News and Comment

Shared Decision Making programme shows the importance of a whole systems approach to implementing change

Tuesday 9 April 2013

The MAGIC (Making Good Decisions in Collaboration) Programme, funded by the Health Foundation, aimed to develop and test practical ways to implement shared decision making (SDM) in different clinical settings. Shared Decision Making – a key commitment in the NHS White Paper – is is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences. Led by consortium of experts at Cardiff University and Newcastle University and involving ran between August 2010 and finished in February 2012 (although it has subsequently been extended) and involved 274 clinical and other staff, including GPs, consultants, nurses and administrative staff. The final evaluation report can be found here.

To this point, much of the research on SDM has concentrated on the role played by patient decision aids in supporting SDM; which while important, does not cover all of the elements of SDM. The MAGIC programme has considered a broader definition of SDM to include all aspects of people’s involvement in their own health and care, including access to personal health records, supported self management, personal health budgets, care planning and decision aids.

This evaluation report is thus important reading for anyone involved in the wider implementation of SDM across health settings, and offers lessons and practical tips that help practitioners involved in every aspect of SDM from changing leadership systems and implementing new measurement tools to implementing better training programmes or instigating new ways to engage patients.

The programme was successful in raising the awareness, skills and confidence of those that took part. The evaluation was also able to identify with some confidence the positive impact of specific interventions and tools that were piloted as part of the programme, such as new training sessions, social marketing tools and option grids which are used to steer shared decisions in clinical encounters. The evaluation report and accompanying Improvement Stories provide numerous lessons tailored to different audiences that can help them grapple with implementing these.

Most important of our findings, however, was the importance of the programmes “holistic” or whole systems focus. Recognising from the beginning the difficulty in driving institutional change by focus on a single issue or element of performance, the programme succeeded in pushing along change and sustaining commitment by encompassing in its design not just a focus on processes, techniques or systems, but also behaviours, cultures and attitudes. The result was the programme was more than a sum of its parts, able to motivate a wide range of stakeholders to take part and capitalise on a broad range of levers for change.

The publication of the evaluation follows the release of our own report and guest blog on coproduction last week; and, over the coming months, OPM Connects – our new centre supporting practitioners in the health and social care sector –will be undertaking further research on shared decision making, including exploring how GP practices can involve disadvantaged patients in SDM in the North West.

If you are interested in finding out more about our work in coproduction and SDM, please do not hesitate to contact us at

Both the full evaluation of the MAGIC programme and associated learning report are available on our the Health Foundation website for free download.