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Co-creatingHealthSupporting self-management8 July 2010

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The pillars of the HealthFoundations approach

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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.

Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.

Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.

Encourage. We work across every level of the healthcare system tocreate advocates for our approach.

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The pillars of the HealthFoundations approach

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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.

Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.

Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.

Encourage. We work across every level of the healthcare system tocreate advocates for our approach.

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The pillars of the HealthFoundations approach

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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.

Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.

Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.

Encourage. We work across every level of the healthcare system tocreate advocates for our approach.

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The pillars of the HealthFoundations approach

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Identify. We provide the evidence and highlight the success stories toshow that improvement is possible.

Innovate . We help people to take a step back, innovate, and plan thepracticalities of change.

Demonstrate. We put ideas to work, share our learning and turndemonstration into accepted practice.

Encourage. We work across every level of the healthcare system tocreate advocates for our approach.

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Our aim

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To improve the quality of care bytransforming the dynamic

between people who use servicesand those that provide them

The nature of the interactioncreated by the structures, processes andbehaviours that exist within the system

Patients, clients groups,service users, carers,

families and communities

All those who work in ordeliver care services

Safe, effective, timely,person centred, equitable

and efficient

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Our starting point...

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Quality can be improved only so far by focusing withinorganisations and professional bodiesHigh quality care demands high quality interactions between thepeople using services and those that provide them

People using services need to be able to play an active role in their careand they need to feel respected, supported and cared about

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What needs to bedifferent?

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Clinicians, managers, services and systems need to:

invite and enable an active role , meet physical, psychologicaland emotional needs

approach people with compassion and respect support people in understanding their options and in making

their decisions.This requires changes in philosophy , beliefs and behaviours

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Transforming the dynamicWhich dynamic

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Shifting from an orientation in which the habits and rules of providers andprofessions come first, to one in which the world is seen through the eyesof the person: felt experience and authority

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Transforming the dynamicwhat have king Solomon and the Beckhams to say?

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Co-creatingHealth:Transforming healthservices dynamics withpeople living with a long-term condition

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Now? Service driven ...

Care pathwaysBio-medically informed treatment escalators

for individual conditionsGate -keepers on every floor

Self care support

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and reactive to crises

Please help me

Ill do my best

I amscared

****, I dont have anything

else to try

Anxiety informs the decision making process

Clinician becomes primary decision maker

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Peoples perspective?

Scheduled care planningappointments, providingproactive, structured

support

Scheduled follow upappointments,providing motivational support

Scheduled carepathway, providingspecificinterventions

Shared decisionmakingDecision aids

Life with a long term condition: the persons perspective

Interactions with the service: planned or unplanned

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Informed, activatedpatients

Prepared, proactive teams

Optimal functional and clinical outcomes

Working in partnershipSharing decisionsPlanning care and support

A supportive system

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Co-creating Health (CCH)Aim: to a chieve measurable improvements in the quality of life of people living with long term conditions and improve theirexperience of the healthcare system by embedding self managementsupport within mainstream health services

Co-creating Health

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Supported self-managementhappens here

Locating Co-creating Health

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supporting people on their journey of activation

Activated people; pro-

active teams

Understanding haverole; confident and

capable in role

Supported self-managementhappens here

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Agenda setting agreeing a joint agenda

Goal setting Small and achievable goals Builds confidence and momentum Clinical?

Goal follow-up Proactive Soon Regular reinforcement

Becoming active partners

Making change

Maintaining change

Co-creating healththe three enablers

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Advance Development Programme

Self-management Programme

Service Improvement Programme

Co-creating healththe three on-site programmes

Clinicians with the knowledge, skillsand attitudes required to provideeffective self-management support

People with a belief in the efficacy of self-management and the confidenceand skills to undertake it

Health systems that encourage andfacilitate self-management by patientsand self-management support byclinicians

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Advance Development Programme Skills to work in partnership Motivational support Co-facilitated

Self-management Programme Health literacy Collaborative decision making skills Self-management techniques and

confidence Co-facilitated

Service Improvement Programme Intensive change management support Quality improvement methodology

Co-creating healththe three on-site programmes

Clinicians with the knowledge, skillsand attitudes required to provideeffective self-management support

People with a belief in the efficacy of self-management and the confidenceand skills to undertake it

Health systems that encourage andfacilitate self-management by patientsand self-management support byclinicians

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Informed, activatedpatients

Prepared, proactive teams

Optimal functional and clinical outcomes

Working in partnershipSharing decisionsPlanning care and support

A supportive system

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Co-creating Health

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WandsworthTeaching PrimaryCare Trust &South WestLondon and StGeorges MentalHealth NHS

Torbay Care Trust& DevonPartnership Trust

CambridgeshirePrimary CareTrust &CambridgeUniversityHospitals NHSFoundation Trust

NHS Ayrshire andArran

Calderdale andKirklees PrimaryCare Trusts &Calderdale andHuddersfield NHSFoundation Trust

Bristol PrimaryCare Trust &North Bristol NHSTrust

Southwark Healthand Social Care &Guys and StThomas NHSFoundation Trust

Islington andHaringey PrimaryCare Trusts & TheWhittington NHSHospital Trust

3 years plus 2 People living with 4 conditions 8 sites

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It takes just that little bit longer the first time but how amazing it is to

find that when people are managing themselves and doing that bit

more for themselves how much less they need to see you as aclinician. People do need to see you less .... Theres a real bonus to

clinicians seeing patients in front of you have light bulb moments and

go Oh I see and actually Ive sat here and said very little, its quite

empowering for the doctor because its wonderful to see.

General practitioner

Co-creating Healththe difference

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We are used to the traditional way where you visit a patient and say

okay today were going to do da.. da.. da.., and the patient saysokay you are the boss, youre the nurse, and most of the time

were wondering why is it not working ... now its the reverse and

you are saying, okay, what do you want us to do today.

Community matron

Co-creating Healththe difference

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In the past, I used to go to the doctor and say What are you

going to do to fix my problem?, but now Im saying like, Im

not sure these particular painkillers are working the way we

hoped, can we try something else?

Person living with a long-term condition

Co-creating Healththe difference

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I found out about the Self Management Programme ... It changed the way I thought

about myself and my depression in particular - because that was what was crippling

me... The skills that I learnt ... was the real key for me ... One of the big issues I hadwas finding a rheumatologist that was sympathetic to my symptoms. And, being on

the SMP, it actually raised the issue that I could negotiate this with my GP. I didnt

realise how receptive she would be. But it gave me the confidence to raise the issue

with her, and also, helped me realise how important it was for me to actually find aspecialist that I felt comfortable with.

Person living with a long-term condition

Co-creating Healththe difference

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Co-creating Healthchanging roles

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CLINICIAN

Believes knowledge creates behaviour

change

Gives expert advice and prescription

Seeks compliance with cliniciandetermined goals

Scientific focus on condition

Lead part

Reactive

CLINICIAN

Believes supported self-efficacy plus

knowledge create behaviour change

Provides enabling support

Seeks exploration of persons goals

Empathetic focus on person

Supporting role

Proactive

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Co-creating Healthchanging roles

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PATIENT

Believes clinicians role is toimprove health

Passive recipient of care

Supporting role

Reactive

PERSON

Believes supported self-efficacyplus knowledge create behaviourchange

Determines and enacts goals

Lead part

Proactive

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Co-creating Healthchanging models

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Conventional model

SYSTEMTraining: clinicians trained incommunications skills to enable themto get agreement to cliniciandetermined goalsInformation flows: results sent toclinician to share with patient during

consultationAppointments system allows for onlyfixed time 1:1 consultation

Engagement: individually-based,representative

Co-creating Health model

SYSTEMTraining: clinician trained in skills tosupport people to determine and enacttheir own goals

Information flows: person receivesresults in advance of consultation

unless they determine otherwiseAppointments system allows differenttypes of consultation e.g. group,telephone e.g. emailEngagement: community-based,participative

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Being differently Roles

o Clinician from expert to enablero Patient from expectant to

empoweredo Managers from regulators to

liberators

Wayso Quality improvement

Co-creating healthsome challenges

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Being differently Roles

o Clinician from expert to enablero Patient from expectant to

empoweredo Managers from regulators to

liberators

Wayso Measurement from audit to quality

improvement

Leadership for change differentlyLeadership for change Clinical leadership: social modelling Project leadership: keeping on track Executive leadership: supporting the

vision

Training in QI techniques

Co-creating healthovercoming challenges

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Being differently Roles

o Clinician from expert to enablero Patient from expectant to

empoweredo Managers from regulators to

liberators

Wayso Measurement from audit to quality

improvement

Leadership for change differentlyLeadership for change Clinical leadership: social modelling Project leadership: keeping on track Executive leadership: supporting the

vision

Training in QI techniques

incentiverhetoric reality

motivation

Co-creating healthinternalising change

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Embed the approach within the existing condition

Identify successful approaches to making the model self-sustaining

Demonstrate successful approaches to securing the wider uptake of the approach

Spread approach to other conditions, clinical communities and/orsettings

Co-creating Healthgoing forward

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Presentation title set in header

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Presentation title set in header

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Co-creating Healthto see differently is to do differently

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Transforming the dynamicworking together to do things differently

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www.health.org.uk

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Song of Songs

Transforming the dynamicking Solomon and the Beckhams

I am my beloveds andmy beloved is mine