Shared decision making
How can we improve shared decision making within patient consultations?
With a specific focus on the co-creation of a simple guide which sets out the key components of 'a good consultation', the use of shared decision making tools in priority disease areas (such as diabetes, respiratory and cardiovascular disease) along with patient and professional education programmes. 

Ideas (Publish, Detailed Submission)

Innovation 'Elevator Pitch':
A shared decision making tool that helps to organise the psychiatric consultation and empowers the service users with right information to make the right choices.
Overview of Innovation:
John impressed me with occasional sparks of intelligence and wit. When I first saw him in outpatients, he had all too familiar decline in his personality resulting from a severe mental illness.  As a bright young man he was able to secure a place at Oxford for studying history, his long term passion. He was brilliant in his studies but then unfortunately had a gradual decline in studies and in less than one year he had to leave his course.

John appeared hostile in consultations.His mother who supported him in his struggle against voices, delusions and social isolation sat quietly during the appointments, bewildered and confused about what has happened to her very intelligent son.

Despite my best efforts, I could not persuade John to engage in my consultations. He and his mom appeared to be happy with the care but they appeared to have little to ask. The appointments were stereotyped; checking of symptoms, medications, mostly acrimonious debate against continuing treatments and the next appointment.

Once I asked whether they will be interested in few questions which other patients had asked me about their condition. Slightly puzzled as to why a consultant would give them questions to ask (and not answers!), they agreed.  I gave John few questions for each appointment, which either John could explore himself or simply bring them to the next appointment.

Gradually the consultations became more engaging and I could see sparks of brilliance in the questions.John now demanded answers to the questions which became more challenging for me. His mother also asked interesting questions, not merely sitting as spectator. For the first time, I could see the shared decision making in action!

That was the start of QDoc (Questions from doctor). I developed a user friendly mobile application that provides all the questions service users can ask in psychiatric consultation about any aspect of illness. Patients can select appropriate questions for each consultation and also add their own questions or notes. QDoc also has other functions to organise the consultation in most effective way. No more scribbling on pieces of paper and then looking for them in the consultation hurriedly!

I have ideas to develope the utilities and functions in QDoc,making it one of the most powerful tools for shared decision making and self-management. I am keen to collaborate to take this further. QDoc is avialable at Google app store bleow
//play.google.com/store/apps/details?id=com.syml.mhq&hl=en_GB
 
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Digital health / Person centred care
Benefit to NHS:
Non-attendance at outpatient appointments - known as did not attends (DNA) - has a significant impact on the NHS in terms of cost and increased waiting times. It is estimated that around £360 million per year is lost due to non-attendance of appointments in the NHS as  around 11 per cent of patients fail to attend an outpatient appointment which equates to 5 million appointments a year. The rate of psychiatric DNA is about 19, resulting in even greater losses ( see: http://qir.bmj.com/content/3/1/u202228.w1114.full).
An app that helps to engage the patients in psychiatric consultations will result in higher attendance rates and greater patient satisfaction. This will  reduce DNA rates and will achieve significant savings for NHS. It will also help to reduce the waiting time.
Shared Decision Making is the policy priority for NHS as outlined in Department of Health, London, 2012 document ‘Liberating the NHS: no decision about me, without me’. The aim is to increase patient involvement in decisions about their care. There is abundant evidence from research that informed patients have better engagement with services and higher quality of life. Uninformed patients may not be able to access the voluntary sector organization and other resources which can help them to achieve recovery.
When patients go through the questions, select appropriate questions to be asked for each consultation, this will help to organise the psychiatric consultation in a an effective way. This will enhance their involvement in decision making, understand their treatment better and be an active partner in the treatment process rather than the passive recipients of information. Therefore the shared decision making will become a norm rather than exception in those who use this app.
The QDoc is a simple app, which is available at present for the android platform freely. This can be downloaded easily and can be a cost effective way of reducing costs, improving efficiency, decreasing waste and improving patient outcomes.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
The innovation has the potential to benefit NHS in west midlands to reduce the waste and improve the efficiency. The West Midlands has a high proportion of people from black and ethnic minority population. There is evidence that people from BME communities have higher incidence of psychosis, a form of severe mental illness. There is also evidence in the literature that the BME population also has lesser engagement with the mental health services and lesser satisfaction from the services. Therefore the innovation will have added benefits for the west Midlands.
The digital technology companies in West Midlands can potentially enhance the value of innovation, thus contributing to the health and wealth in the West Midlands.
Current and planned activity: 
The QDoc has been used in Black Country NHS Foundation Trust. I received excellent feedback from patients and colleagues, who used the application. The present version is a basic app, which has a generic use. I am now considering the upgrades and development of new functionalities in the app, which will enhance the uptake and use of the app. These improvements will enhance the value of the tool and can lead to use for potential for commercial and business purposes.
The security and interoperability with current systems which are in use currently in NHS is a major priority. The tool also has the potential for integration with other self-management and decision making tools. I have been in discussion with service users groups and IT professionals and now working on upgrades. I am also working on a business model that will lead to creating a revenue stream from the tool. 
What is the intellectual property status of your innovation?:
I own the intellectual property rights
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
2
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saeed farooq 07/02/2017 - 10:44 Publish Login or Register to post comments
0
0
Votes
-99999
Innovation 'Elevator Pitch':
This novel approach  involves people reviewing their medicines in a 3/4 hour session with two health professionals.
We provide people with their own notes in the form of a written action plan, which they can share with clinicians.
Overview of Innovation:
Our work introduces a novel approach to helping people manage their medicines and treatments.

It involves group sessions for patients on medicines, covering what ‘medicines’ are (not just prescribed substances), how they work, side-effects and interactions, alternatives to medicines, finding trusted information and how to have a productive conversation with your Doctor / Health Professional on medicines and treatments.

Following this we offer optional individual support sessions where people can talk about their medicines and treatments in confidence, with two health professionals, one of whom is always a Pharmacist. We developed this novel approach as part of a project commissioned by the Department of Work and Pensions.

Most people received the information they needed from the group sessions. Less than one third of the attendees went on to have an individual session. Those who attended individual sessions were people with more complex issues, including people who are classed as ‘high cost’ e.g. frequent attenders at G.P Surgeries, those on multiple medications, and people with substance misuse issues. In these individual sessions, participants felt able to share information on their medicines, treatments and overall wellbeing that they haven’t previously shared with anyone. For some this included areas where they felt unsafe and had not talked about to professionals before. On several occasions, we have been able to provide information on safeguarding options, and maintaining safety. This included signposting people to available services, they previously either avoided or had been unaware of.

The success criteria for the DWP funded project, which were all met, related to helping people back on the route to employment. By collecting accounts from attendees, we also found that our sessions appeared to lead to a reduced number of prescribed medicines and more appropriate contacts with services. Indicating that adopting this approach as part of core services will be self-sustaining.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Innovation and adoption / Patient and medicines safety
Benefit to NHS:
Benefits identified to date include improved adherence with medicines; improved quality of life; reduced unnecessary medicines; identification and actions on previously unreported patient safety issues. A thematic analysis of the feedback showed that out of the 28 people who had an individual session 19 were given advice on referral pathways; 9 signposted to existing resources (such as Medicines Use Reviews) and trusted source of information; 9 people were recommended to ask for a clinical medicines review, 4 were advised on options for opioid switches and 10 on dosage, side-effects or interactions. This prompted one person to comment:
‘In the support session you listened to me, and helped me work out what I needed to say. I gave the notes to my G.P. who changed my medicines and made the referrals you suggested. I now no longer walk with a stick, and feel a lot better. I thoroughly recommend these sessions’
 
We also carried out a thematic analysis of the presenting issues in the individual sessions, based on the feedback and on our reflective log. The top five issues were mental health problems (13/28); suicidal ideation (5/28); use of non-prescribed medicines, including borrowed and illicit substances (5/28); anger issues (5/28); previously unreported risk or safeguarding issues (3/28).
 

In summary, we found three main areas of benefits:
  1. Addressing the fact that specialists in different areas of medicine only ever review the medicines they have prescribed. So people end up with a continuation of medicines they don’t need and often medicines which make things worse.
  2.   Helping bring out the things people don’t normally tell their doctors (we all do this). In the jargon this is called ‘intentional non-adherence’. This increased trust and openness seems to be because we deliver these reviews as part of larger project led by users of services, so by the time we see people they have built up a degree of trust in the process.
  3. We’re finding some unexpected patient safety benefits. We’re learning that, as a result of the way the sessions are carried out, some people feel able to share information on their medicines and treatments with us that they haven’t previously shared with anyone. On a number of occasions we have been able to give advice on medicines safety and signpost people to services they need, but had previously either avoided or been unaware of.
 
Initial Review Rating
4.20 (2 ratings)
Benefit to WM population:
As a result of the sessions and individual reviews, this approach can be tailored to promote local services and resources, and meet the needs of differing patient groups from all backgrounds.
Current and planned activity: 
Onoing projects in the South West and devleoping links to London Trusts. Presented to NICE Mediciens and Prescribing Associates.
What is the intellectual property status of your innovation?:
The name Patient Led Clincial Education (TM) related educational materials, governance policies and procedures are the property of Care Right Now CIC.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
3
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Steve Turner 16/01/2017 - 10:40 Publish 2 comments
0
0
Votes
-99999
Innovation 'Elevator Pitch':

Kinesis lets clinicians (mostly GPs) request expert clinical advice from consultants at their provider trusts as an alternative to making a referral.

Find an expert – ask for patient related advice – receive a rapid reply – treat locally/refer
 

Overview of Innovation:

​Evidence shows that around 65% of referrals to outpatient clinics are 'inappropriate' [1. NHS Institute for Innovation and Improvement. Delivering Quality and Value – Focus on: Productivity and Efficiency. April 2009.], resulting in unnecessary delays to treatment and avoidable costs.

Kinesis is a browser-based application that allows clinicians to request expert clinical advice as an alternative to making a referral. It is most commonly used by GPs, who request advice from consultants at their provider trusts, though this can be extended to a wide range of healthcare professionals.
High level process:
Find an expert – ask for advice related to a patient – receive a rapid reply – treat locally/refer

Kinesis has a number of unique features that: drive rapid replies to requests for advice (typically within 24 hours), notify users of requests and responses, tracks outcomes, allows tariff payments, supports real-world work patterns.

Kinesis is fully encrypted, runs securely over N3, is very simple to set up and use.
Kinesis delivers improved clinical outcomes, fewer referrals (50% saved), improved primary-secondary engagement, referral cost reduction.


In practice, CCGs adopt Kinesis and set up all their GPs and engage consultants in specialties at their provider trusts in a phased approach to provide a responsive service. As adoption grows, more specialties and providers are added, often based on the demand from GPs.
Initial set up is rapid, requiring only a list of the names and email addresses (usually NHS email addresses) and their role (and optionally further profile information) to bulk add users, plus agreement on the configuration and preferred message text in the system. Typically, this takes around 2 weeks to complete, following which the system is announced as live to users and they can log in at the URL they are given, add further information to their profile (work days, mobile number, notification preferences, interests etc) and start using the system.

Administrators are similarly set up and have access to manage users, run reports, download data and provide general system management.
​The supplier runs all the servers etc. that make it work, help with set up, support &advice on getting the most from the system.
Kinesis is under active development and this is driven by the Steering Group, consisting of representatives from all the CCGS, providers and the supplier. New features are added on a rolling basis and made available to everyone.
 

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Education, training and future workforce / Digital health / Innovation and adoption
Benefit to NHS:

For Patient

  • Provides confidence that their needs are being quickly assessed by experts.
  • Minimises waiting time for appointments and delays in treatment – reduced Time To Treatment
  • More convenient locally based treatment where possible
  • Can lead to a more urgent referral.
  • Saves NHS Money

For GP

  • Keeps GP’s at the centre of referral decisions and improvers patient care
  • Provides easy, quick and certain access to clinical specialists
  • Provides significantly improved care and treatment options for patients
  • Builds relationships with secondary care
  • Provides opportunities for joint education & joint working
  • Minimises unnecessary referrals, can trigger more urgent referrals
  • Opportunity for learning
  • Saves money for practice and CCG

For CCG

  • Improves the efficiency & effectiveness of the referral management process
  • Provides direct savings through a reduction in unnecessary referrals
  • Reduces waiting lists and waiting time for specialist assessments
  • Stimulates and improves direct communication between primary and secondary care
  • Improves governance through the auditable tracking of advice
  • Provides an inbuilt reporting and administration system

For Specialists

  • Uses knowledge and expertise efficiently and effectively
  • Saves wasted time with unnecessary referrals & improves utilisation of clinics
  • Extends their sphere of influence
  • Provides income and improved service levels for the trust
  • Enhances relationships with GP’s and primary practice
  • Provides opportunities for joint education & joint working
  • Improves governance through the auditable tracking of advice
  • Can enhance/expedite necessary referrals
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:

As above

Current and planned activity: 

Fully implemented in a number of South London CCGs, with substantial clinical, financial and operational success.
Active engagment with GPSoC
​Ongoing Steering Group driven enhancements
Active discussions with DXS around integration and synergy
Ongoing disucssion with eRS around use of the eRS APIs when published
Pilot use with prison service

What is the intellectual property status of your innovation?:

We have full ownership of IP

Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
The solution has been scalable to a national level.
Experience has shown that it takes around 2 weeks to deploy per CCG and that CCGs take around 6 months to scale up to widely engaged GPs and a representative selection of specialities.
Strong ramp up in usage continues into year 2 in most cases, as new specialties and providers are brought on and as GPs and consultants habituate inclusion of Kinesis in their personal workloads.
Measures:
The CCGs who currently use a system track a number of measures, predominantly:
  • number of referrers
  • number of advisers
  • number and type of messages,  by date, practice  and specialty
  • referrals avoided and detailed outcome status
  • percentage of requests answered within 24 hours
  • percentages requests answered with a single exchange of information
  • total savings
For Example

Wandsworth CCG Kinesis analysis April 2014 - March 2015
Advice requests sent = 2869
Referrals Saved = 1660
% saved = 57.9%
Total Saving £239,590
 
Top specialties by Messages sent
Haematology 383
Paediatrics 304
Gastroenterology 280
Diabetes and Endocrinology 249
Gynaecology 248
Cardiology194
 
 Active Users = 269
79 users sent 12 + messages
 
59% of messages answered within 24 hours
53% of messages answered in 1 exchange
 
Adoption target:
We seek a 50% adoption by CCG with a stretch goal of 80% (we recognise that some CCGs have other priorities or have address this need with locally developed solutions)

Within a CCG, 100% of GP practices to have use on the system and 30%+ of GPs to become active users.

Suggested usage targets of 10 conferrals per 1000 (weighted) population.



 
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Simon Hudson 24/03/2016 - 11:47 Detailed Submission 6 comments
5.7
3
Votes
-99999
Innovation 'Elevator Pitch':
Whose Shoes? uses a range of scenarios and topics to help staff explore the concerns, challenges and opportunities facing different groups. So you can walk in their shoes understand the process and issuses associaed with making (an informed) decision
Overview of Innovation:
Whose Shoes? is a popular approach to co-production within the NHS, endorsed and actively supported by the Patient Experience team at NHS England and the Transformation team within NHS Improving Quality, as well as local authorities, universities and other public services. It is a flexible tool that can be adapted (through bespoke partnerships) to a wide range of topics and challenges. The original board game, launched in 2008, explored issues around the emerging personalisation agenda.
A person-centred and values-based focus remains central to all development.
New material is being developed through strong collaborations with passionate people, fired by a very strong social media presence and networking capability. Whose Shoes looks at issues from different perspectives and triggers crucial conversations, with real ‘light-bulb moments’ as participants come together as ‘people’ rather than roles and work together to find solutions to the issues that matter to them. Getting as wide a range of participants as possible around the table cuts across boundaries and flattens hierarchy.
The relaxed approach creates the conditions for ‘service users’ to contribute as equals in a relaxed environment which is conducive to open, honest exchanges. People are empowered to lead rather than simply contribute. There is a strong focus on action and sharing good practice widely, with participants encouraged to make pledges and to share good practice through stories and case studies and to promote these through social media. Graphic recording of Whose Shoes workshops is very popular with hospitals using the records as action plans.
The maternity version of Whose Shoes? has been developed in partnership with the London Strategic Clinical Network and NHS England. It was piloted in five London hospitals. Workshops are now spreading – including other London hospitals, Guernsey, Leeds, Cumbria and Manchester.
Whose Shoes? material to improve communications between children and young people, their parents and healthcare professionals has been co-produced with Great Ormond Street and HENCEL.
Scenarios to promote dementia-friendly communities and understanding by NHS staff of the challenges of living with dementia have been produced through partnerships with Skills for Health and an Age UK consortium. Integration scenarios are used in the Darzi programme. Bespoke scenarios around other areas of patient experience (e.g operating theatres) is being trialled with Kingston Hospital
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
“ Whose Shoes brings people together to have conversations that matter, the resources stimulate thoughts whichlead to new insights & importantly to actions through the power of human connection & the use of narrative. ..... The energy generated is tangible .......it’s sustained long after as the creativity of both the public and professionals in unleashed. I’d really recommend the approach as a vehicle for any service committed to ongoing improvement
#Hellomynameis… Kath Evans, Experience of Care Lead (Maternity, Infants, Children and Young People), NHS England
 
“ ‘Whose Shoes’ has been an incredible catalyst in Maternity care. Having set up 5 pilot workshops with the London maternity strategic clinical network there has been a tremendous ripple out to hold further workshops in other Trusts as well as the phenomenal change platform that is #MatExp.
The actions are far to numerous to list here, some examples: a  graffiti board …to give live feedback on services, decorating the maternity theatre ceilings to improve the environment for women undergoing Caesarean section (CS), optimal cord clamping ……. midwifery workshop to explore better collaborative working - the list is endless.
We have also used ‘Whose shoes’ in other areas of the hospital with success #KHFTWhoseshoes, improving  staff attitude & environment and patient experience in our main operating theatres & having a drop in session on administration at our Trust Open Day”.

Florence Wilcock, Consultant Obstetrician Kingston Hospital NHS Foundation Trust, Chair of the London Maternity Strategic Clinical Network maternity experience subgroup.
 
"Whose Shoes is a creative opportunity to engage staff, women and patients in a process of improvement and enlightenment, The #MatExp social movement for change ... used in our failing maternity service to better understand the experiences of women, their birth partners & our staff.  The creative energy & ideas generated during our session were directly developed into practical actions & we have subsequently used the model of engagement in other clinical areas.  Whose Shoes played an important part in our improvement journey & is having a direct impact on outcomes for women, birth partners and staff"
At the time of engaging with Whose Shoes, Steve Hams ex-Interim Dir. of Clinical Governance & Chief Nurse for the Health and Social Services Department at the States of Guernsey, now Interim Dir. of Clinical Performance & Delivery, NHS Surrey Downs CCG
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
t feels currently as though the West Midlands is largely missing out on what is now a popular, proven improvement methodology being adopted rapidly in other parts of the UK and now reaching out internationally. This tool is very different from the ‘same old’ , traditional ‘top-down’ consultation models. It is about real staff and patient engagement leading to rapid improvements – and people find it fun too!

The NHS benefits would be similar to other parts of the country but it would be easier and cheaper (travel, accommodation) to work in partnership with West Midlands (ie local) NHS Trusts / CCGs.

Also New Possibilities, the recommended graphic facilitators, with whom we work as very close business associates, are based in Birmingham.

Thus greater adoption in addition to helping, patients and helcare providers it would also allow our regionally based company to grow and develop new specialised products as well exporting this delivery process overseas e.g Currently exploring taking 'Whose Shoes Maternity' approach to Uganda.

Currently Adopted / Procured by:
  • NHS England: North region; East Midlands
  • Hospital Trusts include:
    • Kingston, Guy’s and St Thomas’s, Lewisham & Greenwich, King’s College, UCLH, Leeds, Croydon, Maidstone & Tunbridge Wells, Stockport, Manchester, NHS Cumbria, North Cumbria
  • Cheshire & Wirrall Partnership Trust
  • Guernsey HSSD
  • Great Ormond Street (partnership - CYPMeFirst masterclasses)
  • CCGs include: West Leicester, West Kent, Leeds
  • AHSN / Area Team: Wessex, Thames Valley
  • International workshops and talks delivered: Australia, Malta, France; Puerto Rico
See: www.nutshellcomms.co.uk for 'Case Studies' and other information.
Current and planned activity: 
  • Building on 5 pilot workshops (& Train the Facilitator session) carried out with NHS Eng. & the London Strategic Clinical Network supporting the new maternity experience; now spreading to hospital trusts across the UK
  • 12 Whose Shoes #dementiachallengers in March 2016 workshops across Kent, Surrey and Sussex, run by Age UK consortium, commissioned by HEEKSS
  • On-going partnership with Great Ormond Street Hospital to use bespoke scenarios in #CYPMeFirst masterclasses for multi-disciplinary health professionals working in paediatric services from many hospitals; the first 20 ‘Communications Champions, who are taking this into their own organisations; more being recruited (up to 100)  
Required activity
  • Procurement / Adoption of Whose Shoes? -  Across the W Midlands NHS Trusts, via workshops or via purchase of online/board game versions of Whose Shoes?
  • Collaborative work to personalise Whose Shoes? For particular projects or departments
What is the intellectual property status of your innovation?:
Design registered. UK Registration Design No. 4009563; Trade Mark (Whose Shoes): No. 2502651
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Gill Phillips 01/03/2016 - 10:00 Publish Login or Register to post comments
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2
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