Sustainability & Spread

Maureen FallonAssistant Director Innovation & Improvement,Cardiff and Vale University Health Board

Sustainability

Means…….Holding the improvements and evolving as required

ALTHOUGH…….. history tells us that 1/3 of all major improvement initiatives in healthcare fail to achieve the sustainable changes neededto meet their planned objective.

Take 2 minutes to discuss possible reasons WHY with your neighbour?

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Session objectives

1• Introduce the Sustainability Tool• Factors influencing SDM uptake

2• Top Tips for embedding, sustaining

and spreading SDM

3• Life beyond MAGIC in Cardiff and

Newcastle – ‘walking the talk’

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Sustainability Tool

4www.institute.nhs.uk/sustainability

Sustainability Tool

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Process OrganisationStaff

• Credibility of the evidence• Adaptability• Benefit

beyond helping patients• Monitoring progress

• Behaviours• Training and involvement• Senior leaders• Clinical

leaders

• Fits with the goals and culture (internal and external)• Infrastructure

Or, put another way, the Micro (local team level); the Meso (the department/practice level) the Macro (the organisation level)

Team level ingredients

• Does your team agree that SDM is important?

• Do you have support from the key members in the team?

• Have you got an interested patient advocate?

• Are you able to access SDM skills training?

Dept/Practice level ingredients

Credibility of the evidence – be able to demonstrate a positive impact on staff and an improved patient experience e.g. what are the benefits beyond helping patients?

In South Tyneside CCG, shared decision making was a key component of the referral management scheme (project focused on improving the quality of referrals). Focus on General Surgery, Orthopaedics and Gynaecology. The results included:

• reduced referrals• improved patient satisfaction and engagement with secondary care• £500k savings in one year.

In South Tyneside CCG, shared decision making was a key component of the referral management scheme (project focused on improving the quality of referrals). Focus on General Surgery, Orthopaedics and Gynaecology. The results included:

• reduced referrals• improved patient satisfaction and engagement with secondary care• £500k savings in one year.

Patients’ knowledge post diagnostic consultation

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Before routine use of Option GridFebruary – June 2011 (n=27)

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Question Topic

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After routine use of Option Grid July-September 2011 (n=29)

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Question Topic

Measuring impact of change in clinical practice (Option Grid)

Dept/Practice level ingredients

• Monitoring progress – be able to demonstrate that patients are involved in their care and that their views are listened to e.g. simple tools such as SUREScore or more detailed tools such as DQM’s (Cardiff) and SDMQ’s (Newcastle)

1. Did you discuss the different treatment options for you?

2. Did you discuss the risks and benefits of the different options?

3. Did you discuss what is important to you in your treatment?

Yes No Unsure

Organisation level ingredients

INTERNAL

• Fits with the organisation’s culture: ‘Caring for people, keeping people well’.

• QI agenda – patient centredness

• CQUIN

EXTERNAL

‘A promise to learn – a commitment to act’

‘…patients and their carers should be PRESENT, POWERFUL and INVOLVED at all levels of healthcare organisations’

‘A promise to learn – a commitment to act’

‘…patients and their carers should be PRESENT, POWERFUL and INVOLVED at all levels of healthcare organisations’

Summary & Top TipsEnsure the ‘conditions are right:

• Identify your aim – does it fit with the direction of travel?

• Going it alone rarely works…. remember Renal…Adopt a team approach.

• Access to training/ AGILE

• Engage your Patient Experience/PALS teams at the outset

• Evaluation – how will you know a change is an improvement?

• Organisation levers

Life beyond MAGIC• Both Newcastle and Cardiff are engaged in an Evaluation study,

sponsored by the Health Foundation;

• The teams continue to collaborate to ensure Sustainability and Spread;

• Newcastle has well established links with Health Education North East in the undergraduate curriculum. Opportunity to expand across all levels of inter-professional education as part of a regional strategy;

• Cardiff is engaged in discussions with Public Health Wales with a focus on SDM as a pillar of the Welsh Co-Production agenda

• The Health Foundation continue to play an important role in enabling ‘Walking the Walk’

www.personcentredcare.health.org.uk