One of the prominent themes in feedback from our previous ‘What matters to you?’ days has been that people find it difficult to make the ‘What matters to you?’ conversation business as usual. This an important issue and highlights the need to create person-centred systems and cultures that support healthcare professionals to work in this way. Our current systems don’t make it easy!
In recent months I’ve come across two great examples of what is possible when the space is created, and the imperative maintained, to make ‘What matters to you?’ conversations business as usual in a service. In subsequent blogs we will move up a level and look at some examples of person-centred organisations and systems.
In Edinburgh the NHS Lothian Patient Experience and Anticipatory Care Team (PACT), has been focusing the conversation on what really matters and creating personalised anticipatory care plans for people who frequently attend the Emergency Department and for people with complex long term conditions at high risk of admission to hospital.
This way of working has resulted in some significant improvements. Unscheduled hospital admissions amongst this specific population are down by 33% and there has been a similar reduction in unscheduled attendance at the Emergency Department. Outcomes for the people concerned have improved and simultaneously a productive gain of £2.4m has been realised. This lead to the PACT team receiving the Scottish Health Award for Innovation in November 2016
Jim Marple, a GP working across the interface between primary and secondary care, is a member of the PACT team: “The outcomes, the demonstrated gains and the award have all helped to keep the programme going – despite current financial pressures – whilst we seek permanent funding. All or work focuses on this person-centred approach.”
In Tromso, northern Norway, a similar piece of work has also had impressive results. Here the team worked with a similar population as in Scotland, people over 60 with multiple long-term chronic conditions. The main intervention was to have a conversation about ‘What matters to you?’ e.g. What keeps you well? What do you love doing? Once the team understood these personal goals they used them to guide care and support.
One of the leaders of the project, Gro Berntsen, said “Identifying the personal goals and staying loyal to these personal goals was the thing we discovered made the real difference.”
What was that difference? Compared to the rest of this frail elderly population the ‘What matters to you?’ cohort spent 30% less time in hospital and had a 50% reduction in mortality[i].
With results like this one might ask why isn’t everyone working in this way and focusing on what matters to people? I wonder what would happen if we did?
~ Shaun Maher, Strategic Advisor for Person Centred Care and Improvement, Scottish Government
[i] Berntsen GR, Hurley JS, Dalbakk M, Bergmo T, Bellika JG, Solbakken B, et al. Personcentered, cross organizational and multiprofessional team halves mortality risk. The PAtient Centered Care Team (PACT) Study – Preliminary results from a comparative effectiveness study. 17th International Conference on Integrated Care, 8-10th of May 2017 Dublin: International Journal of Integrated Care, ; 2017. p. 1-8.