Education for health The National Strategy for COPD It’s taking shape! Monica Fletcher Chief...

education for health

The National Strategy for COPDThe National Strategy for COPDIt’s taking shape!It’s taking shape!

Monica Fletcher

Chief Executive Education for Health

Chair European Lung Foundation


COPD care: a change in attitude

Diagnosing Predicting

Pessimistic Optimistic

Treating Preventing

The past few years have revealed an attitudinal shift in COPD care

‘From Unjustified Nihilism to evidence based Optimism’ (Celli et al 2006)

The COPD Vision:

To that everyone diagnosed with COPD receives equitable, responsive, high quality and effective health and social care services from the right person, at the right time, in the right place.

On going commitment is to ensure that all communities can expect better prevention strategies for COPD, quicker identification for those at greatest risk, clear standards of care and treatment that ensure dignity and respect that lie at the heart of the patient journey


The public consultation document contained 24 evidence based recommendations to improve care

Combined with NICE/BTS guidelines should be enough to kick start service delivery of high quality COPD and asthma care

Ministers currently considering how to turn it into an outcomes based strategy


Why do we need to wait for the DOH strategy

The political wheels turn very slowly

COPD in 40–65 year olds ages them and creates frustration

“I feel like I am old. I feel like I am really old, and I am 51.”

UK patient

“I hate not being able to do something and that my wife has to help me. It is infuriating.

I have never depended on anyone.” Spanish patient

“I’m totally disgusted with my life.”

U.S. patient

“The most important thing I’ve lost is probably getting together with my dad and

playing outdoors.” UK son

“We had a very big group of friends and relatives, but since my wife got ill only 2 or 3

people are left.” U.S. Spouse

“She is throwing her life away and she is throwing my life away.”

U.S. Spouse

“A bad day is when you need to sit down because you can’t handle it anymore but you need to make it to the office and deal

with 200 emails.” Spanish patient

Fletcher at al 5th IPCRG World Conference, June 2010,

The

Number of COPD patients diagnosed 900,000, but actual estimated prevalence 3.7million……..these are the “Missing Millions”

(Graph based on DH unpublished estimate, 2009).

Shawab et al Thorax 2006

Spectrum of COPDPrevention and Awareness toEnd of Life Care

Well At-risk With COPD diagnosis

No symptoms Symptoms but no diagnosis

MILDstage

MODERATEstage

SEVEREstage

The earliest point at which airflow obstruction may be detected by spirometry

Damage

Unaware of lung health

Aware of lung health

•Raising awareness of early signs and symptoms

VERY SEVEREstage

•Access to supportive care for patient and family through to bereavement stage

•Managed according to guidelines, e.g. Liverpool Care Pathway

DH focus for improving outcomes

Prevention & Health improvement

Early Accurate Diagnosis and Assessment

Chronic disease managementincluding self management, exacerbations and treatment

Palliative and ‘End of life’ care

Earlier identification: More proactive management: Care closer to home: Integrated care

What has been accomplished so far by DOH?

Published national consultation document Developed clinical leadership and joint partnership

working including with industry and patient organisations Gathered evidence on what is working well Testing different models of care Introduced measurement of performance Changes to system levers and incentives Funded pilot and research studies Aligned with new and emerging policies


DOH Practical help for youDOH Practical help for you

We have an approachable team at the DOH, with strong leadership

The NHS improvement Lung Improvement team and their website for inspiration

Worked on competences and a range of educational programmes with more on the way to support staff development

We have respiratory leads in every SHA who can share local benchmarking data

Implementation

SHA Respiratory leads

Paul Corris

Sharon Haggerty

John White

Mike Ward

Jane Scullion

Dermot O’Ryan

John Williams

June Roberts

Stephen Gaduzo

Colin Gelder

Sandy Walmsley

Tasks:• Set up high level steering group• Develop communities of practice• Support improvement programme• Benchmarking data• Annual report of progress

Steve Holmes

James Calvert

David Halpin Maxine Hardinge

Jo Congleton

Jo Wookey

Julia Bott

Tony Davison

Leanne Jongepier

Louise Restrick and team


Despite their widespread promulgation, there is unequivocal evidence that guidelines have: limited effect on changing physician behaviour, marginal improvement in patient outcomes and their cost effectiveness is called into question!

Lomas et al(1989), Woolfe et al(1993), Grimshaw et al 2004, Thomas et al (2005)


Why don’t physicians use guidelines?Why don’t physicians use guidelines?Cabana M. (1999)JAMACabana M. (1999)JAMA

Systematic review

5658 articles reviewed

76 published studies at least one barrier

76 articles included 120 different physician surveys

Identifying 293 potential barriers!!!

Clustered these into 7 main themes

Developed three groups: Knowledge, attitude and behaviour


KNOWLEDGE ATTITUDES BEHAVIOUR

Lack of

familiarity

Lack of awareness

Lack of outcome expectancy

Lack of self-efficacy

Lack of Motivation

External Barriers:

Patient Factors

Guideline Factors

Environmental Factors

Lack of Agreement with: Specific guidelines

Guidelines in general

Cabana 1999


Clinical ExperienceClinical ExperienceMaking the same mistakes Making the same mistakes with increasing confidence with increasing confidence over an impressive over an impressive number of yearsnumber of years

“If you always do what you have always done, you will always get what you always got”


Diffusion of InnovationsDiffusion of InnovationsRogers (1995)Rogers (1995)

EarlyMajority

LateMajority

EarlyAdopters LaggardsInnovators

2.5% 13.5% 34.0% 34.0% 16%


Achieving behaviour changeAchieving behaviour change

ACTIVITY

Inform

Educate

Engage

Enlist

VALUE

Behaviour

Commitment

Under-standing

Aware-ness


Implementation of change : Your roleImplementation of change : Your role

EDUCATION

SOCIOLOGY

PSYCHOLOGY

COMMUNICATIONS

MARKETING


Where are you at?

Where do you want to get to?

What is stopping you getting there?

So what are you going to do about it?


Questions to ask yourselfQuestions to ask yourself

Early outcomes or long term perspective

Tangible rewards or do you gain rewards in other ways

Naturally a doer or do you prefer to facilitate others

Do you personally prefer a high or low profile

Are you a follower or a leader

Happy on your own or in a team


Death of the Lone RangerDeath of the Lone Ranger Powerful

Charismatic

High achiever

High risk

Impersonal

Distant

Short term gains


The Wizard of Oz!The Wizard of Oz!

Scarecrow: The Brain

Tin Woodsman: The Heart

Lion: Courage

Dorothy..


BrainBrain

Conceptual thinker

Emotional intelligence

Systems thinker

Accomplishing tasks

Critical view of self


LionLion Challenge the status quo

Draw out and deal with conflict

Risk taker

Learn from failures

Instil courage in others to follow

Lead change


HeartHeart

Outstanding leaders appeal to the hearts of their followers – not just their minds

Passion and compassion

Mission driven

Relationships

Interpersonal


DorothyDorothy

Humanity

Strong communication

Ability to harness diversity


Others must……

Trust you

Have faith in you

Believe in you

Essentially you have to believe in yourself!

Be prepared to challenge!

Control the ‘I can’t’

Don’t take no for an answer

Be a boundroid


Enabling qualitiesEnabling qualities Sense of humour

Empathetic

Energetic

Passionate

Sensitive

Visionary


There’s no place like homeThere’s no place like home


There are three kinds of people:There are three kinds of people:

Those who watch Things Happen Those who wonder what happened Those who make things happen

Where do you fit???

Lee Lacocca

CEO Chrysler

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