More than two million people in the UK suffer from diabetes. This is a currently incurable condition in which too much sugar is present in the blood, leading to symptoms such as increased thirst, fatigue, blurred vision and loss of weight.
A further million people are estimated to have the condition without being aware of it and, over the next ten years, the number of people in the UK with diabetes is predicted to double. Health professionals working in this field have two main aims: to prevent people developing diabetes in the first place; and to help those who do develop it to avoid the symptoms and potential complications of the condition. The Health Foundation’s Shared Leadership for Change scheme was set up in 2005, with the aim of improving the quality of care for people with diabetes. It provides leadership development training for teams working across organisations in order to help them provide good quality care for people with diabetes. One of the six teams working with the Health Foundation on this scheme is based in Lothian, Scotland. The team includes Mary Scott, manager for the Diabetes Managed Clinical Network in Lothian, and Dr Ewan Crawford, diabetes lead for Lothian Primary Care Division. Changing the way you work Commenting on the scheme, Mary says that it has helped the team look at how they work together, make decisions and conduct meetings. “In the way I work, I think I’m getting better at sharing and at recognising peoples’ strengths and weaknesses,” she says. “I’m more comfortable with questioning what others are doing and why, and more prepared to stand my ground.” Mary highlights the scale of the challenge facing the team. “We’re responsible for 27,000 diabetic patients and it’s hard to be sure that we have improved every individual’s care yet,” she says. “But we’ve certainly identified some areas we need to progress, and have clarified our direction of travel.” “It’s been more about clarifying exactly where the group wants to improve service quality, focusing on a realistic structure and programme of care,” she continues. “The protected time that the scheme offers us is essential to go through these issues, so we can deliver.” Ewan raises the issue of how quality is measured. “We’re very good at assuming that because we do something and no-one complains that we’ve done a quality job,” he says. “But this scheme gets us to focus on a goal of success that we have to write down and formalise, and then take positive steps to achieve.” The patient perspective To ensure that the changes made remain patient focused, the Lothian Diabetes Services Advisory Group includes a patient representative, Gerry Shapiro, who was involved in the 360 degree progress assessment. Gerry says that this kind of patient involvement has led to a higher standing for diabetes patients within the medical community. Making change last Another challenge is to ‘future-proof’ the changes that the team makes, in order to ensure they will be sustained. Mary says that the way to do this is by getting the right structures in place. “We’re putting in place the processes to replace people when they go,” she comments. “Clarifying our roles, our direction of travel and documented processes and structures all help. We’re also identifying areas of over-provision and under-provision, analysing activity, targeting services and mapping national standards.” To assess this, Ewan says the team is working to provide “a creative environment where patients feel comfortable to bring up service and quality of care issues at every consultation,” rather than just accepting the care they’re given.
“It’s something we need to build into the system,” Ewan agrees. “We all understand that genuine public and patient involvement is an ongoing process. Given how often we see patients with diabetes, we’re very bad at using the huge amount of patient contact to ask them how the service is going for them and how we might improve. This scheme has indicated that we still have a long way to go to get as much public and patient involvement as we really should have in designing our services.”
26 September 2006