Right Care for Patients

Right Care for Patients

The National Shared Decision Making Programme

One thing I have always found is that you have got to start with the customer experience and work backwards to the technology.

Steve Jobs 1955-2011

I wanted to ask questions but did not feel fit to do so at the

time.

No choice on treatments, even though I asked for

the options!

Being treated as a person.

Treat the person, not the condition!

More patient education for the GPs  

Need to know what to ask for.

Get education.

Information is at the core of decision

making - up to date information, new

treatments and patient mentoring.

I wanted to know more about the kidneys not just

the condition. Cannot make decisions unless I'm

informed.

Knowledge is power!

%

Wanted more involvement in treatment decisions:

Source: NHS inpatient surveys

Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.

Whole Group High-Comorbidity

Murtagh et al. NDT 2007

Choice of Modality

38%

20%

Patient ChoiceAdvanced Kidney Disease

• The BOLDE Project (Brown E.A et al. 2010)Part 1- Older patients can successfully be dialysed using PD;- Patients on PD perceived significantly less illness and treatment intrusion;- After regression analysis, patients on PD and HD reported similar quality of life.

Part 2- Patients want to be involved withmodality decision-making;

- The unit with the lowest use of PDhad the lowest patient involvement in decision making.

UK Renal Registry 13th Annual Report

Home HD 1%

Hosp HD 23%

Satellite HD 20%

Transplant 48%

APD 4%CAPD 4%

Figure 2.6: Treatment modailty in prevalent RRT patients on 31/12/2009

UK Renal Registry 13th Annual Report

Figure 2.8: Percentage of prevalent haemodialysis patients treated at satellite or by home haemodialysis by centre on 12/31/2009

0

10

20

30

40

50

60

70

80

90

Centre

Per

cent

age

of d

ialy

sis

patie

nts % home HD

% sat HD

Variation in UK

Shared Decision Making

Shared decision-making is a process which involves patients:

– as active partners with their clinician;

– in clarifying acceptable medical options;

– and in choosing a preferred course of clinical care.

What are they sharing?

Shared Decision Making in the NHS

‘The Government’s ambition is to achieve healthcare outcomes that are among the best in the world.’

‘This can only be achieved by involving patients in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone.’

‘We want the principle of ‘shared decision-making’ to become the norm: no decision about me without me.’

The policy context

Why shared decision making?The benefits are:

• Improving patient satisfaction, experience, knowledge;• Helping patients make healthcare choices aligned with

their personal needs, values and circumstances;• Improving clinical outcomes and safety; • Achieving the right intervention rate and reducing

unwarranted practice variation;• Reducing cost and litigation costs.

Decision Aids reduce rates of discretionary surgery

RR=0.76 (0.6, 0.9)

O’Connor et al., Cochrane Library, 2009

The National SDM Programme

QIPP PMO

SDM Programme

Board

Lot 2 Provider

SDM Programme

Team

Lot 1 Provider

Lot 1 Sub-Contractors

SDM Advisory Group

SDM Reference Group

DH Patient & Service User Engagement

Lot 3 Provider

Lot 2 Sub-contractors

Lot 3 Sub-Contractors

Right Care Programme

Team

National Right Care Shared Decision Making ProgrammeGovernance Structure (draft)

Thank you

Management is doing things right; leadership is doing the right things

Peter F Drucker

steven.laitner@nhs.net www.rightcare.nhs.uk