Focusing on person- reported measures… (i.e. self-reported, completed via qs/surveys) • Ou Outcom come e me measur sures es – (e.g. QoL, mobility, wellbeing) • Ex Exper perience ience me measur sures es – objective (e.g. appt wait) vs subjective (e.g. satisfaction) ‘Standard’ lists? (ICHOCM – multidisciplinary) Carers? Staff?
Questions to consider… Do you real eally y know what matters to your population of interest? What are you basing that on? How confident are you?
In your groups… Do you reall eally y know what matters to your population of interest? What are you basing that on? How confident are you? Be ch e chall allen enging! ging!
Assuming there’s room to improve… What are you going to do about it?
Could follow a structured process e.g. How will we What’s the Who are the What will we How will we use our purpose? population? measure? measure it? findings? Reviewing, incorporating and producing evidence Building capability through training and development Evaluating change
Could follow a structured process e.g. How will we What’s the Who are the What will we How will we use our purpose? population? measure? measure it? findings? Aka ka.. .. • Why are we doing this? • Who are we doing this with - an and d how ar are w e we i e involvin olving g th them em? • What’s our chosen measure(s)? (hierarchy of measures/decision criteria) • How will we practically do this? (sample/methodology/collection) • How will we analyse/learn/continue to improve?
Making it meaningful… How will we What’s the Who are the What will we How will we use our purpose? population? measure? measure it? findings? So So y you ou can: n: ✓ (Know who your data relates to, select a sample accurately) ✓ Und ndersta rstand nd wh what at mat atters ers to to the hem ✓ In Involv olve e the hem m in in the he de deci cisio sions ns to to co come Cha hall llenge enge: Are we underestimating capability? Or assuming a desire to be involved?
As a group… How will we What’s the Who are the What will we How will we use our purpose? population? measure? measure it? findings? • What could you do to bet better er un unde derstand stand wh what at mat atter ers s to your pop’n of interest? • How (and when) could you in invol olve e them hem in the decision- making process as you progress? What are the options? Then let’s get SMART…
Making it meaningful… How will we What’s the Who are the What will we How will we use our purpose? population? measure? measure it? findings? • Focus groups? • Surveys? • Events/workshops? • (Previous work)?
What’s going to de -rail you? Imagi Im gine ne its its all all go gone ne wr wron ong! g! • There’s no way you can describe any of the measures as really ‘person - centred’… • The population weren’t involved in decision -making process at all… • We’ve no idea what matters to them… Just another ‘box - ticking’, window - dressing exercise…
What’s going to de -rail you? “A pre -mortem may be the best way to circumvent any need for a painful post- mortem” Klein (2007)
In your groups… Wha hat t wen ent t wr wron ong? g? (1-2-table) • List them • Which are ‘show - stoppers’? (not in the bake -off sense) • Which are most likely? • Which do you have no control over?
In your groups… Then… And what could you do to prevent it? Foc ocus us on on the the one ones in in y you our r co cont ntrol! ol! What are your actions? Who will take responsibility?
Population Health Management Measuring What Matters for PHM Understanding complexity, context, and competencies Al Mulley NHS England and NHS Improvement
Learning from Variation for PHM: Conceptual and Operational Barriers Learn from Variation System Organise for Leadership Innovation at all Levels Measure Deliver with What Teams Deliver Matters What is Valued
Learning from Variation for PHM: Conceptual and Operational Barriers Learn from Variation 1 System Organise for Complexity Leadership Innovation at all Levels 3 2 Measure Context Deliver with Competencies What Sensitivity Teams Deliver Matters What is Valued
Learning from Variation for PHM: Conceptual and Operational Barriers Learn from Variation 1 System Organise for Complexity Leadership Innovation at all Levels 3 2 Measure Context Deliver with Competencies What Sensitivity Teams Deliver Matters What is Valued
Learning from Variation for PHM: Conceptual and Operational Barriers 1 System Complexity Leadership at all Levels 3 2 Measure Context Deliver with Competencies What Sensitivity Teams Matters
Learning from Variation for PHM: Conceptual and Operational Barriers Learn from Variation 1 System Organise for Complexity Leadership Innovation at all Levels 3 2 Measure Context Deliver with Competencies What Sensitivity Teams Deliver Matters What is Valued
Respecting Complexity at the Level of the System and the Individual High Chaos Disagreement about Value Complexity The Need for Simple Rules: 1. Meeting needs and wants; no less but no more 2. No decisions made with avoidable ignorance 3. Showing manifest respect for the individual Control Low Low High Uncertainty about Outcomes Evidence-Based Modified from Stacey, Plsek, IOM, 2001
Complementary Competencies for PHM: Technical and Relational High Ineffective Difficulty of the task Inefficient Low High Low Level of competence
Complementary Competencies for PHM: Technical and Relational High Relational Difficulty Ineffective Inefficient Low High Low Relational Competence
Complementary Competencies for PHM: Technical and Relational Measuring Teamwork as Relational Coordination (Gittel) High • Shared Goals • Shared Knowledge • Mutual Respect • Communication that is… Ineffective Difficulty of the task • Frequent • Timely • Problem- solving • Accurate Measuring Teamwork as Patient Experience Inefficient Low High Low Level of competence
Measuring What Matters for PHM Making People’s Choices Matter High Measurement-Subjectivity Personal Value Control Low High Low Context-Sensitivity
Preferences Matter: Measuring Decision Quality for PHM
Person-centred intelligence We’re here to support you! • Microsite (PHM + PCI - forthcoming) • Detailed guides • Wider offer of support (advisory, analytics, evaluation/evidence expertise, implementation partners) To be shared…
Learning objectives By the he end nd of of th the se session, ssion, pa participants ticipants wil ill l be be able ble to to: • Understand how theory leads to a measurement framework for learning • Describe the concept of person-centred intelligence (PCI) • Understand the importance of decision quality • Describe practical steps to support implementation • Outline a set of actions to progress this aspect of their projects • Know where to access further resources to support this process
Population Health Management Break NHS England and NHS Improvement
Population Health Management The Professor Sir Muir Gray Award for Failure NHS England and NHS Improvement
Population Health Management Population and Personal Value: Competing approaches or two sides of the same coin? NHS England and NHS Improvement
Dr Clara Day Consultant Nephrologist and Value in kidney care Assistant Medical Director for Finance and Value University Hospitals Birmingham
Chronic kidney disease • Gradual and irreversible decline in kidney function • General population 5- 6%. Much greater in elderly • Guidelines are for referral at certain level; huge numbers of elderly • Very few symptoms or clinical relevance in elderly
Treatment for kidney failure: dialysis
Haemodialysis: hospital, satellite unit or home?
Peritoneal dialysis Uses lining of abdominal cavity (peritoneum) as a membrane to facilitate removal of toxins
What does • Not what you think they should want the patient actually • Some difference in price but cannot perform home therapy if don’t want to want?
Ensure equity of treatment for all; not just those who shout the loudest
Barriers to live donor kidney transplantation: ATTOM Less likely to have a live donor kidney if: • Non-white • Not married • Not as well educated • Not as wealthy Not from Northern Ireland Wu et al Nephrol Dial Transplant 2017 32 890-900
Population Health Management Core Team Academy 18 th and 19 th September NHS England and NHS Improvement
Population Health Management Welcome to Day 2 Fraser Battye NHS England and NHS Improvement
09:30-10:50 Teaming and leading for a culture of stewardship 10:50-11:00 Break 11:00-12:45 Design thinking: how to approach planning 12:45-13:30 Lunch 13:30-15:30 Theory of change and project planning 15:30-16:00 Wrap up and next steps 16:00 Close
Population Health Management Teaming and leading for a culture of stewardship Dr Tim Wilson, Margaret Mulley and Belinda Weir NHS England and NHS Improvement
Is this what we are doing? Is this right? Where efforts are focussed Where the impact is Culture Culture Process Process Structure Structure
Session Outline • Building a common purpose for your teams • Team exercise • Behaviours to drive a new culture • Personal actions
Population Health Management Building a common purpose for your team NHS England and NHS Improvement
Building a Strong Team Culture Culture is not something you are – it is something that you do 95
Three Areas for Action Create safety Share vulnerability Establish purpose
Team Exercise Share the answers to these questions with your team: 1. The one thing that excites me about this particular opportunity is_____________ 2. I confess, the one thing I’m not so excited about with this particular opportunity is___________ 3. On this project, I would like to get better at____________
Think about during the rest of the day and share some thoughts before the end of the day Des esign ign a f a few simpl ple, , for orthrig thright ht sen entences ences th that wi t will l make a significant difference to your group’s be beha haviour viour.
Population Health Management Lost at Sea NHS England and NHS Improvement
Background You have chartered a yacht with three friends, for the holiday trip of a lifetime across the Atlantic Ocean. Because none of you have any previous sailing experience, you have hired an experienced skipper and two-person crew. Unfortunately in mid Atlantic a fierce fire breaks out in the ship’s galley and the skipper and crew have been lost whilst trying to fight the blaze. Much of the yacht is destroyed and is slowly sinking. Your location is unclear because vital navigational and radio equipment have been damaged in the fire. Your best estimate is that you are many hundreds of miles from the nearest landfall. You and your friends have managed to save 15 items, undamaged and intact after the fire. In addition, you have salvaged a four-person rubber life craft and a box of matches. Your task is to rank the 15 items in terms of their importance for you, as you wait to be rescued. Plac Place e the number r 1 b by the most t impor ortant tant item, , the number r 2 b by the secon ond d most t impor orta tant nt and so forth th until l you have e ranked ed all 15 i items s in the first column. mn.
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