person-centred care -10 years of research and practice

Getting to person-centred careBuilding and using the evidence

Helen Crisp, Assistant Director Research

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Conflicts of interest:• I am employed by the Health Foundation

• As such, I am paid to attend this conference and to give this talk

• This presentation is based on the work of many individuals and institutions, much of it funded by the Health Foundation

• I will be publicising free publications and resources that the Health Foundation makes available to promote improvement science and person-centre care

• I have no other interests to declare

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Thanks toColleagues at the Health Foundation: Adrian SieffDarshan PatelEd McKiernan Hannah O’MalleyLizzie WrobelMatt TaitNicola PowellShaun Leamon

Who all contributed to the preparation of this presentation

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Person-centred care as a facet ofImprovement ScienceThe Health Foundation is committed to building the field of ‘Improvement Science’ - by which we mean:

The application of a range of basic and applied sciences in order to improve the effectiveness and efficiency of efforts to improve quality of health care for patients and populations

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Dimensions of qualityThe Health Foundation is working to support improvements to health services so that they are:

• Safe

• Effective

• Patient-centred

• Timely

• Efficient

• Equitable

Institute of Medicine, 2001

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Dimensions of qualityThe Health Foundation is working to support improvements to health services so that they are:

• Safe

• Effective

• Person-centred• Timely

• Efficient

• Equitable

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What are the aims for person-centred care?

• Better experience of care

• Better clinical outcomes

• Better use of health care resources

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What are the challenges?• Perceptions of health care staff about person-centred care

We already do this

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We already do this

Surveys in the NHS consistently report that over 40% inpatients would like more involvement in decisions about their care

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• The changes require social and cultural changes more than technical solutions

Culture Strategy

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What are the challenges?

• Perceptions of health care staff about person-centred care

• The changes require social and cultural changes more than technical solutions

• The evidence base is weak, contested and confusing

- Evidence review of shared decision making found

160 different definitions

- Many other studies with no definition

- ‘Same’ approaches have very different results

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Improvement science approach to person-centred care?

• Theory-based interventions using tested methods

• Written up using SQUIRE guidelines• Outcome measures; personal, process,

clinical• Robust evaluation using a range of

innovative methods

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Improvement science in action

• Research• Evidence reviews• Developing theory

• Improvement programmes• Co-Creating Health• MAGIC• ‘Changing relationships’ projects

• Evaluation: independent, qual & quant, published

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A 10 year journey

A 10 year journey

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A 10 year journey

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The Health Foundation has focussed primarily on two areas:

Self-management support

Shared decision making

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Health Foundation definition‘Self-management support is the assistance caregivers give to patients with chronic disease in order to encourage daily decisions that improve health-related behaviours and clinical outcomes.’

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Health Foundation definition‘Shared decision making is a process in which clinicians and patients work together to select tests, treatments, management, or support packages, based on clinical evidence and patients’ informed preferences.’

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What do we know now?

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Self-management support approaches

Motivational interviewing

Goal setting and action planning

Group-based educational

modelsPeer support

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Peer support

Counselling-oriented approach to consultations

Aims to shift from medical model to one to one support that facilitates behaviour change

Used in Co-Creating Health to train professionals

“ a professional life-changing event”

Training in motivational interviewing described as:

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Care and support planning


• Approach to help people more effectively manage long-term conditions

•Builds confidence by setting attainable goals that matter to the individual and step by step plans to reach them

Key feature of Co-creating Health

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Group-based educational

models

Short courses for groups of people with similar condition to support self-management often led by an individual who has a long term condition

“I’m happy for starting the group when I did. Learning things, pacing, helped to sort my life.”

STOP! Project in Dorset: Group sessions to help people live with chronic back pain

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Peer support

Group or one to one support from someone who lives with a similar condition

Underpinned by key value of reciprocity

I’ll never be the same person I was before my diagnosis but peer support coaching has made me believe in a future where I can recover and develop the new me”

2Gether NHS Foundation Trust: Coaching for recovery:

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Effective shared decision making

• Decision aids • evidence based• include pros and cons of each

option• use real-life examples• use diagrams and visuals

“All need skills to use and attitude trumps skill”

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Evidence based

Two options

FAQs

Option grid breast cancer surgery

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“ ‘Decision aid’ sounds very posh but it’s not ..This was about involving people in their care, and they had never been asked before”

Project lead, Newham COPD Shine project

‘I probably… haven’t involved patients as much as I thought in the past … haven’t made them as aware of all the different options.’ GP, North Shields

MAGIC programme

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Evidence of improved clinical outcomes

Self-management support•Type II diabetes • Reduced HBA1c• Reduced fasting glucose

• Stroke• 6 studies showed improvement• 3 studies showed none

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More confidence for better day-to-day management of health

Able to make and sustain healthy lifestyle changes

Higher satisfaction with care experience

Better adherence to treatment plans and correct medicine use

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More confidence for better day-to-day management of health

Able to make and sustain healthy lifestyle changes

Higher satisfaction with care experience

Better adherence to treatment plans and correct medicine use

Debate about imposition of medical model v. patient goals

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Benefits for health care system

Some evidence of:•Reduced use of emergency hospital services • Diabetes self-management programme

Reduced number of outpatient appointments• Ayrshire & Aran Co-creating Health

• Choice of less invasive treatment• ‘Right Care’ knee pathway project

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Some evidence of:•Reduced use of emergency hospital services

•Reduced number of outpatient appointments

No implementation at scale to demonstrate at system level

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Some evidence of:•Reduced use of emergency hospital services • Diabetes self-management programme

Reduced number of outpatient appointments• Ayrshire & Aran Co-creating Health

• Choice of less invasive treatment• ‘Right Care’ knee pathway project

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Key lessons

Tools PLUS

What works to support implementation?

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Key lesson

s

Tools PLUS

One size does not

fit all


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Key lesson

s

Tools PLUS

One size does not

fit all

New approaches challenge staff AND service users


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Key lesson

s

Tools PLUS

One size does not

fit all


Work with other sectors


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Key lesson

s

Tools PLUS

One size does not

fit all



Fit to local context


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Key lesson

s

Tools PLUS

One size does not

fit all


Team and system

level training




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Key lesson

s

Tools PLUS

One size does not

fit all


Team and system

level training


Clear Goals and plan



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Key lesson

s

Tools PLUS

One size does not

fit all


Team and system

level training


Clear Goals and plan


Evaluate and sustain


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Where next for person-centred care?

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Key areas for research:• How to measure what matters to patients?

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Measurement:Surveys

‘Helping measure person-centred care’ Reviewed the evidence on measures:

Overwhelmingly survey based but also:InterviewsObservations of consultations

Spreadsheet detailing 160 researched measurement tools available at:www.health.org.uk/helpingmeasurepcc

Patient Activation Measure PAM• Current evaluation

http://www.health.org.uk/helpingmeasurepcc

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Key areas for research:• How to measure what matters to patients?

• The changing role/identity for health care professionals as the patient role changes

• What is the workforce of the future?

• What is the contribution of community support?

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Hot off the press!

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Key areas for research• How to measure what matters to patients?

• The changing role/identity for health care professionals as the patient role changes

• What is the workforce of the future?

• What is the contribution of community support?

• Robust studies of cost effectiveness and longer term savings

• How to commission for person-centred care?

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Shared decision

aids


Goal setting

and action

planning

Peer support

Patient group

education

Next steps for implementation

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For more information see:

personcentredcare.health.org.uk

person-centred care -10 years of research and practice

Healthcare