engaging clinicians and patients in the concept and importance … · 2017-05-03 · transforming...

Engaging Clinicians and Patients in the Concept and Importance of

ActivationValuing Individuals -Transforming Participation

in Chronic Kidney Disease

Jonathon Hope

The Passive Patient

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Healthcare can be profoundly disempowering

This can be even more challenging when the condition is highly medicalised (e.g. ESRD)

But most patients want to be treated as active participants – as co-producers of health

Transforming Participation in Chronic Kidney Disease Rachel Gair

To a person centred approach…

| 4Transforming Participation in Chronic Kidney Disease Rachel Gair

Day to day decision making: self management


Hours with NHS / social care professional = 5-10 in a year

Self management= 8,750-55 in a year

The Challenge… takes a long time to develop skills


So…


The system should work in partnership with people with LTCs in order to support them to develop the knowledge, skills and confidence to manage their own wellbeing, health and healthcare

Co-producing health


What are the questions the TP – CKD programme is asking?

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Can we routinely collect measures relating to patient/teams activation, QOL outcomes and patient experience within 10 renal units?

Can we introduce interventions that will increase a patient’s and team’s activation?

Does an activated patient have better outcomes?


Overall Aspiration

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How do we change conversations and behaviours? We believe that targeting solely patients unlikely to

achieve necessary cultural change What are the characteristics within teams that support

and drive person centred care? How can this be shared with other LTC? Sustainability – no additional resource Co-production as a core value


Organisational chart supporting co-production


NHS England (co-production champion) – UKRR

Programme ‘Core’ group (patient and clinical leaders)

Programme board – co chaired expert patient (co-production champion) and clinician with 12/22 board members patients

Workstreams – all 3 co-chaired by patient/clinical partnership and patient/clinical workstream members

Rachel Gair (co-production champion)

Renal Unit working groups with clinical and patient members (the start of real cultural change)

No co-production without representative governance!

Terminology


EQ-5D-5LIPOS renal

Self developed

Patient Activation Measure (PAM)Clinician-support for PAM (CS-PAM)

• PAM– Patient Activation Measure– Skills, knowledge and confidence to manageyour long term condition

• PROMs– Patient Reported Outcome Measure– Quality of life

• Generic• Disease specific

• PREM– Patient Reported Experience Measure– Questions relating to their healthcare experience– All Renal Units X 1 per year

Engagement – HOW

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• 3 Learning Events – teams had to comprise 50% patients

• Teams developed a 30-60-90 day implementation plan

• Encouraged PDSA/AAL with each small cycle of spread

• PCCF – visits, calls, share learning, cohort calls, newsletters, bulletins

• Shared challenges and successes – peer assist

• Feedback of survey results to clinical teams and patients via PV

• Development of an Intervention Toolkit


Your Health Survey Returns


Cohort 1 UnitsTOTAL NUMBER OF RETURNS

Birmingham Heartlands Hospital (Heart of England NHS Foundation Trust) 111

St Luke’s Hospital (Bradford Teaching Hospitals NHS Foundation Trust) 180Coventry (University Hospitals Coventry & Warwickshire NHS Trust) 123Derby (Derby Teaching Hospitals NHS Foundation Trust) 112Hammersmith Hospital (Imperial College Hospital NHS Trust) 61King’s London (King’s College Hospital NHS Trust) 368

Freeman Hospital (Newcastle Upon Tyne Hospitals NHS Foundation Trust) 511

City Hospital ( Nottingham University Hospitals NHS Trust) 465Derriford Hospital ( Plymouth Hospitals NHS Trust) 42

Northern General Hospital (Sheffield Teaching Hospitals NHS Foundation Trust) 326

Total Returns 2,299

Cohort 2 Units TOTAL NUMBER OF RETURNS

Royal Sussex County Hospital (Brighton and Sussex University Hospital Trust) 116New Cross Hospital (Royal Wolverhampton NHS Trust) 61

Royal Stoke University Hospital (University Hospitals of North Midlands NHS Trust) 43Leeds (The Leeds Teaching Hospital NHS Trust) 0Total Returns 159

Phase 1 – CS-PAM Results


CS-PAM - Clinicians’ beliefs and attitudes toward patient self-management

PAM: Patient Activation Measure


Patient activation is a measure of how engaged people are in managing their own health

PROM – Patient Reported Outcome Measure


0%10%20%30%40%50%60%70%80%90%

100%

Not at all/slightly

At leastmoderately

Intervention Toolkit


Lessons Learned – Emerging Patterns

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Empower patients from the beginning – governance

‘Be the change you want to see’ - mirror co-production culture change in programme team and board

Share power - Senior clinical champion + patient champion

Leadership – moving towards changing practice

Start small and build – QI cycles of change

Engagement of whole patient/clinical team to really embed

Different ways of working – volunteers – IT – process

The power of patient involvement (e.g. measurement)


Phase 2 – Spread and Sustainability

Transforming Participation in Chronic Kidney Disease Date | 20

Continue spread across 14 units Continue re-surveying of patients – embedding Provision of workshops to units – discussing data + changing

practice Introduction of interventions: Ask 4 Questions Communication – using PAM in conversations Patient View Care planning – goal setting Peer support

Key messages so far

Transforming Participation in Chronic Kidney Disease Date | 21

‘Be the change you want to see’ - mirror co-production/ culture shift you want to see in programme team and board

Peer assist model supports cultural shift – vs. last year Developing a faculty system – group of experts Transferability to other LTC – far reaching change Influence commissioning approach – testing interventions No additional resource to units – supports sustainable change Patient stories – website PAM/CSPAM combination - powerful

Richard FluckClinical Co-Chair Internal Medicine Programme of Care NHS [email protected]

Ron CullenDirectorUK Renal [email protected]

How to find out more

Karen ThomasThink Kidneys Programme ManagerUK Renal [email protected]

Rachel GairPerson Centred Care FacilitatorUK Renal [email protected]

Catherine StannardProgramme Support OfficerUK Renal [email protected]

Contact Think Kidneys

www.linkedin.com/company/think-kidneyswww.twitter.com/ThinkKidneyswww.facebook.com/thinkkidneyswww.youtube.com/user/thinkkidneyswww.slideshare.net/ThinkKidneyswww.thinkkidneys.nhs.uk


mailto:[email protected]





http://www.linkedin.com/company/think-kidneys

http://www.twitter.com/ThinkKidneys

http://www.facebook.com/thinkkidneys

http://www.slideshare.net/ThinkKidneys

engaging clinicians and patients in the concept and importance … · 2017-05-03 · transforming...

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