care is restricted to the medical profession. This colludes with the ability for the powerful experts to remain powerful. But in a digital world, information and knowledge is freely accessible to everyone – which challenges the traditional notion of leadership and power. Everyone becomes a leader and everyone becomes powerful. This is a fundamental challenge to the old paradigm and enables patients to truly embrace the opportunity to become partners and share in the decision-making that affects their care.
This is easier said than done. But the choice is not whether, but when, health care leaders will ride this wave. Failing to do so will see them swamped.
With the aim of supporting new and positive innovations in this space, the team at The King’s Fund has been nurturing this changing patient relationship for the past 12 months by supporting a number of projects where patients have worked in 'collaborative pairs' with health professionals. This has given us insight into the power when patients and healthcare professionals collaborate in determining individual care pathways. Today we publish a new guide to building collaborative relationships with patients based on the lessons from this work.
Developing this way of working on a wider scale requires support and a change of attitude. The power to determine care pathways has to be a shared decision. This requires a fundamental shift in power dynamics, which will require support to unlearn generations of behaviour.
One way of providing this support is seeing patients as partners recognising that the pathways for development of patient and community-based leaders is historically under resourced and undervalued in comparison to the investment in leadership for clinicians and managers. The King's Fund is therefore keen to work specifically with patient leaders to support their practice as leadership partners.
Central to this is a move away from a ‘them and us’ way of relating to a much more collaborative approach, and that this will need a shift from all of us in the way that we think about our leadership roles and the validity of the different perspectives and expertise that we each hold. Collaboration is not about compromise – it brings the best from everyone to find new and potentially exciting innovations.
With a view to tackling this, The King's Fund runs a programme on leading collaboratively with patients and communities, and is also looking to build up a national network of previous attendees that will put a name to this new relational dynamic and support both patient and health care leaders to move into a different role where leadership is shared.
To reinforce the Fund's commitment to this agenda, we are also announcing the appointment of Mark Doughty, co-founder of the Centre for Patient Leadership, as a member of our staff. By appointing Mark, we aim to help address this and to embed a collaborative approach to working with patients across our work.
Working in partnership with patients has and will continue to be a journey for the Fund and we are learning many lessons along the way. We also know that there are many other people and organisations who are doing great work and who have championed this agenda over the years. By making a new commitment to working in this way, we hope to encourage others to do the same. This is why we are calling on every NHS organisation to commit to working with patients as partners and ensure that their perspectives are embedded at the heart of everything the NHS does.
See original article at The King's Fund website
A Practical Guide to Self Management Support
This is an excellent, very readable guide to implementing self management support.
A practical guide to Self Management Support
10 New Rules to Accelerate Healthcare Redesign
Loehrer S, Feeley D, Berwick D. 10 new rules to accelerate healthcare redesign. Healthcare Executive. 2015 Nov;30(6):66-69.
"This article describes ten "new rules" that were developed and are being tested by members of the IHI Leadership Alliance as a set of guiding principles to help accelerate their progress toward delivering on the full promise of the Triple Aim. The authors also provide brief case examples demonstrating how Alliance member organizations are enacting some of these rules." Download article on IHI website. (free log in required)
New animated video about stroke
A group of young doctors from the UK have set up a new charity called Health Sketches and started creating animated explanations about common health conditions.
Their first one explains what a stroke is and has wide appeal to all ages and cultural groups. Have a look for yourself.
For additional videos and patient information about stroke, visit the stroke section, on Health Navigator NZ.
Cochrane Review - Care Planning
Personalised care planning for adults with chronic or long-term health conditions
For any teams wondering about the value of care planning, a review published in March 2015 by the Cochrane Collaboration assessing the evidence for personalised care planning is worth reading. The review includes 19 trials published before July 2013 (involving 10,856 patients) covering a range of conditions such as diabetes, mental health problems, asthma, heart failure and kidney disease.
- In terms of physical symptoms, improvements were seen in blood glucose levels, lower blood pressure in patients with diabetes, and better control of asthma.
- For psychological health, there was evidence of reduced symptoms of depression and improved confidence and skills to manage their own health.
- Overall, there was no evidence of harm.
The process worked best when "it included preparation, record-sharing, care co-ordination and review, involved more intensive support from health professionals and was integrated into routine care."
The quality of evidence was only moderate, meaning further research might change these findings.
The overall conclusion is that "personalised care planning is a promising approach that offers the potential to provide effective help to patients leading to better health outcomes. More research is needed to work out which aspects are most effective for specific patient groups."
Reference:
- Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015,3:CD010523.
Doctors' checklist could help decrease length of COPD patients' hospital stay
Recent study in Canadian Respiratory Journal by Dr. Samir Gupta, looked at the use of a checklist of steps called order sets for patients with worsening chronic obstructive pulmonary disease. Results showed order set use led to patients spending less time in hospital.
Order sets help doctors and other clinicians choose the most appropriate care for a patient and can help improve care across several diseases.
“Using order sets to manage worsening COPD can lead to better medical care and better results for patients,” said Dr. Gupta, a respirologist at St. Michael’s Hospital. “By providing doctors with the best, evidence-based information at the point in time when they are deciding on medications and tests for their patients, we can improve doctors’ adherence to best practices.”
As part of the study, physicians and staff were encouraged to use an order set developed by a team from the respirology and internal medicine wards at St. Michael’s for all patients admitted with worsening COPD. The order set provided comprehensive admission instructions.
Patients’ length of stay in hospital dropped by about two-and-a-half days when the order set was used.
“This is a dramatic drop, and points to one of the key, positive findings in our research,” said Dr. Gupta. “The faster we can get patients home and breathing easier, the better for our patients and for our health-care system.” Read more at: St Michael's, our stories.
- A Kitchlu, T Abdelshaheed, E Tullis, S Gupta. Gaps in the inpatient management of chronic obstructive pulmonary disease exacerbation and impact of an evidence-based order set. Canadian Respiratory Journal, 2015
E-learning opportunities - Learn on line
There are a number of web based learning opportunities available . Listed below are a range of structured e-learning programmes, selected, based on the quality of their content and their focus on either self management support or quality improvement.
All of these programmes are free to access.
In order to access the programmes on the Ministry of Health's 'learnonline' site, you must first register with your username and password. Registration is free. Log into learnonline here
Some programmes have been approved by the Royal New Zealand College of General Practitioners for Continuing Medical Education MOPS points.
Heart Foundation programmes
Cardiovascular risk assessment and management – Improve Heart Health
Improve Heart Health is a course to support health professionals successfully design and deliver CV risk assessment and management services. The course will also assist you to use the Heart Foundation’s ‘Taking Control’ self-management support care plan. The content of this eCourse related to self-management support is transferable and can be applied when supporting individuals and families/whānau to manage a wide range of conditions.
Heart Failure Support
Completing this heart failure support will help you to build a foundation of knowledge and practical skills that will enable you to more confidently and effectively support people with chronic heart failure and their families/whānau. The course will also assist you to use the Heart Foundation’s ‘Staying well with heart failure’ self-management support care plan. Importantly, the content of this eCourse related to self-management support is transferable and can be applied when supporting individuals and families/whānau to manage a wide range of conditions.
Brief Intervention – risky lifestyle behaviors
Smoking Cessation
In this smoking cessation course for health practitioners, including GPs, Nurses, Midwives, Oral Health Professionals, Mental Health professionals and Pharmacists, you’ll get to see and experience the benefits of using the revised ABC pathway with each of your patients or clients. Non-clincial or non-registered staff may also complete the assessment, however they may not be eligible to become a quit card provider.
Alcohol
This ABC alcohol course for health practitioners, comprising two modules and one case study. The first part looks at the harm caused by alcohol in NZ, and demonstrates how screening and brief interventions improve patient outcomes.
The next part covers the principles of ABC Alcohol:
- Asking all patients about their alcohol use.
- Briefly advising patients who are drinking above recommended guidelines.
- Counselling patients to enhance their motivation to change.
The third part shows an example of how ABC Alcohol has been implemented, and the tools used to support it.
Weight Management
This weight management course has been developed for healthcare professionals to give an overview of the New Zealand Clinical Weight Management Guidelines and how to engage with patients about their weight and the importance of achieving and maintaining a healthy weight.
Quality Improvement
LEAN
This course introduces the LEAN methodology and a number of associated tools to implement the methodology in your work environment. LEAN Thinking is a methodology that will help you improve quality of care, increase efficiency of processes, and identify and eliminate waste. LEAN Thinking evolved in the manufacturing industry but is now routinely applied in the health sector.
