Tuesday, February 11, 2014

Evaluation of the Health Foundation’s MAGIC programme

Background

There is a growing body of research that highlights the benefits of shared decision making, including patients being more comfortable with decisions, having improved confidence and coping skills and making more appropriate use of services. But putting it into practice in the day-to-day reality of hard-pressed health services remains a challenge.

The MAGIC programme aims to take on this challenge by bringing together a small group of passionate frontline staff, managers and academics in NHS sites in Newcastle and Cardiff to implement and embed shared decision making at individual, team and organisation level.

The programme worked to embed SDM in a range of primary and secondary care settings and involved developing and testing practical solutions that support patients and healthcare professionals to work together to make decisions about treatment and care.

The programme combined a range of activities and forms of support to embed SDM. This included running skills development workshops for participating clinicians, working closely with a number of clinical teams to develop and implement decision support tools for use in consultations as well as social marketing campaigns to increase organisational and patient awareness of SDM. The programme also provided regular facilitation and peer support with the participating clinical teams and sought regular feedback and input from a patient public panel.

What we did

The aim of the evaluation was to assess how, and to what extent, the MAGIC programme was able to embed SDM within clinical settings. The primary focus was on understanding and exploring the ‘process’ through which SDM was implemented. It used largely qualitative methods to elicit insights about what worked well, what worked less well, and in what circumstances, rather than establishing the impact of the programme on measurable outcomes.

The evaluation findings are based on a range of data, including the development of a programme logic model, observations at MAGIC local design team (LDT) and core design team (CDT) meetings, in-depth interviews with participants and stakeholders, and interviews with patient representatives. In-depth interviews with key staff and a small sample of patients were carried out seven clinical settings across the two sites Finally, an online survey was conducted to capture the views and experiences of all staff in the clinical teams that took part in the programme.

Impact

The evaluation helps to fulfil the core of aim of the MAGIC programme which is to build practical and transferable knowledge about how SDM can become a core characteristic of routine clinical care, how this can be achieved and what the conditions for success are.

Insights and learning has been captured through:

Wednesday, June 19, 2013

Health and wellbeing boards – making health and social care integration work

Health and wellbeing boards are in a unique position to ensure the delivery of true integration across health, social care, third sector and across the public.

At OPM, we have been working with health and wellbeing boards since their inception in 2012, so we’re in the best place to help you engage local communities, identify health priorities, make integration work and get the best value out of local services.

You can download our brand new guide with top tips for how boards can achieve real change here

To find out more about how we can work together to ensure that health and wellbeing boards reach their full potential contact Deborah Rozansky, Head of OPM’s Health and Social care team.

 

 

Wednesday, May 15, 2013

Talk is cheap when it comes to integrating health and social care

Yesterday’s revelation of plans to join up the adult health and social care system in England by 2018, means that in the last month representatives of all three major political parties have acknowledge the need to better integrate health and social care in this country.

Care Minister Normand Lamb and Health Secretary Jeremy Hunt jointly pledged to “end the institutional divide between health and social care”, by working with pioneer areas around the country to find out “what the barriers [to integration] are and remove them.” This follows less than a month after Labour launched an independent integration commission intended to report on how best to create a “whole care service”.

While such cross party consensus on this issue is to be welcomed, agreement around further integration in theory is nothing new; it has, after all been a recurrent goal of public policy since the 1970’s. If these recent announcements are to be taken seriously, the public will need to see this policy translated into practice, and that raises an altogether more contentious question: what form should integration take?

Integration is after all, a broad church. It can occur between organisations, or between different clinical or service departments within a single organisation. It can take the form of effective partnership working between health and social care agencies, or the more extreme approach of structurally integrating these agencies into one service.

Both of these overall apporoaches throw up a number of challenges for those involved in integrating services, especially around, infrastructure and IT, leadership, cost allocation and culture. And whilst overcoming these barriers will be crucial to the success of any more integrated health and social care ‘system’ in future; our experience of working on integration projects on the ground tells us that focusing on such issues to the detriment of the ‘patient experience’ is foolhardy.

Understanding the patient journey and their requirements to support self management is essential if integration is to deliver the ambitious benefits it aspires to. Best practice involves working closely with patients to ensure their perspective is fully recognised and in some cases, solutions are being created through co-production.

As we’ve blogged about previously, our work in Hounslow and Richmond showed us not to underestimate the public’s appetite for integration, innovation and change, and this is corroborated by the emergent findings of work were currently doing in the North West, London and beyond. Integration initiatives that ignore the voice of patients and the public, and instead focus solely on trying to ‘keep people out of hospital’ or ‘reduce their levels of service’, are destined to be less successful than they otherwise could be.

We remain optimistic that in the coming years integration will go from something that is talked about, to something that increasingly happens. After all, the driver for more integrated care – changing demographics, increased levels of long-term conditions, and more complex conditions – are things that are here to stay.

In our inaugural Changing Times interview on the OPM blog, Matthew Taylor of the RSA called integration “the biggest urgent, solvable problem faced by public services.” This Friday, we’ll hear from Lord Victor Abedowale who reminds us that the challenges we face in health and social care “are partly due to the success of the system.” For the system to continue to be successful in future there seems to be agreement that some form of integration is needed. The question remains, which?

Tuesday, April 9, 2013

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

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 info@www.opm.co.uk.

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