frontline staff building the right hand wall of the house of care [orange pillar]

Frontline StaffBuilding the right hand wall of The House of Care[Orange pillar]

Practitioner development programme

What

• Interactive• Mix power-point slides with teaching, demonstration & MODELLING• Facilitated group discussion• Large and small group exercise and feedback• Role play +/- paired exercises with coaching feedback [with/without

Simulated Patient]• Based on core underpinning principles & Structure• Key enablers, skills & tools• Attitudes and beliefs [To & For]• Action learning between sessions• Follow up• Preparation of environment including room set up• Admin support

• Co-facilitation

http://personcentredcare.health.org.uk


What we have learnt that has value

• Successes/challenges, affirm skills & expertise, find out what’s important TO them• Strategic context national & local, quality, PROM’s, KPI’s, economic, guidelines• Evidence [from different HoC perspectives] peer reviewed, local narrative• Definition & shared understanding• Core clinical communication skills & language • Teacher / Manager / Coach & problem solving• Key enablers COLLABORATIVE agenda setting, action planning SMARTER goal

setting & follow-up [ER]• Activation & exploring ambivalence• Scaling importance and confidence [AR]• Peer support programmes & recognising assets• SIP methodology [IQT Bronze & Silver]• Professionalism & risk – advanced clinical reasoning, duty of discharge, do no harm• Signposting resources



Core clinical communication skills are essential, improve with training, should be accessible/modelled by all and include;

• Active listening• Exploration, open ended questions [caution whys and buts]• Reflection• Empathy [Hojat 2011 Academic Medicine, Vol. 86, No. 3 / March

2011]• Reflective summaries• Affirmation• Normalisation• Equipoise• Practice – even those who’ve had previous training• Small changes big impact


Activating patients for SDM :Ask 3 questions

Is SDM a/the first step?

www.health.org.uk/areas-of-work/programmes/shared-decision-making


Who

• Whole teams / pathways / professional groups• Mixed approaches to build engagement• Leaders and those in positions of influence• Self selected versus mandatory


Challenges & barriers

• Time [perceived / real ]• Activation & conflict with professional identity, role, guidelines• Workforce knowledge of community assets and services• Follow up• Local geography• Affordability• Facilitator input unsustainable• Advanced facilitation

• •


Top tip 1

This is behaviour change for workforces as well

• Work in partnership, model collaborative approach• Deliver comprehensive package preparation, interaction, follow up• Design around activation individual & workforce groups• Capitalise - involve whole workforce• Those learning new skills progress quickly • Practice, practice, practice… collect narrative

• Give permission


Outcomes

• Shift in favour of attitudes and beliefs in favour of partnership working

• Increases in self reported knowledge and confidence to support self management and use associated skills and enablers

• Increased awareness and confidence to refer to peer support programmes

• Increased confidence and translation of intention into action to change the way we work and change systems [link to SIP awards]


Outcomes

“My approach to interviewing is changing from being process driven to patient led. I am finding that I am also encouraging and supporting similar change amongst the therapists that I work with”

“Since attending the workshop and adjusting my approach, people leave appts clearly more motivated and happy. They report that they feel they have been listened to and have a plan of action which puts them back in control. They return to follow up appts having tried out the techniques and having found benefit from them”

“I thought I was working in a person centred way and I now clearly realise I’m not”

“My consultations are now more focussed and I am more confident that I am meeting my patient’s needs”

“I’ve never actually asked anyone before what is important to them…….” http://personcentredcare.health.org.uk

Top tip 2

Be flexible in what you offer and adapt to local context

• Co-design your offer • Offer variety of models based on core principles & underpinning

skills• Build on local assets• Link / signpost / integrate other key programmes • Encourage development of local context specific tools &

resources• Quality assurance with flexibility• Follow up


Name: ………………………………………………………………………………………………………..

Name of Person you are coming to see: ……………………………………………………..

Date:…………………………………………………………………………………………………………..

To make the most of your appointment, it would be helpful to think about what you would like to discuss. The focus of the appointment is to review the things that are most important for you to achieve in your life at this moment in time. You may want to think about:

What is important to me now?

Out of the things which are important to you where would you like to start?

Is there anything else you would like us to know?

Top tip 3

Upscaling & Facilitator sustainability is challenging

• Optimise non face to face approaches including e-learning• Put nudges in the system• Identify and utilise synergies, opportunities & assets• Grow local experts & peer opinion leaders• Build team and pathway capability, capacity, narrative• What’s the right training model for us?


Top tip 4

Acknowledge and work with the tensions

• Different workforce groups may need different approaches• Invest resource for greatest return• Utilise opportunities to experience the service user perspective• Make sure that all team members give PERMISSION not barriers

to utilise the approach • Consider giving more junior staff the opportunity to explore

potential SIP projects then use senior staff to support them to work through the clinical risk elements


It’s a fine balance

It’s a balance; Subjective vs. objective in [notions of value] in health care… the value narrative effectively splits patients and physicians into separate teams….Focussing on physicians invites objective measures…..Focussing on patients invites subjective considerations……

http://theincidentaleconomist.com/wordpress/alweknmrfla-or-something/

On the other hand, there is also evidence that what patients really want is to be listened to, for their concerns to be understood and taken seriously. That suggests the route to patient satisfaction might not be an imaging study, a procedure, or a pill. Perhaps a thorough conversation is what the patient really seeks. When it was explained to Mr. W why additional testing wouldn’t be helpful (but some other things might), he replied with relief, “No one has ever explained any of this to me before.”To the extent that (subjective) satisfaction and (objective) evidence-based care align, the apparent conflict between the two evaporates. It’s not likely this will always occur or that getting it to do so where possible is easy. There’s likely room for both notions of value. Getting them to work in concert may require clinicians and patients to communicate differently, which takes time and effort. It sounds simple, but it’s a big challenge.

Top tip 5

Building sustainability & resilience

It’s about how we choose to use time not how we manage it -

• Novice to expert / unconscious incompetence to unconscious competence takes time, practice and permission

• Plan for funding implications early• Put nudges in the system • Measure the right outcomes• Optimise the service user expertise for SIP and design [WTfC] link

to shine• It’s a small investment for a triple impact return

Can we afford not to?


Outcomes

“We are now saving 100 Consultant appts/year”

“after the first Self-management course in March of this year I decided to try out the technique on myself. I had decided to lose weight and become more active. So after deciding the importance and confidence levels were 7 and above, and I could realistically achieve the goals I set; I joined a trampoline class in April which I now do once a week and I have lost over a stone with some tweaks to my diet”

“I manage a staff group who were previously quite hostile, defensive and angry. Taking this approach has engaged them and they are now more collaborative and proactive”


Core messages

• Behaviour change for workforces• Innovation requires non traditional

approaches• Give permission• Follow up


Practical tools & resources to help clinicians understand and implement Person-centred care


frontline staff building the right hand wall of the house of care [orange pillar]

Documents

skills toolsattitudes

skills expertise

associated skills

permission http

mandatory http

new skills progress

harmsignposting resources

favour of partnership