Creating a receptive culture for shared decision making

How do you begin to change the culture of an organisation like the NHS within a year?

That’s the task Emma Walker faces in her work at the Advancing Quality Alliance (AQuA). She’s leading on culture change for the government’s Rightcare Shared Decision Making programme. Emma, who previously led shared decision making at NHS Direct, talks about why change is needed and how the work will bring benefits for clinicians and patients alike.

What's the aim of the Rightcare programme's work on shared decision making?

The year-long programme started at the beginning of 2012 and it’s about embedding shared decision making into routine practice in the NHS.

Digital agency Totally Health are developing 36 tools, such as mobile phone applications, that will help patients and clinicians put shared decision making into practice. Business solutions company Capita are working with commissioners to embed shared decision making into NHS systems. And the AQuA role is about developing a receptive culture for both clinicians and patients. You can’t have these tools and systems without making sure patients and clinicians understand shared decision making.

How are you working to 'create a receptive culture for shared decision making'?

We are working with universities to get shared decision making into the curricula for medical students, as well as pre and post registration courses for allied health professionals, nurses and midwives.

We're training 30 teams of clinicians from three specialities – kidney care, maternity and musculoskeletal. Training sessions bring multi-disciplinary teams together and use exercises and role play to work through what shared decision making is and when they might use it.

Finally, we are working with patients. We have asked clinical teams to identify patient leaders that we can work with to spread the word, develop resources and create case studies.

How will this work improve the NHS?

There is evidence to suggest that patients involved in their care have improved knowledge and understanding, are more committed to following their treatment plan and have better health outcomes. Fewer patients have procedures that they don’t want and there’s reduced likelihood of litigation and complaints.

Why does the NHS culture need to change?

More people know about their healthcare choices now because of the internet. They want clear information, based on UK evidence and the chance to discuss choices that fit with their values and lifestyle.

Clinicians can’t make assumptions about what individual patients want and don't want to know. Unless they ask, a clinician won't fully understand the implications of a treatment they recommend for an individual patient. Do they know if their patient can take time off work, or if they are a carer? Patients’ views are as important as that of the doctor – they have to live with their decision so it has to be right for them.

What are the challenges of achieving this change?

The embedding of shared decision making into the NHS could take up to 10 years and we are just starting on this journey at a time of organisational change.

People say: 'We do this already'. Often, there are pockets of good practice, but rarely are the whole team doing it. We look at what they may need to move forward. Others say: 'We haven’t got time to do this'. But all the evidence suggests that it doesn’t take any longer. For example, informed patients need less follow up.

It's been hard to engage patients but we are working on this and would welcome any help or suggestions.

What has been achieved so far?

We've got 30 teams of clinicians on board and have trained 19 of them. From September, a free e-learning resource will be available for NHS staff, medical and dental students and organisations.

Trusts, colleges and professional bodies want to be involved in the work. It’s early days but we’re moving in the right direction.

What plans do you have for the future?

At AQuA we see shared decision making as an ongoing part of our agenda. Cultural change can’t be achieved in a year and I’d like to see it through for longer – until it gets into routine practice.

I'm optimistic we’ll get there, especially if people push for it at the rate they are doing now.