Shared decision-making between clinicians and patients is delivering significant improvements in musculoskeletal care at Sussex MSK Partnership. Physiotherapist Helen Patten shares the benefits
One of our core values at Sussex MSK Partnership is ‘putting patients in control’. We seek to ensure care is tailored to their needs. And this is at the heart of any shared decision-making process.
We have more than 100 clinicians in our service. They include physiotherapists, nurse specialists, podiatrists, osteopaths and orthopaedic surgeons. Two years ago, we embarked on a training programme designed to educate clinicians to align patient consultations to this core value. The programme also sought to improve our understanding and delivery of shared decision-making to put people at the centre of decisions about their own treatment and care.
We know that patients want more involvement in making decisions about their healthcare (CQC inpatient survey, 2016). In addition, we know that both clinicians and patients overestimate the benefits and underestimate the harm of treatment interventions (Hoffman, 2017).
A responsibility to present the facts
As a result, we have a responsibility to present both the benefits and risks of treatment clearly, keeping in mind what is important to each individual. This is also part of the NHS Long-Term Plan for England.
As clinicians, many of us feel that we have a good understanding of shared decision-making. But through our training programme, we realised that we required a significant cultural shift in communication.
We are generally competent in offering informed choice, for example treatment and options, to patients. Equally, we feel less competent about understanding what matters to them.
There is a fundamental difference between offering informed choice and involving patients at all stages of their healthcare journey. This means ensuring that treatment options align with patients’ preferences and values. And it means they feel involved in decisions about their care.
To truly put a patient at the centre of their treatment, we need to make them aware of their role in a collaborative way – viewing them as an expert in their own health journey. Instead of asking ‘what’s the matter with you?’ we should be asking ‘what matters to you?’ This is a significant move away from the paternalistic model that has dominated medicine for so long.
We are fortunate to have Chloe Stewart, a self-care lead in our service. She is health psychologist and has given a unique and expert perspective in leading our training programme. Chloe has been a consistent and valued voice for the project.
We took a multifaceted approach to our education strategy, ensuing that we engaged with our clinicians in as many ways as possible to get people engaging with the process.
To start, we held expert-led training in shared decision-making and motivational interviewing. All clinical staff were invited. Then we supported a group of self-selecting clinicians to complete a ‘train the trainer programme’.
This resulted in a team of ‘clinical champions’ who were able to offer peer support and tailored feedback to colleagues within their teams. It gave staff the opportunity to identify strengths and areas for improvement, but in a practical way using reflective practice and peer support. We have realised through our shared decision-making journey that the process takes time – not least in engaging with staff.
Another shift in our process has been to engage patients in their health journey through a patient outcome letter that outlines individualised care plans. This means we write directly to the patient, rather than sending them a copy of a letter about them, but written to their GP. This new patient outcome letter acts as a summary of their consultation. It also includes self-management information; treatment options, in accordance with their preferences and values; and the relevant benefits and risks of treatments.
We developed this letter with our patient partners. It connects the patient to their consultation and reflects the conversations that have taken place within the clinical setting.
The impact of our programme has been demonstrated in many ways. For instance, over the past two years we have seen improvements in patients’ experience of shared decision-making, measured using the SureScore system.
Since 2015, there has been a significant reduction in referrals to secondary care. This suggests that patients are opting for conservative management over surgical intervention; which is also reflected in lower secondary care spend.
We strive to integrate the shared decision-making process into our organisation as a whole. This has been achieved through interactions with colleagues, as well as leadership teams. We have a strong presence from our patient partners, administrators, as well as leaders in our meetings and projects on shared decision-making. This ensures every voice is heard and that the culture of shared decision-making is embedded within our organisation.
We are keen to share our learning. Earlier this year, Chloe Stewart spoke at an NHS England webinar about shared decision-making. In March, she was recruited to the panel for the new National Institute for Health and Care Excellence guidelines on shared decision-making.
The highlight of the project so far, however, has been the HSJ Partnership Awards 2019. We entered in the category for education and training. And we went on to win. This feels like a reflection of the hard work and collaboration of our whole team in sharing this journey. It is a great opportunity to spread the word about shared decision-making too.
Helen Patten is clinical lead for the upper limb pathway at Sussex MSK Partnership Central
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