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 (Person centred care)

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 - 12:44 Publish Login or Register to post comments
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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 - 12:00 Publish Login or Register to post comments
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