preparing PEOPLE, PATIENTS and carers for personalised care

• Why prepare people for personalised care
• The problem
• How to achieve a change in the conversation
• How to run an 'It's OK to Ask' campaign 
• Checking people's understanding
• Sample materials for your campaign

Personalised care encourages individuals to be as involved in their health and care decisions as they can, and want, to be.

‘Prepared patients’ – those who are better involved in their care - have 18% fewer GP appointments. (The Health Foundation 2018.)

To help people prepare for having shared decision making conversations, Coventry & Warwickshire colleagues have access to a range of materials for people to use before, during and after their appointments. These include patient feedback materials to help clinicians assess and improve their own skills, and materials which stress to people that 'It's OK to Ask'.

Personalised Care is central to our System aspirations to achieve a new integrated service model for our local population in which people have more options, better support, and properly joined-up care at the right time and in the right care setting. Personalisation is also a means to focus on reducing health inequalities and address the wider determinants of health, ensuring our most disadvantaged communities get the support and assistance they need to reduce the gap in life choices and resulting health outcomes.

Why prepare people for personalised care

An individual’s participation in personalised care, and in particular shared decision making, is an essential component of its success. There is growing evidence that patient participation in discussions (that they fully understand) improves outcomes, and improves patient and staff satisfaction. It facilitates self-management and self-care and reduces complications. It is also a useful strategy for tackling over-diagnosis and over-treatment. Shared Decision Making ensures that individuals are (Hoffman, 2017):

1. supported to make decisions based on their personal preferences
2. more likely to adhere to evidence-based treatment regimes
3. more likely to have improved outcomes, and
4. less likely to regret the decisions that are made.

‘Prepared patients’ – those who are better involved in their care - have 18% fewer GP appointments. (The Health Foundation 2018.)

Shared decision making is effective. Evaluations of various forms of shared decision making show that it can lead to the following benefits (from 'Making shared decision-making a reality', The King's Fund publication, July 2011):

1. improved knowledge and understanding
2. more accurate risk perceptions
3. greater comfort with decisions
4. more participation
5. fewer patients choosing major surgery
6. better treatment adherence
7. improved confidence and coping skills
8. improved health behaviours
9. more appropriate service use.

Current evidence tells us that people want to be more involved than they currently are in making decisions about their own health and health care10. We would also encourage people to think about involving their carers as part of an optimal shared decision making conversation that explores a person’s values and circumstances, if they wish to do so.

But - there is a problem

However, we know that people can be reluctant to question clinicians because they don’t want to take up a busy health professional’s time, don’t want to appear “difficult”, are embarrassed to tell us they don’t understand for fear of appearing “stupid”, and want the clinician to tell them what to do.

We also know that 'health literacy' is an issue, and between 43 – 61% of the English working age population do not understand health information they are given (Institute of Health Equity/Public Health England 2015).

And how about carers?

It is just as crucial that carers are encouraged and prepared to be involved in shared decision making conversations about their own health and wellbeing. An optimal shared decision making conversation for a carer could be where the carer’s caring responsibilities form part of the conversation to enable them to explore options that enable them to either carry on caring or explore alternatives.

Some carers feel compelled to put the health and social care needs of the person they care for above their own. This is why a shared decision making conversation which explores risks, benefits, reasonable variants and alternatives from their perspective, prioritising their values preferences and circumstances, is crucial when they are making decisions about their own health and care.

The Social Care Institute for Excellence has produced a personalisation briefing for Carers.

How do we achieve a change in the conversation?

When care is personalised, individuals are supported to play as active a role as they wish in decisions about their care, and clinicians ensure that people are ready to share decisions by:

1. providing timely, clear communication that our patients can understand
2. providing an environment where patients are confident to ask questions
3. learning from patients themselves how much information they would like to receive and the way they would like to receive it.

 

Preparing people - run an 'It's OK to Ask' campaign

1. Assess current staff shared decision making training - who has done what, who needs to do what - and bring everyone up to speed. Promote free SDM training for all those staff yet to start or complete the online Personalised Care Institute modules. (See 'workforce training' for recommended training options.)  E​nsure reception and admin staff are involved in the training.

2. Arrange further, face-to-face developmental personalisation training for your team to embed personalisation in professional practice.

3. Select the 'It's OK to Ask' materials you wish to use, appropriately branded for your organisation, and ensure all staff understand when and how to use them. These can include 'It's OK' leaflets, posters, digital downloads and pull-up banners. In the 'Materials to adapt' box below, you will find a series of materials courtesy of Hereford & Worcestershire ICB and George Eliott Hospital NHS Trust - you are free to download these and rebrand to fit your service and organisation.

4. Add your 'It's OK to Ask' and other personalisation information to your public website and other communications channels. Add QR codes, if appropriate, to your 'It's OK to Ask' materials which link directly to your public web page, explaining what personalisation is, why you're doing it, and what people and patients can expect.

5. Communicate that 'It's OK to Ask' with people and patients through your social media and other channels. These could include: 

• Team/organisation website
• Any regular patient representative meetings
• Newsletters
• Twitter, Facebook, others?
• Neighbourhood newsletters/social media (eg Next Door; Local Authority newsletters)
• Clinic noticeboards
• Appointment letters
• 'Waiting well' communications
• ICB and Local Authority websites, newsletters and social media
• Email signatures

 

Sample timeline for your campaign:

	Month 1	Month 2	Month 3	Month 4
Planning and materials preparation
Staff online training/PLT session(s)
Distribution of 'It's OK to Ask' materials
Evaluation and process review

 

Check that people really do understand what you are telling them

It's not uncommon to think we are explaining things clearly, that patients have understood what we have said, and that they have been fully involved and ultimately responsible for the decisions made about their health and care treatment. 

Yet research has shown that between 43-61% of the English working age population do not understand health information they are given (Institute of Health Equity/Public health England 2015).

Using health literacy techniques is an essential component of creating quality systems and processes, as the low level of health literacy is a barrier to optimal Shared Decision Making conversations. Clinicians need to tailor their consultations appropriately by using specific techniques, building on the national health literacy toolkit.

Teach Back

The teach-back technique is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands. 

Teach-back is NOT a test of the patient’s knowledge. Teach-back:

1. Is a test of how well you have explained the concept.
2. Should be used by everyone with everyone.
3. Avoids use of ‘closed’ questions.
4. Takes time to learn, requires practice.
5. Can save time in the long run.
6. Is a person-centred approach.
7. Can improve patient safety and patient outcomes.

'Half of what a person is told is forgotten and half is misunderstood.' George Bernard Shaw said that the single biggest problem in communication is the illusion that it has taken place. Listen to Graham Kramer, Clinical Lead for Health Literacy with the Scottish Government, about using the teach back method to promote health literacy:

 

Materials for your campaign

These materials are courtesy of Hereford & Worcestershire ICB and George Eliot NHS Trust. You are welcome to download and rebrand to suit your service and organisation - click on the image thumbnails or visit the document library box below.

Sample posters for printing (with and without QR code - remember to create your own QR code and supporting web pages):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample digital screen images:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample email/print letter footer:

 

 

 

 

 

Sample social media messaging images: