Personalised Care In Dorset - Finding Our Focus

22 February 2020

Andy Brogan Founding Partner @ Easier Inc. Guest Author Guest Author @ Easier Inc.

This blog is the second in a series co-authored with Saskie Dorman (a consultant in palliative medicine from Dorset) and Karen Stratford (a system lead for personalised care in Dorset). Today's blog also includes comments from leaders within the 3 Primary Care Network teams that are involved in the projects discussed.

Finding Our Focus

Arriving into the kick-start days (blog 1), collaborators were grouped around 3 PCN (Primary Care Network) areas. Each PCN arrived with a project in mind; something they felt would have value for the people and communities they support. The projects they had identified were:

Making the most of Social Prescribing.
Increasing patient activation in diabetic patients.
Making it easier to capture and share information about what matters to patients who are frail.

Our earlier discussions (blog 1) had helped to set a context in which to consider these project ideas. We now wanted to drill down into them to really understand what value they could deliver. To do this we used Easier Inc’s 4 tests of a purpose statement, which are:

Describe the difference.
Remove ‘buzz’ and ‘fluff’.
Think ‘what’ not ‘how’.
Use the Ronseal Test.

NB Find out more about how to use these 4 tests here.

PCN teams worked together, critically evaluating their initial ideas for change through the lens of the 4 tests. They emerged with simple statements that described their intent and suggested some important shifts in emphasis:

“Making the most of Social Prescribing” became “Make it easy for the community to manage their health and wellbeing”

This meant that the project would be:

…much less about a model of public services prescribing social support.

…much more about how public services might help people and communities to grow their own strengths, solutions and resilience.

“Increasing patient activation in diabetic patients” became “Understanding people beyond their diabetes to support them to live well”

This meant that the project would be:

…using diabetes as a selection criteria;

…but treating the focus of support as “whatever really matters to these individuals” (which may or may not be related to having diabetes).

“Making it easier to capture and share information about what matters to patients who are frail” became “As you age we will shape your care around what matters most to you”

This meant that the project would ensure that better information and information sharing add up to:

…a new reality of better care and support that does what really matters.

…not just a new bureaucracy of better care and support records that describe what really matters.

From Purpose to Points of Leverage

Work on the purpose statements had helped the PCN teams to crystallise the overall outcomes they hoped their projects would enable. There was now a need to focus in and consider what it would take to achieve these outcomes. In particular, we wanted to avoid either (i) failing because we were trying to do too much or (ii) failing because we were not ambitious enough. Our aim was to find a few key points of leverage; things we could work on that would keep our focus tight and that would enable a step change.

To do this we used the Easier Inc. sense-making framework:

Team 1: “Make it easy for the community to manage their health and wellbeing”

Carol Tilley (Managing Partner at The Blandford Group Practice) writes:

“Our discussion focused on the groups of people that are often out of sight until they are in crisis. We think there are patterns to this and that the events that can tip lives out of balance are probably identifiable but may be in areas that are felt to be stigmatising or that make it less likely that people will ask for help. For example someone starting to struggle with gambling or debt, a first-time mum who doesn’t want to be seen as not coping, someone retiring and feeling a loss of purpose in their lives.

We think we could make a meaningful difference by:

Better understanding the scenarios that people in our local communities have experienced.
Using these scenarios to identify where opportunities to ask for help, to self-help or to offer support may have been missed then using the insights this gives us to:

Develop tests of change that make it easier for people to ask for help, to self-help or to find support in their communities.
Identify diagnostic indicators that could help us to be more proactive in offering support where it may be needed.”

Team 2: “Understanding people beyond their diabetes to support them to live well”

Dr Shelley Carter (GP Partner, Personalised Care Lead and Deputy Director at South Coast Medical Group) writes:

“Our discussion focused on the role (initially) of life coaches and (laterally) of a much wider range of ‘skilled listener’ roles. These already exist in various forms in our community and in the services that support them but (to date) they have been conceived separately from each other and not really as part of a shared ecosystem. They all are capable of providing opportunities that would help people to:

understand what really matters to them in the context of their lives and condition(s).
develop realistic plans and goals.
identify and access support that would make it easier for them to follow through on their plans and goals.

We think we could make a meaningful difference by:

Joining our efforts up so that instead of separately supporting people with bits of what matters to them we can:

collectively support them ‘in the round’.
in ways that make better use of our collective capacity.
and in ways that allow us to develop shared resources and a more coherent/less complicated ecosystem of help and support.

And if that sounds like a panacea, even just this conversation helped us to agree the outline of a new approach to how we could have a 'what matters triage' across 2 organisations.”

Team 3: “As you age we will shape your care around what matters most to you”

Sara Froud (Practice Manager for Blackmore Vale Partnership and part of The Vale Network) writes:

“We talked about how good information about what really matters to people has to pass various tests. For example, it has to be:

accessible to those who need it when they need it.
as secure as the individual it’s about wants it to be.
quick to find and easy to understand.
accurate and up-to-date.
necessary, relevant and sufficient to support right care and support to happen.
valued and used by those involved in care and support.

Passing these tests won’t be easy, since some of them will rely on (potentially significant) IT support, negotiation between partners, etc. However, we think we could make a meaningful difference by:

Prototyping a paper-based ‘alert card’ approach that is focused on key information and that may help us to scope what we need in order to pass most of the above tests.
Establishing shared learning and engagement mechanisms that enhance ownership of this work and make it more likely that we will pass the last test in particular.”

Next Time…

IN BLOG 3 - The Move to Action:

Action as learning / learning as action.

How will our PCN teams translate their identified areas of focus into practical actions? How will they ensure that they learn from what happens and adapt in real time?

Staying connected.

How will they stay connected - learning with and from others and from each other? How can you stay connected too?

Easier INC