1. An Overview of MAGIC Richard Thomson/Maureen Fallon On behalf of MAGIC Cardiff and Newcastle

2. Models of clinical decision making in the consultation Paternalistic Informed Choice Shared Decision Making Patient well informed (Knowledge) Knows what’s important to them (Values elicited) Decision consistent with values SDM is an approach where clinicians and patients make decisions together using the best available evidence. (Elwyn et al. BMJ 2010)

3. “Shall I have a knee replacement?” “Shall I have a prostate operation?” “Shall I take a statin tablet for the rest of my life?” “Should I use insulin or an alternative?” “I would like to lose weight” “I would like to eat/smoke/drink less” Spectrum of SDM to SSM TOOLS SKILLS

5. Are patients involved?

6. So why aren’t we doing it? Multiple barriers - “We’re doing it already” - “It’s too difficult” (time constraints) - Accessible knowledge - Skills & Experience - Decision support for patients / professionals - Fit into clinical systems and pathways Lack of implementation strategy

7. Key features of the MAGIC programme

8. Key elements: Phase 1 Effective engagement of multidisciplinary clinical teams - clinical champions, skills development, trained facilitators, and embedding change into clinical pathways and practice Awareness, attitude, skills development Drawing upon what we know works in change management and professional behaviour change, whilst testing some additional innovative elements Used decision aid tools: both decision-specific and generic Rapid action learning and feedback (implementation monitoring) Patient and public involvement

9. MAGIC – Phase II  Moving from pilot departments and general practices to hospitals and health communities: embedding and sustainability  Leadership and organisational engagement, including new commissioning structures (Newcastle) and Welsh Govt (Cardiff)  Expanding and accelerating clinical engagement and impact, by testing learning from Phase 1  Enhanced patient and public involvement, including an emphasis on patient activation and the wider community.  More efficient ways of delivering education and training  Quality metrics: demonstrating value to commissioners and primary and secondary care organisations. 9

10. Key learning from the MAGIC programme: headlines. “When we want your opinion, we’ll give it to you”

11. Key learning Attitudes and skills (DT) Patient “activation” (MS) Accessible decision support (RT) Fit to pathways or pathway re-design (RT) Clinical engagement/champions (MF) Commissioning and system issues (MF) Metrics and measures/”black box”