Report on SDM and SMS AQuA Collaborative Programme 2013/14
AQuA - Advancing Quality Aliance
Content and copy editor, 2014
The overall driver behind the AQuA Shared Decision Making and Self-Management Support Collaborative programme was to achieve a 10% improvement in the number of patients actively engaged in their care and treatment. Although we did not meet this overall aim during the lifetime of this programme we have made notable strides towards it through implementation of Shared Decision Making (SDM) and Self-Management Support (SMS). In addition, we have identified many positive data trends and captured a wide range of lessons learnt to support future organisations and initiatives.
Achieving this major culture shift and overturning paternalistic ‘doctor knows best’ attitudes will take time. Research indicates that improvement programmes initially meet with scepticism but that staff will gravitate towards the new culture in the second year. In the third year, remaining staff will align with the new culture or leave the organisation. In light of this, we acknowledge that a 10% improvement in year one was ambitious.
In seeking to empower patients as active partners in care programme worked with 22 teams using a Breakthrough Series Collaborative model. AQuA and the clinical teams used measurement for improvement to collect data and identify improvements. We believe that there are several key drivers for success.
Engaged leadership and an open organisational culture are the only tenable foundations for SDM/SMS. Buy-in to the principles of SDM/SMS must be sought at clinical lead and executive level. The most successful teams were highly engaged, viewing this as a long-term investment in organisational culture.
A wide range of tools and techniques must be implemented to achieve active engagement with patients in varied clinical settings. Agenda setting, Ask 3 Questions and SDM/SMS training sessions were essential tools for all effective clinical teams.
To facilitate effective staff delivery the most successful teams took time out from service commitments to train and practice tools and techniques. Through this programme numerous staff have realised and highlighted the benefits of SDM/SMS on engagement with patients, carers and families. This testimony forms a compelling argument for the continuation of this approach.
Patients are right at the heart of this project: patient engagement is both the reason for this project and the way to achieve its aims. Throughout the programme we have seen increased patient empowerment with more questions about choices and options. Teams with the greatest clinical commitment and fastest uptake showed the strongest commitment to patient voice, using the patient ambassador programme or established patient forums.
The continuation of SDM/SMS is an imperative within healthcare with benefits in quality, outcomes, experience and cost. We use systematic processes to secure the sustainable use of SDM/SMS. Organisational advocates with executive support, clear alignment with organisational values and continuous monitoring of relevant data are mainstays of sustainability. We believe we must offer sustainability measures to ensure that the Collaborative’s achievements contribute to a legacy of shared learning and accelerate the uptake of SDM and SMS in clinical practice.
For full report please go to http://www.aquanw.nhs.uk/Downloads/SDM/SDM_Final_Report_2013-14.pdf
