Helen Crisp presented on building evidence to support person-centered care. She discussed challenges like staff perceptions that they already provide person-centered care and the weak evidence base. Effective approaches include motivational interviewing, goal setting, peer support, and shared decision aids. Benefits include improved patient outcomes and satisfaction, as well as potential cost savings. Key lessons are that approaches must fit local contexts, challenge both staff and patients, involve training, and have clear goals and evaluation plans. Future research areas include better outcome measurement, changing professional roles, community support contributions, and cost-effectiveness studies.

1. Getting to person-
centred care
Building and using the evidence
Helen Crisp, Assistant Director Research

2. Conflicts of interest:
2
• I am employed by the Health Foundation
• As such, I am paid to attend this conference and to give this talk
• This presentation is based on the work of many individuals and
institutions, much of it funded by the Health Foundation
• I will be publicising free publications and resources that the
Health Foundation makes available to promote improvement
science and person-centre care
• I have no other interests to declare

3. 3
Thanks to
Colleagues at the Health Foundation:
Adrian Sieff
Darshan Patel
Ed McKiernan
Hannah O’Malley
Lizzie Wrobel
Matt Tait
Nicola Powell
Shaun Leamon
Who all contributed to the preparation of this presentation

4. Person-centred care as a facet of
Improvement Science
4
The Health Foundation is committed to building the field of
‘Improvement Science’ - by which we mean:
The application of a range of basic and applied sciences in
order to improve the effectiveness and efficiency of efforts to
improve quality of health care for patients and populations

5. Dimensions of quality
5
The Health Foundation is working to support improvements
to health services so that they are:
• Safe
• Effective
• Patient-centred
• Timely
• Efficient
• Equitable
Institute of Medicine, 2001

6. Dimensions of quality
6
The Health Foundation is working to support improvements
to health services so that they are:
• Safe
• Effective
• Person-centred
• Timely
• Efficient
• Equitable

7. 7

8. What are the aims for person-
centred care?
8
• Better experience of care
• Better clinical outcomes
• Better use of health care resources

9. What are the challenges?
9
• Perceptions of health care staff about person-centred care
We already
do this

10. What are the challenges?
10
• Perceptions of health care staff about person-centred care
We already
do this
Surveys in the NHS consistently report that over 40%
inpatients would like more involvement in decisions
about their care

11. What are the challenges?
11
• Perceptions of health care staff about person-centred care
• The changes require social and cultural changes more than
technical solutions

12. What are the challenges?
12
• Perceptions of health care staff about person-centred care
• The changes require social and cultural changes more than
technical solutions
• The evidence base is weak, contested and confusing
- Evidence review of shared decision making found
160 different definitions
- Many other studies with no definition
- ‘Same’ approaches have very different results

13. Improvement science approach
to person-centred care?
13
• Theory-based interventions using tested
methods
• Written up using SQUIRE guidelines
• Outcome measures; personal, process,
clinical
• Robust evaluation using a range of
innovative methods

14. Improvement science in action
14
• Research
• Evidence reviews
• Developing theory
• Improvement programmes
• Co-Creating Health
• MAGIC
• ‘Changing relationships’ projects
• Evaluation: independent, qual & quant, published

15. A 10 year journey
15

16. A 10 year journey
16

17. A 10 year journey

19. The Health Foundation has
focussed primarily on two areas:
19
Self-management support
Shared decision making

20. Health Foundation definition
20
‘Self-management support is the
assistance caregivers give to patients with
chronic disease in order to encourage
daily decisions that improve health-related
behaviours and clinical outcomes.’

21. Health Foundation definition
21
‘Shared decision making is a process in
which clinicians and patients work together
to select tests, treatments, management,
or support packages, based on clinical
evidence and patients’ informed
preferences.’

22. What do we know
now?
22

23. What works?
23
Self-management support approaches
Motivational
interviewing
Goal setting
and action
planning
Group-based
educational
models
Peer support

24. Self-management support approaches
24
Motivational
interviewing
Goal setting
and action
planning
Peer
support
Counselling-oriented
approach to consultations
Aims to shift from medical
model to one to one support
that facilitates behaviour
change
Used in Co-Creating Health
to train professionals
“ a professional life-
changing event”
Training in
motivational
interviewing
described as:

25. Self-management
support
approaches
25
Care and support
planning
Goal setting and
action planning
• Approach to help people more
effectively manage long-term
conditions
•Builds confidence by setting
attainable goals that matter to
the individual and step by step
plans to reach them
Key feature of Co-creating
Health

26. Self-management support approaches
26
Group-based
educational
models
Short courses for groups of people
with similar condition to support self-
management often led by an
individual who has a long term
condition
“I’m happy for starting
the group when I did.
Learning things, pacing,
helped to sort my life.”
STOP! Project in Dorset:
Group sessions to help people
live with chronic back pain

27. Self-management support approaches
27
Peer support
Group or one to one support from someone who lives
with a similar condition
Underpinned by key value of reciprocity
I’ll never be the same person
I was before my diagnosis but
peer support coaching has
made me believe in a future
where I can recover and
develop the new me”
2Gether NHS Foundation
Trust: Coaching for
recovery:

28. Effective shared decision
making
28
• Decision aids
• evidence based
• include pros and cons of each
option
• use real-life examples
• use diagrams and visuals
“All need skills to use and
attitude trumps skill”

29. 29
Evidence
based
Two options
FAQs
Option
grid
breast
cancer
surgery

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“ ‘Decision aid’ sounds very
posh but it’s not ..This was
about involving people in their
care, and they had never been
asked before”
Project lead, Newham
COPD Shine project
‘I probably… haven’t
involved patients as much
as I thought in the past …
haven’t made them as
aware of all the different
options.’
GP, North Shields
MAGIC programme

31. Evidence of improved clinical
outcomes
31
Self-management support
•Type II diabetes
• Reduced HBA1c
• Reduced fasting glucose
• Stroke
• 6 studies showed improvement
• 3 studies showed none

32. Benefits to patients
32
More confidence for better day-to-day management of health
Able to make and sustain healthy lifestyle changes
Higher satisfaction with care experience
Better adherence to treatment plans and correct medicine
use

33. Benefits to patients
33
More confidence for better day-to-day management of health
Able to make and sustain healthy lifestyle changes
Higher satisfaction with care experience
Better adherence to treatment plans and
correct medicine use
Debate about imposition of medical model v. patient
goals

34. Benefits for health care system
34
Some evidence of:
•Reduced use of emergency hospital services
• Diabetes self-management programme
Reduced number of outpatient appointments
• Ayrshire & Aran Co-creating Health
• Choice of less invasive treatment
• ‘Right Care’ knee pathway project

35. Benefits for health care system
35
Some evidence of:
•Reduced use of emergency hospital services
•Reduced number of outpatient appointments
No implementation at scale to demonstrate at
system level

36. Benefits for health care system
36
Some evidence of:
•Reduced use of emergency hospital services
• Diabetes self-management programme
Reduced number of outpatient appointments
• Ayrshire & Aran Co-creating Health
• Choice of less invasive treatment
• ‘Right Care’ knee pathway project

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Key
lessons
Tools
PLUS
What works to support
implementation?

38. 38
Key
lessons
Tools
PLUS
One size
does not
fit all
What works to support
implementation?

39. 39
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
What works to support
implementation?

40. 40
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
Work with
other
sectors
What works to support
implementation?

41. 41
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
Work with
other
sectors
Fit to
local
context
What works to support
implementation?

42. 42
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
Team and
system
level
training
Work with
other
sectors
Fit to
local
context
What works to support
implementation?

43. 43
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
Team and
system
level
training
Work with
other
sectors
Clear
Goals and
plan
Fit to
local
context
What works to support
implementation?

44. 44
Key
lessons
Tools
PLUS
One size
does not
fit all
New
approaches
challenge
staff AND
service
users
Team and
system
level
training
Work with
other
sectors
Clear
Goals and
plan
Fit to
local
context
Evaluate
and
sustain
What works to support
implementation?

45. Where next for
person-centred care?
45

46. Key areas for research:
46
• How to measure what matters to patients?

47. Measurement:
Surveys
47
‘Helping measure person-centred care’
Reviewed the evidence on measures:
Overwhelmingly survey based
but also:
Interviews
Observations of consultations
Spreadsheet detailing 160 researched
measurement tools available at:
www.health.org.uk/helpingmeasurepcc
Patient Activation Measure PAM
• Current evaluation

48. Key areas for research:
48
• How to measure what matters to patients?
• The changing role/identity for health care
professionals as the patient role changes
• What is the workforce of the future?
• What is the contribution of community support?

49. Hot off the press!
49

50. Key areas for research
50
• How to measure what matters to patients?
• The changing role/identity for health care professionals as the
patient role changes
• What is the workforce of the future?
• What is the contribution of community support?
• Robust studies of cost effectiveness and longer
term savings
• How to commission for person-centred care?

51. Shared
decision
aids
Motivational
interviewing
Goal
setting
and
action
planning
Peer
support
Patient
group
education
Next steps for implementation
51

52. For more information see:
personcentredcare.health.org.uk
52

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