Q12 People Powered Health

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1 Q12 People Powered Health Sir John Oldham Anette Nilsson AndersVege With special thanks to Michael Bergstrom & acknowledgement to Nesta The presenters have nothing to disclose

2 Session Objectives Apply the rationale and business case for involving everyday folk in QI Understand the five design principles for systematically involving people in care improvement and how to apply them Describe how to create large-scale health care movements and change using ordinary people

3 When asked in polls. 85% of clinicians believe they share decisions about treatment with patients 50% of patients believe this is the case Blakeman T BJGP 2004

5 Responses to disruptive innovation The people wont use them Trains They wont replace our products IBM about Personal Computers and Microsoft They wont replace our products Microsoft about I pads???

6 Responses to co-management Patients can t do this It will never happen where I work Thats my job as doctor its what they pay me for. No evidence about co-management making a difference Quality will fall

7 A definition of co-management. (Shared Decision Making. Coulter, Collins. Kings Fund, July 2011) Shared decision making is a process in which clinicians and patients work together to clarify treatment, management or self management support goals, sharing information about options and preferred outcomes with the aim of reaching mutual agreement on the best course of action.

8 Why should we do this? Ethical imperative (patients want to be involved more than they are) Legal imperative (medicolegal requirement to discuss options, risks, consequences prior to any intervention) Evidence base shows it improves quality Appropriate allocation of resources (patients get the care they need and no less, the care they want and no more )

9 Self management of warfarin and INR. Cochrane review Heneghan et al April Clinician management of warfarin and INR 2. Self monitoring of INR and clinician advice re: warfarin dose 3. Self management of INR and warfarin Compared to groups 1 and 2, group 3 have same risk of bleeding 50% fewer thrombotic episodes 36% lower mortality

10 Key principles for co- management (Ref: Getting good information Achieving self confidence Altering behaviour (Ability to go online, use medical devices -technical skills)

11 Achieving self-confidence Person owned records Written care plans Telephone coaching Motivational interviewing Goal setting Information Provision Online Courses Online discussion groups Group Education Behaviour Change Electronic information interactive apps Skype coaching Self monitoring Sir John Oldham 2016 Technical Skills

12 Levels of activation (Ref:Health Foundation) ACTIVATION PREDICTS OUTCOMES

13 Business case for People Powered Health (Nesta 2013) Reduction in cost of managing people with long term conditions by up to 20% 7% reduction in ED attendances 7% reduction in emergency admissions 60% primary care interventions can be dealt with remotely

14 Decision aid and coaching in gynaecology Treatment costs ($) over 2 years Usual care Decision aid Decision aid + coaching

15 Data from reablement Tordis had 9,3 hours a week of community nurse before reablement started Intensive reabelmentprogram were initiated She ended up with 0,5 hours a week from community nurse

16 Ladder of participation / patientpersoncenteredness. Individual Indvidual guiding/ Brosjure/ information material Dialogue Individual plan / Shared descissionmaking / Coordinating team User driven service Personal assistent System-/service Information meetings User council User serveys Employed users Userowned services Users as spescialist guides Political Information campagne User councils User participation in creating guidelines and designing programs Local and national political election Information consultation Co-design Customer-owned Versjon 2 Udness, Bakke og Nordheim 2017

Customer-owner and Relationship Douglas Eby MD MPH, Vice President of Medical Services Joshua Franks Special Assistant, Resource and Development Copyright 2011 Southcentral Foundation.

17 Customer-owner and Relationship Douglas Eby MD MPH, Vice President of Medical Services Joshua Franks Special Assistant, Resource and Development Copyright 2011 Southcentral Foundation. All Rights Reserved. NOTICE: Unless otherwise indicated, this work represents copyrighted material protected by United States and international law. This work may not be used, reproduced, downloaded, disseminated, published, transferred or transmitted, in whole or in part, in any form or by any means, electronic or mechanical, including photocopying, recording or information storage and retrieval, except with the express written permission of the publisher. This work may not be edited, altered, or otherwise modified, in whole or in part, except with the express written permission of the publisher.

18 Objectives Customer-Driven Healthcare: Customer-Owner Voice JOB s, Advisory Committees, Staff/leadership, etc. Workforce Development Family Wellness Warriors Initiative/Men s Wellness Wellness Care Plans New Generations Initiative 3 year gestation Behavioral Health Redesign Copyright 2011 Southcentral Foundation. All Rights Reserved.

19 Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission Working together with the Native Community to achieve wellness through health and related services Copyright 2011 Southcentral Foundation. All Rights Reserved.

Key Points Shared Responsibility Commitment to Quality Family

Customer-owner Southcentral Foundation uses the term customerowner instead of:

Key Improvements Customer Focus Governing board Advisory committees Elders Council Focus Groups Annual Gathering 24- hour hotline Community

22 Key Improvements Customer Focus Governing board Advisory committees Elders Council Focus Groups Annual Gathering 24- hour hotline Community gatherings Personal interaction with employees Satisfaction surveys Comment cards Copyright 2011 Southcentral Foundation. All Rights Reserved.

23 Key Improvements Workforce Core Concepts Work together in relationship to learn and grow E ncourage understanding L isten with an open mind L augh and enjoy humor throughout the day Notice the dignity and value of ourselves and others E ngage others with compassion S hare our stories and our hearts S trive to honor and respect ourselves and others Copyright 2011 Southcentral Foundation. All Rights Reserved.

24 Activated patients A quality marker Working in partnership with prepared and trained clinical teams To proactively manage health and to anticipate and plan for times of need (care planning and anticipatory care planning) In a system where incentives and processes are aligned to achieve the above

25 House of Care (variation on the original by Dr Sue Roberts) Organisational Processes & Arrangements Engaged, Informed, Empowered Individuals & Carers Goal is What matters to you? Health & Care professional team committed to partnership working Quality Improvement methods

26 Passion for life Passion för livet Anette Nilsson & Elsa Ingesson

27 Passion for life - purpose To create possibilities for a healthy life with high life quality for elders. To test procedures to find new methods that can affect the overall goal we all probably aim for: best possible life the whole life

28 Passion for life - goals To incite senior citizens to take their own responsibility for preventive work for an as rich and healthy life as possible To find messengers who can communicate knowledge and methods and spread ideas

29 Passion for life - strategy By modern methods of quality development incite people to go from words and knowledge to action and changed lifestyle

30 Passion for life how is it done? We meet in six life cafés, which are rooms of possibilities where everybody's experiences contribute to improvements On the way Safety, food & drink, exercising, social network

Life café 5 - Physical activities A P https://www.youtube.com/watch?

heart and vascular diseases, high bloodpressure, brittleness of the

31 Life café 5 - Physical activities A P BJ7TZ-n-044 Do I exercise so that I prevent overweight, diabetes, heart and vascular diseases, high bloodpressure, brittleness of the bones, back trouble and balance problems? Goal: A well-functioning body S D

2014 2014 Passion for life won first prize in EU contest Social innovation in ageing The European Award The prize is

32 Passion for life won first prize in EU contest Social innovation in ageing The European Award The prize is awarded by the Belgian royal family fund the King Baudouin Foundation for the renewal of work in the area of the elderly.

33 Learning points Be clear with the central message, the heart of Passion for life and repeat the method of quality improvement It is possible to use these methods to improve health and quality of life Have fun when working Plan for spread from the very beginning Strong and enthousiastic ambassadors know your own context and from that perspective bewater how to translate Passion for life in your way. When you have a social movement, you can t have the full control you can just enjoy and support Timing Homepage, films, working book and instruction material A messege for others is, don t wait, start to build a structure for empowerment and do it with love and joyfulness

35 Malin Britt-Marie Esther Sigge Arne

36 Digital support Work place Care Community School

37 Health Café for people with chronic disease Self-management - Co-design - Empowerment - live good life with high life quality

38 How it all started? A story about 4th of June and a farmer from Norway

39 What matters to you?

40 4.th of June 2014

41 This is what matters to me

42 6. Juni 2017 Helse og omsorgsminister Bent Høie

45 Skottland

46 Brasil

47 BC Canada

48 Trento, Italia

49 The Healthy Communities Model (Sir John Oldham 2003) Topic Stimulates Desire for other topics Successful action Enhances Community Development

50 Session Objectives Apply the rationale and business case for involving everyday folk in QI Understand the five design principles for systematically involving people in care improvement and how to apply them Describe how to create large-scale health care movements and change using ordinary people

2014 Patient Centered Medical Home (PCMH) Recognition

Collaboration Catalyst Community 2014 Patient Centered Medical Home (PCMH) Recognition PRESENTED BY: Oct. 2015 RuthAnn Craven, MS Transformation Coach AHI is an independent, nonprofit organization that