As clinicians working with people with long term conditions, we are all patient-centred aren’t we? It’s hard to imagine anyone coming to work intending not to listen to their patients or aiming to ignore their thoughts or ideas.
And yet, I’m afraid, this is exactly what people are experiencing all too often. Patient surveys have persistently shown that around half feel they weren’t involved in decisions as much as they would like, or feel they weren’t asked about what is important to them.
So there may be a disconnect between what we hope we are doing and what is actually happening. Some of us may be brilliant, others less so, but – simple question – how do you know which you are? Have you measured it? If you don’t actually know how you are doing, how can you be sure you are as good as you’d like to be or work to improve further?
I’m afraid broad satisfaction surveys or absence of complaints don’t count. It is more than that. Indeed, we could argue that when working with people with long term conditions even patient-centred care – understanding the patient’s needs so we can make a plan for them – simply isn’t enough. Supporting people to develop the knowledge, skills and confidence to self manage their conditions effectively takes much more. We need to stop seeing people as recipients of our care and encourage and support their role as active self-managers.
If at this point you are feeling a bit sheepish, you will not be alone. Over the past decade or so, we have taken great strides with biomedical care with national service frameworks, the quality and outcomes framework and national audits. We are measuring (and improving) more and more. But, systematically measuring consultation quality or effective service support at the individual team or clinician level is rare.
Is this important? If you believe the adage that ‘what’s important gets measured, and what gets measured gets done’, then absolutely it is. If you believe we need to value our consultation skills and approach as highly as we’d value biomedical care, then absolutely it is. Arguably, is a team or service commissionable if they can’t demonstrate these crucial quality measures?
So, what to do? There are tools available that you could start to use across your teams or services right now. For example, the CARE questionnaire to measure consultation quality and/or the LTC6 to measure overall support and confidence, which is being used across the LTC QIPP collaboratives.
But, what would it take to incorporate some of these questions into existing national surveys, where the current questions are poor to say the least? How helpful would it be if we had comparable benchmarking information across the country at practice level that helped us understand how many people feel they were asked what was important to them, feel involved in decisions and about their confidence to self-manage? Overnight this could transform conversations from ‘we do it already’ to ‘gosh, I had hoped we were doing better than that, what can we do about this?’
Improving the support we offer people with long term conditions is a massive challenge; but one we simply have to meet. Improvement will need strong individual and clinical leadership. Training needs to move from the quick fix of skills to helping us think about our role and approach, and what systems need to be in place to make it happen. As individuals and teams, knowing how we are doing and where could improve would be an important first step, but only a first step.
Simon Eaton is Clinical lead for long term conditions in the North East