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  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 | 3

To a person centred approach… Transforming Participation in Chronic Kidney Disease Rachel Gair | 4

Day to day decision making: self management Self management = 8,750-55 in a year Hours with NHS / social care professional = 5-10 in a year Transforming Participation in Chronic Kidney Disease Rachel Gair | 5

The Challenge… takes a long time to develop skills Transforming Participation in Chronic Kidney Disease Rachel Gair | 6

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 Transforming Participation in Chronic Kidney Disease Rachel Gair | 7

Co-producing health Transforming Participation in Chronic Kidney Disease Rachel Gair | 8

What are the questions the TP – CKD programme is asking?  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 | 9

Overall Aspiration  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 | 10

Organisational chart supporting co-production No co-production without representative governance!  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) Transforming Participation in Chronic Kidney Disease Rachel Gair | 11

Terminology • PAM Patient Activation Measure – Patient Activation Measure (PAM) – Skills, knowledge and confidence to manage Clinician-support for PAM your long term condition • PROMs (CS-PAM) – Patient Reported Outcome Measure – Quality of life EQ-5D-5L • Generic IPOS renal • Disease specific • PREM Self developed – Patient Reported Experience Measure – Questions relating to their healthcare experience – All Renal Units X 1 per year Transforming Participation in Chronic Kidney Disease Rachel Gair | 12

Engagement – HOW • 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 | 13

Your Health Survey Returns TOTAL NUMBER Cohort 1 Units 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 2,299 Total Returns TOTAL NUMBER OF Cohort 2 Units 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) 0 Total Returns 159 Transforming Participation in Chronic Kidney Disease Rachel Gair | 14

Phase 1 – CS-PAM Results CS-PAM - Clinicians’ beliefs and attitudes toward patient self-management Transforming Participation in Chronic Kidney Disease Rachel Gair | 15

PAM: Patient Activation Measure Patient activation is a measure of how engaged people are in managing their own health Transforming Participation in Chronic Kidney Disease Rachel Gair | 16

PROM – Patient Reported Outcome Measure 100% 90% 80% Not at all/slightly 70% 60% 50% 40% At least 30% 20% moderately 10% 0% Transforming Participation in Chronic Kidney Disease Rachel Gair | 17

Intervention Toolkit Transforming Participation in Chronic Kidney Disease Rachel Gair | 18

Lessons Learned – Emerging Patterns  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 | 19

Phase 2 – Spread and Sustainability  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 Transforming Participation in Chronic Kidney Disease Date | 20

Key messages so far  ‘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 Transforming Participation in Chronic Kidney Disease Date | 21

Contact Think Kidneys How to find out more Richard Fluck Karen Thomas Clinical Co-Chair Internal Medicine Think Kidneys Programme Manager www.linkedin.com/company/think- Programme of Care NHS England UK Renal Registry kidneyswww.twitter.com/ThinkKidneys Richard.fluck@nhs.net Karen.thomas@renalregistry.nhs.uk www.facebook.com/thinkkidneyswww. youtube.com/user/thinkkidneyswww.sl Ron Cullen Rachel Gair ideshare.net/ThinkKidneyswww.thinkki Director Person Centred Care Facilitator dneys.nhs.uk UK Renal Registry UK Renal Registry Ron.cullen@renalregistry.nhs.uk Rachel.gair@renalregistry.nhs.uk Catherine Stannard Programme Support Officer UK Renal Registry Sarah.evans@renalregistry.nhs.uk Transforming Participation in Chronic Kidney Disease Rachel Gair | 23