Embedding Shared Decision Making in Provider Organisations Sheila Macphail Dave Tomson Maureen Fallon

Welcome Who is here? Where is everyone at already with SDM in their organisation - ahead of MAGIC or not yet started? How and why did you start? Embedding Shared Decision Making in Provider Organisations 2

What have we achieved? Embedding Shared Decision Making in a Provider Organisation 3 Widespread change Generated enthusiasm Collaborative working across health systems, sites and care providers

What have we achieved – GP practices ? Embedding Shared Decision Making in a Provider Organisation 4 6 in depth practices 30 MAGIC lite practices Examples: Use of tools/ different phrases used/discussion over coffee. Beginnings of pathway change – urological referral in North Tyneside Significant change in referral behaviour in South Tyneside

What works and challenges in primary care Leadership, learning sets, professional pride Education - particularly skills training Finding ways of keeping SDM on the practice agenda - facilitators Paying the practice for time taken to deliver a QI process Peer pressure or CCG initiatives Embedding Shared Decision Making in a Provider Organisation 5

What have we achieved – secondary care in Newcastle? Embedding Shared Decision Making in a Provider Organisation 6 Teams engaged in SDM – increasing requests for training More informed and trained clinical teams Established Trust SDM group Making inroads to less obvious areas for SDM – ITU admission, MDTs, Transplant. Supporting a dialogue with commissioners including services commissioned at a national level Influence on PG and UG curriculum content and delivery Development of more tools Incorporation into standard letter format

What have we achieved –secondary care in Cardiff Developed a consultancy model in order to “scale up” team development Worked to support phase 1 teams Identified additional teams (pre-existing interest and after call for expressions of interest) – not all progressed Currently working with 10 teams in a wide variety of specialties –Ask 3 and SureScore introduced into some teams –Training provided to teams –Option grids being developed in some teams Developed links with 1000 lives plus person centred care work stream Ensured “involvement in decisions” is recognised as a key component in the Welsh Government Patient Experience Framework Embedding Shared Decision Making in a Provider Organisation 7

What works? Must have a local champion – prepared to walk the walk Need resource with which to support the innovators Shortened skills training with a different focus Align with an existing priority or target – two birds with one stone Get non-medical staff on board – specialist nurses/midwives invaluable Ensure no extra paperwork/ bureacracy – ‘instead of’ rather than ‘as well as ‘ 8 Embedding Shared Decision Making in a Provider Organisation

Challenges to doing SDM ? Challenges We do it already We don’t have time to do it Our patients don’t want it Patient involvement often overlooked We don’t want it - It’s my job to give an opinion Teams not as ready for change as they thought We don’t have any tools to do it with ‘I don’t agree with the data in the tool ‘ Teams reluctant to engage in data collection My manager does not value this in my practice ? There is no financial incentive - this is designed to reduce referral and activity I have other bigger problems to sort first? There is limited evidence for benefit The Trust does not value this Clinical skills not at level required Senior (medical) colleagues won’t do it 9 Embedding Shared Decision Making in a Provider Organisation

Themes and challenges 10 Who owns SDM ? Who wants SDM ? Who measures SDM? Who pays for SDM ? Board priority Service priority Whole team approach Leadership Incentive ‘Top –down’ vs ‘bottom-up’ approach Embedding Shared Decision Making in a Provider Organisation

11 “I didn't know I had a choice, I thought everyone had the test. This tool has helped me to make a decision.” Source – patient feedback on screening programme