My theory of change…

•  Influence matters •  Pictures speak loudly •  So do stories •  Determinants of health… •  People are surprising – •  People as sources of innovation and

change.

The individual's perspective

3 out of 8757 hours or 0.03%

Informed, Activated Patient

Productive Interactions

Prepared, Proactive Practice Team

Delivery

System Design

Decision

Support

Clinical Informatio

n Systems

Self- Management

Support

Health System

Resources and Policies

Health Care Organization

Community

Prepared Person!

Community Resources and Assets!

Health care conversation/aka !(Shared Decision

Making/ care planning)!

Col

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ed h

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care

pr

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Organisational Processes & Arrangements!

Community Resources and Assets !(‘More than medicine’)!

both uncommissioned and those sustained by responsive commissioning!

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Organisational Processes & Arrangements!

Enga

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in

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mpo

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indi

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& c

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!

!Care Planning!Conversation!

A simple draft Scottish House

Stories and the latest •  Multiple Conditions action plan •  Three ‘early adopter’ sites

– Glasgow – Edinburgh – Dundee

•  Presentation to ‘Essence of General Practice’ – Alan McDevitt, Paul Gray, Miles Mack

•  Future investment •  BHF

Co-designed Peer and

professional support!

Shared!Correspondence!

Pre-consultation

results!

Emotional ! psychological

support!

Clinical expertise!

Educated in SM!

Reflective practitioners!

Consultation skills!/Attitudes!

Multidisciplinary team!

Named contact!

IT!

Access & communication!

Recall system!

Patient access to records!

Leadership from the start, right through!

Contractual arrangements – making time!

Community Resources and Assets !(‘More than medicine’)!

both uncommissioned and those sustained by responsive commissioning!

Col

labo

rativ

ely

orie

ntat

ed

heal

thca

re p

rofe

ssio

nal!

Organisational Processes & Arrangements!

Enga

ged,

info

rmed

, !

Empo

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ndiv

idua

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& c

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!

!

Person Centred Care and Support . Planning!*Health Care Conversation – which includes mental, physical & social Health!*Shared Decision Making !*Talking Points! *Personal outcomes!

Components of the evaluation…..

See the whole smorgasbord of possible things we might want to know

•  See which of those questions has already been answered – a.k.a check the systematic reviews and relevant existing evidence.

•  See which questions haven’t been answered (what elements should be considered for evaluation)

•  (we should pay attention to both process and intervention as either could be responsible for poor outcomes – this is especially true complex interventions.)

•  Note: I think we are making the case for a change for ethical as well as effectiveness reasons – people being in the driving seat of their care is right even if it turns out to be more expensive and no more effective – but increased effectiveness would be handy!)

•  what the appropriate methods might be for exploring them, to establish what kind of beast the evaluation might be

•  and then develop some outline proposals which could be worked up. •  Work out the relationships with ‘local’ evaluations, and with ‘parallel’

evaluations, like the links worker evaluation, Talking points, and no doubt others

•  Prioritise these •  Seek funding.

Competence in care planning

Provision of development support for Care Planning conversations

NHS Education Scotland professional bodies, patient groups to develop National support for programme for Care planning

Possible e.g’s of level of things

Community Resources and Assets !(‘More than medicine’)!

both uncommissioned and those sustained by responsive commissioning!

Col

labo

rativ

ely

orie

ntat

ed

heal

thca

re p

rofe

ssio

nal!

Organisational Processes & Arrangements!

Enga

ged,

info

rmed

!in

divi

dual

s! &

car

ers!

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to p

artn

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ip w

orki

ng!

! Care Planning!

Russian

Eyes on the Prize

Community Resources and Assets !(‘More than medicine’)!

both uncommissioned and those sustained by responsive commissioning!

Col

labo

rativ

ely

orie

ntat

ed

heal

thca

re p

rofe

ssio

nal!

Organisational Processes & Arrangements!

Enga

ged,

info

rmed

, em

pow

ered

, in

divi

dual

s! &

car

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Hea

lth &

car

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team

s co

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itted

to

partn

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orki

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!

Person Centred Care and Support . Planning!*Health Care Conversation – which include mental, physical & social Health!*Shared Decision Making !*Talking Points! *Personal outcomes!

How do we know?

Immediate Questions Pts 1-3

•  HoC is the CCM re-drawn…what is the evidence that the CCM has improved healthcare and outcomes in the UK?

•  Is there any evidence from anywhere that the CCM has reduced health inequalities or the effects of the ICL?

•  How can the HoC help tackle the ICL?

Immediate Questions Pts 1-3

•  How do you know how much of the different parts of the house need to change in order to reduce inequalities in health?

•  I.e. is it all the walls, roof, floor and centre, or some of these?

•  It may be tempting to say all…but in a world of cost-effectiveness, how would you show this, rather than say, changing one wall (e.g. patient activation)?

Immediate Questions Pts 1-3 •  Would the MRC Complex Intervention

Guidelines help you think through how to design and evaluate an intervention on HoC?

•  It also seems there are now a lot of different HoCs…i.e. you change the words and emphasis depending on the context and level..does this not mean it can mean anything you want it to mean?

•  In that case it can’t really fail?

Immediate Questions err..4

•  Perhaps the most important things are the values and policies that lie behind HoC…..

•  ….which will determine where it is built and establish the level of quality of the building?

Attentive, compliant

Patient!

List of vetted and approved community resources!

Space for diagnosis and treatment!

Expe

rt he

alth

care

pro

fess

iona

l!

Professionally designed, clinically correct

resources !Secure, accurate electronic

correspondence between

professionals!Test results

reliably available at consultation!

Clear focus on task, avoiding

issues that cannot be resolved.!

Clinical expertise!

Well educated!

Confident practitioners!

Diagnostic skills!!

Clear referral pathways to other professionals !

Contacts info with surgery hours!

IT driven by clinical concerns!

System development

driven by clinical needs!

Records compliant with data protection!

Leadership!

Contractual arrangements – well managed equal, fair

appointment slots!

Organisational Processes & Arrangements!

How to make evaluation irrelevant to the policy ….and to the end beneficiaries

•  Don’t talk to the imp[lementers •  Findings a year late •  Measure the wrong the things •  Answer known questions •  Vvery long •  Lots of jargon •  Shelvr ther rreport •  Ignore the beneficiaries •  Don’t ask for a logic model

•  Don’t involve the stake holders •  Make unrealistic recommondations •  Silo theory researcha dn pracitce •  Don’t follow up •  Don’t use spell check •  Lots of biased information •  No pictures •  No context •  Use an alien model or pradigm •  No new media •  No interim reprots •  No sonsideration on how to use findings, if

you have any