Securing and Sustaining Change

The long term impact of rolling out Shared Decision Making in your local health economy will in part rely upon the projects ability to secure and sustain change. Your experience of your current SDM project and the success of that project in securing quick wins will affect this stage. This will largely be due to two main factors; barriers to change and enablers for change.

Below is a table for considering the key barriers and enablers during the project, this may have changed from the barriers and enablers considered during the early stages of the project. Also consider any future enablers including redesign in specific areas or priority areas for the CCG that may provide a link to SDM.

Barriers Enablers
GP engagement patchy CCG enthusiasm
18 week referral to treatment time pressure on acute trust Good engagement from community provider, especially tier 2 services
Engagement with patients groups Service redesign of Maternity services planned

In the example above there is also an opportunity to use the experiences of the community provider in rolling out SDM across tier 2 services to encourage a broader SDM roll out across all community services. Contractual levers such as a CQUIN or quality schedule may be useful in securing a change in the long term. Local measurement, and capture of information or data to inform that measurement, will increase awareness of Shared Decision Making and will prompt training for staff who would be responsible for collating the data and information.

Below is an example SDM CQUIN for community services, however this could be amended and used also for secondary care services if a tier two service is provided by a secondary care provider. It is important to include some element of cultural change or training in the CQUIN otherwise there is a risk that SDM will become transactional as opposed to transformational. Also attached below is a draft Quality Schedule (Section B Part 11 – Service Development and Improvement Plan). This has been developed for use as an appendix to an acute or community contract.