Case Studies

Building capability to deliver personalised care and secure buy-in from disadvantage patient populations

Customer: North West Boroughs Healthcare NHS Foundation Trust (NWBH)

Challenge

The borough of Knowsley is the fifth most deprived in the country and suffers from marked health inequality. Employment opportunities and income are some of the lowest in any local authority district in England. The expected healthy life expectancy is 59.2 years for males and 58.8 years for females: 3 years below the national average for each.

Aqua was commissioned to work with two NWBH Trust’s teams to build capability to deliver personalised care which inspires patients to take ownership of their treatment and health.

The two teams were the Healthy Knowsley Team, a non-clinical service team providing lifestyle and advice to encourage healthy behaviours; and the Community Therapy Team, which comprises occupational therapists and physiotherapists who work with patients with complex long-term conditions.

Key challenges included reservations from clinicians that they would not have the time and appropriate training to successfully build a personalised approach into their work. There was also feedback that patients were unwilling to buy in; that they were dis-engaged and overwhelmed when asked to co-design their own care, feeling it should be solely the practitioner’s job.

Solution

Aqua reviewed feedback from focus groups and one-to-one interviews which the Trust held with stakeholders and team members. Knowledge gaps and misconceptions about delivering personalised care were identified and used to design bespoke training sessions. These sessions also covered the Patient Activation Measure®, a well-evidenced, reliable tool to assess and track patient readiness to engage with co-designed personalised care.

Initial factors leading to practitioner resistance and reservation were taken onboard. A common theme arising from early engagement sessions was that a ‘one size fits all’ approach wasn’t appropriate for two very different teams, treating patients with differing levels of engagement.

Bespoke training was designed and delivered to allay these concerns. All practitioners from both teams attended between four and five training sessions. These sessions conveyed that, properly utilised, PAM® identifies behavioural characteristics about a patient’s beliefs and knowledge around their healthcare, supporting tailored conversations about share-decision making.

Outcome

Training sessions were rated 9.5 / 10 on average with almost all attendees immediately implementing PAM® in their own work. Post-training feedback was universal in praise for its bespoke nature. One clinician noted: “You have been the most helpful people we have engaged with in the last year. You have definitely listened and that has really helped.

“The training has worked because it has been tailored to the needs of the service.”

Of the 178 patients discharged during the period April – August 2019 where a final PAM® was undertaken, more than half had an improved rating.

Qualitative comments from practitioners included that PAM® had helped to “break down barriers, educate and change the mindset of patients”

Both teams have embedded PAM® within initial and final appointments as the preferred outcome measure. They have the tools and framework to continually improve and refine the training in line with the most current thinking on personalised care.

The programme has helped the Trust to deliver on its 2019-21 Quality Strategy and wider rollout across other health and care teams within the borough is being explored.

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