Co-creating

Health
Supporting self-management
8 July 2010
The pillars of the Health
Foundation‟s approach
Identify. We provide the evidence and highlight the success stories to
show that improvement is possible.

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

Demonstrate. We put ideas to work, share our learning and turn

demonstration into accepted practice.

Encourage. We work across every level of the healthcare system to

create advocates for our approach.

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The pillars of the Health
Foundation‟s approach
Identify. We provide the evidence and highlight the success stories to
show that improvement is possible.

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

Demonstrate. We put ideas to work, share our learning and turn

demonstration into accepted practice.

Encourage. We work across every level of the healthcare system to

create advocates for our approach.

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The pillars of the Health
Foundation‟s approach
Identify. We provide the evidence and highlight the success stories to
show that improvement is possible.

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

Demonstrate. We put ideas to work, share our learning and turn

demonstration into accepted practice.

Encourage. We work across every level of the healthcare system to

create advocates for our approach.

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The pillars of the Health
Foundation‟s approach
Identify. We provide the evidence and highlight the success stories to
show that improvement is possible.

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

Demonstrate. We put ideas to work, share our learning and turn

demonstration into accepted practice.

Encourage. We work across every level of the healthcare system to

create advocates for our approach.

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Our aim
The nature of the interaction
Safe, effective, timely,
created by the structures, processes and
person centred, equitable
behaviours that exist within the system
and efficient

To improve the quality of care by

transforming the dynamic
between people who use services
and those that provide them
Patients, clients groups,
service users, carers, All those who work in or
families and communities deliver care services
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Presentation title set in header

Our starting point...

Quality can be improved only so far by focusing within

organisations and professional bodies
High quality care demands high quality interactions between the
people using services and those that provide them

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

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Presentation title set in header

What needs to be
different?
Clinicians, managers, services and systems need to:

– invite and enable an active role, meet physical, psychological

and 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 dynamic
Which dynamic

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

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Presentation title set in header

Transforming the dynamic

what have king Solomon and the Beckhams to say?

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Presentation title set in header

Co-creating
Health:
Transforming health
services‟ dynamics with
people living with a long-
term condition

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Now? Service driven ...

Self care support

Care pathways
Bio-medically informed treatment escalators
for individual conditions
„Gate-keepers‟ on every floor
… and reactive to crises
****, I don’t
have anything
I am else to try
scared
„Please help me‟

„I‟ll do my
best‟

Anxiety informs the decision making process

Clinician becomes primary decision maker
People‟s perspective?
Life with a long term condition: the person‟s perspective

Interactions with the service: planned or unplanned

Shared decision
Scheduled follow up making
appointments, Decision aids
providing motivational support

Scheduled care
Scheduled care planning pathway, providing
appointments, providing specific
proactive, structured interventions
support
A supportive system

Working in partnership
Sharing decisions
Planning care and support

Informed, activated Prepared, proactive teams

patients

Optimal functional and clinical outcomes

 Co-creating
Co-creating Health
Health (CCH)
Aim: to achieve measurable improvements in the quality of life of
people living with long term conditions and improve their
experience of the healthcare system by embedding self management
support within mainstream health services
Locating Co-creating Health

Supported self-management
happens here
Activated people; pro-
active teams

Understanding have
role; confident and
capable in role

supporting people on their

journey of activation
Supported self-management
happens here
Co-creating health
the three enablers
Agenda setting Becoming active partners
– agreeing a joint agenda

Goal setting
Making change
– Small and achievable goals
– Builds confidence and momentum
– Clinical?

Maintaining change
Goal follow-up
– Proactive
– Soon
– Regular reinforcement

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Co-creating health
the three on-site programmes
Advance Development Programme Clinicians with the knowledge, skills
and attitudes required to provide
effective self-management support

Self-management Programme People with a belief in the efficacy of

self-management and the confidence
and skills to undertake it

Service Improvement Programme Health systems that encourage and

facilitate self-management by patients
and self-management support by
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clinicians
Co-creating health
the three on-site programmes
Advance Development Programme Clinicians with the knowledge, skills
– Skills to work in partnership and attitudes required to provide
– Motivational support effective self-management support
– Co-facilitated

Self-management Programme People with a belief in the efficacy of

– Health literacy self-management and the confidence
– Collaborative decision making skills and skills to undertake it
– Self-management techniques and
confidence
– Co-facilitated

Service Improvement Programme Health systems that encourage and

– Intensive change management support facilitate self-management by patients
– Quality improvement methodology and self-management support by
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clinicians
A supportive system

Working in partnership
Sharing decisions
Planning care and support

Informed, activated Prepared, proactive teams

patients

Optimal functional and clinical outcomes

Co-creating Health
• 3 years plus 2
• People living with 4 conditions
• 8 sites

Wandsworth Cambridgeshire Calderdale and Southwark Health

Teaching Primary Primary Care Kirklees Primary and Social Care &
Care Trust & Trust & Care Trusts & Guy’s and St
South West Cambridge Calderdale and Thomas’ NHS
London and St University Huddersfield NHS Foundation Trust
George’s Mental Hospitals NHS Foundation Trust
Health NHS Foundation Trust Islington and
Bristol Primary Haringey Primary
Torbay Care Trust NHS Ayrshire and Care Trust & Care Trusts & The
& Devon Arran North Bristol NHS Whittington NHS
Partnership Trust Trust Hospital Trust

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Co-creating Health
the difference

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 a
clinician. People do need to see you less .... There‟s a real bonus to
clinicians seeing patients in front of you have light bulb moments and
go „Oh I see‟ and actually I‟ve sat here and said very little, it‟s quite
empowering for the doctor because it‟s wonderful to see.
General practitioner

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Co-creating Health
the difference

We are used to the traditional way where you visit a patient and say
“okay today we‟re going to do da.. da.. da..”, and the patient says
“okay you are the boss, you‟re the nurse”, and most of the time
we‟re wondering why is it not working ... now it‟s the reverse and
you are saying, “okay, what do you want us to do today.”
Community matron

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Co-creating Health
the difference

“In the past, I used to go to the doctor and say „What are you
going to do to fix my problem?‟, but now I‟m saying like, „I‟m
not sure these particular painkillers are working the way we
hoped, can we try something else?‟ ”
Person living with a long-term condition

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 Co-creating Health
the difference

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 had
was 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 didn‟t
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 a
specialist that I felt comfortable with.

Person living with a long-term condition

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Co-creating Health
changing roles
CLINICIAN CLINICIAN

Believes knowledge creates behaviour Believes supported self-efficacy plus

change knowledge create behaviour change

Gives expert advice and prescription Provides enabling support

Seeks compliance with clinician Seeks exploration of person‟s goals

determined goals

Scientific focus on condition Empathetic focus on person

Lead part Supporting role

Reactive Proactive
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Co-creating Health
changing roles
PATIENT PERSON

Believes clinicians role is to Believes supported self-efficacy

improve health plus knowledge create behaviour
change

Passive recipient of care Determines and enacts goals

Supporting role Lead part

Reactive Proactive

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Co-creating Health
changing models
Conventional model
SYSTEM
Training: clinicians trained in
„communications‟ skills to enable them
to get agreement to clinician
determined goals
Information flows: results sent to
clinician to share with patient during
consultation
Appointments system allows for only
fixed time 1:1 consultation
Engagement: individually-based,
representative
Co-creating Health model
SYSTEM
Training: clinician trained in skills to
support people to determine and enact
their own goals
Information flows: person receives
results in advance of consultation
unless they determine otherwise
Appointments system allows different
types of consultation – e.g. group,
telephone e.g. email
Engagement: community-based,
participative
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Co-creating health
some challenges
Being differently
– Roles
o Clinician – from expert to enabler
o Patient – from expectant to
empowered
o Managers – from regulators to
liberators

– Ways
o Quality improvement

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Co-creating health
overcoming challenges
Being differently Leadership for change differently
– Roles Leadership for change
o Clinician – from expert to enabler – Clinical leadership: social modelling
o Patient – from expectant to – Project leadership: keeping on track
empowered – Executive leadership: supporting the
o Managers – from regulators to vision
liberators
– Training in QI techniques
– Ways
o Measurement – from audit to quality
improvement

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Co-creating health
internalising change
Being differently Leadership for change differently
– Roles Leadership for change
o Clinician – from expert to enabler – Clinical leadership: social modelling
o Patient – from expectant to – Project leadership: keeping on track
empowered – Executive leadership: supporting the
o Managers – from regulators to vision
liberators
– Training in QI techniques
– Ways
o Measurement – from audit to quality
improvement
incentive
rhetoric reality
motivation 34
 Co-creating Health
going forward

– 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/or

settings

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 Co-creating Health
going forward

– Creating a leadership cadre to champion support for self-

management
– Stronger focus on commissioning (England)
– Embedding the training components
– Running a collaborative to support wider packages of change

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Presentation title set in header

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Presentation title set in header

Co-creating Health
to see differently is to do differently

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Transforming the dynamic
working together to do things differently
www.health.org.uk
Transforming the dynamic
king Solomon and the Beckhams

‫אני לדודי ודודי לי‬

Song of Songs

I am my beloved‟s and
my beloved is mine

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