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Right Care for Patients. The National Shared Decision Making Programme. One thing I have always found is that you have got to start with the customer experience and work backwards to the technology. Steve Jobs 1955-2011. I wanted to ask questions but did not feel fit to do so at the time. - PowerPoint PPT Presentation
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Right Care for Patients
The National Shared Decision Making Programme
One thing I have always found is that you have got to start with the customer experience and work backwards to the technology.
Steve Jobs 1955-2011
I wanted to ask questions but did not feel fit to do so at the
time.
No choice on treatments, even though I asked for
the options!
Being treated as a person.
Treat the person, not the condition!
More patient education for the GPs
Need to know what to ask for.
Get education.
Information is at the core of decision
making - up to date information, new
treatments and patient mentoring.
I wanted to know more about the kidneys not just
the condition. Cannot make decisions unless I'm
informed.
Knowledge is power!
%
Wanted more involvement in treatment decisions:
Source: NHS inpatient surveys
Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.
Whole Group High-Comorbidity
Murtagh et al. NDT 2007
Choice of Modality
38%
20%
Patient ChoiceAdvanced Kidney Disease
• The BOLDE Project (Brown E.A et al. 2010)Part 1- Older patients can successfully be dialysed using PD;- Patients on PD perceived significantly less illness and treatment intrusion;- After regression analysis, patients on PD and HD reported similar quality of life.
Part 2- Patients want to be involved withmodality decision-making;
- The unit with the lowest use of PDhad the lowest patient involvement in decision making.
UK Renal Registry 13th Annual Report
Home HD 1%
Hosp HD 23%
Satellite HD 20%
Transplant 48%
APD 4%CAPD 4%
Figure 2.6: Treatment modailty in prevalent RRT patients on 31/12/2009
UK Renal Registry 13th Annual Report
Figure 2.8: Percentage of prevalent haemodialysis patients treated at satellite or by home haemodialysis by centre on 12/31/2009
0
10
20
30
40
50
60
70
80
90
Centre
Per
cent
age
of d
ialy
sis
patie
nts % home HD
% sat HD
Variation in UK
Shared Decision Making
Shared decision-making is a process which involves patients:
– as active partners with their clinician;
– in clarifying acceptable medical options;
– and in choosing a preferred course of clinical care.
What are they sharing?
Shared Decision Making in the NHS
‘The Government’s ambition is to achieve healthcare outcomes that are among the best in the world.’
‘This can only be achieved by involving patients in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone.’
‘We want the principle of ‘shared decision-making’ to become the norm: no decision about me without me.’
The policy context
Why shared decision making?The benefits are:
• Improving patient satisfaction, experience, knowledge;• Helping patients make healthcare choices aligned with
their personal needs, values and circumstances;• Improving clinical outcomes and safety; • Achieving the right intervention rate and reducing
unwarranted practice variation;• Reducing cost and litigation costs.
Decision Aids reduce rates of discretionary surgery
RR=0.76 (0.6, 0.9)
O’Connor et al., Cochrane Library, 2009
The National SDM Programme
QIPP PMO
SDM Programme
Board
Lot 2 Provider
SDM Programme
Team
Lot 1 Provider
Lot 1 Sub-Contractors
SDM Advisory Group
SDM Reference Group
DH Patient & Service User Engagement
Lot 3 Provider
Lot 2 Sub-contractors
Lot 3 Sub-Contractors
Right Care Programme
Team
National Right Care Shared Decision Making ProgrammeGovernance Structure (draft)
Thank you
Management is doing things right; leadership is doing the right things
Peter F Drucker
[email protected] www.rightcare.nhs.uk
