Engaging Clinicians and Patients in the Concept and Importance of - - PowerPoint PPT Presentation

Engaging Clinicians and Patients in the Concept and Importance of Activation

Valuing 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…

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Day to day decision making: self management

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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

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So…

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The system should work in partnership with people with LTCs in

• rder to support them to develop the knowledge, skills and

confidence to manage their own wellbeing, health and healthcare

Co-producing health

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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?

Transforming Participation in Chronic Kidney Disease Rachel Gair

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

Transforming Participation in Chronic Kidney Disease Rachel Gair

Organisational chart supporting co-production

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• 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

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EQ-5D-5L IPOS renal Self developed Patient Activation Measure (PAM) Clinician-support for PAM (CS-PAM)

• PAM

– Patient Activation Measure – Skills, knowledge and confidence to manage your 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

Transforming Participation in Chronic Kidney Disease Rachel Gair

Your Health Survey Returns

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Cohort 1 Units TOTAL NUMBER OF RETURNS Birmingham Heartlands Hospital (Heart of England NHS Foundation Trust) 111 St Luke’s Hospital (Bradford Teaching Hospitals NHS Foundation Trust) 180 Coventry (University Hospitals Coventry & Warwickshire NHS Trust) 123 Derby (Derby Teaching Hospitals NHS Foundation Trust) 112 Hammersmith Hospital (Imperial College Hospital NHS Trust) 61 King’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) 465 Derriford 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) 116 New Cross Hospital (Royal Wolverhampton NHS Trust) 61 Royal Stoke University Hospital (University Hospitals of North Midlands NHS Trust) 43 Leeds (The Leeds Teaching Hospital NHS Trust) Total Returns 159

Phase 1 – CS-PAM Results

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

PAM: Patient Activation Measure

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

PROM – Patient Reported Outcome Measure

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Not at all/slightly At least moderately

Intervention Toolkit

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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)

Transforming Participation in Chronic Kidney Disease Rachel Gair

Phase 2 – Spread and Sustainability

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• 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

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• ‘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 Fluck

Clinical Co-Chair Internal Medicine Programme of Care NHS England Richard.fluck@nhs.net

Ron Cullen

Director UK Renal Registry Ron.cullen@renalregistry.nhs.uk

How to find out more

Karen Thomas

Think Kidneys Programme Manager UK Renal Registry Karen.thomas@renalregistry.nhs.uk

Rachel Gair

Person Centred Care Facilitator UK Renal Registry Rachel.gair@renalregistry.nhs.uk

Catherine Stannard

Programme Support Officer UK Renal Registry Sarah.evans@renalregistry.nhs.uk

Contact Think Kidneys

www.linkedin.com/company/think- kidneyswww.twitter.com/ThinkKidneys www.facebook.com/thinkkidneyswww. youtube.com/user/thinkkidneyswww.sl ideshare.net/ThinkKidneyswww.thinkki dneys.nhs.uk

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