How to make shared decision making happen

Shared decision making requires shifts in culture and systems, prepared professionals and supported individuals.

Changing the culture

If shared decision making is to become normal practice for healthcare, there needs to be a subtle shift in culture:

  • shared decision making needs to be embedded into all patient pathways; and
  • both professionals and patients need to become more collaborative in the way they relate to each other, giving each other mutual respect and acknowledging that both has an equal responsibility for making the ‘right’ decision.

Commissioners need to help to support this culture change. The Health Foundation’s three part model from the Co-creating Health Programme provides a good foundation for this.  It is designed to help systems enable professionals to form collaborative relationships with patients to support self-management. It ensures that improvement projects address both sides of that relationship. The same approach can be applied by those commissioning or developing shared decision making projects.

Successful culture change cannot be achieved in isolation, so it is really important to take everyone involved with the process with you – keeping everyone informed and making sure that all stakeholders’ views are taken into account.

Stakeholders in shared decision making and how they can support improvement


Consider those who will be directly involved and those indirectly affected; including those in administrative and corporate roles. Staff can provide valuable insight into where there are opportunities or barriers. All staff can help ensure shared decision making happens by making it part of the culture.


Commissioners can have a direct and dramatic influence over pathway design and service quality. They need to be mindful of shared decision making when they commission services, to ensure that they are not creating counterincentives (with targets to make a certain number of referrals for example, or perform a certain number of procedures). Working in partnership with healthcare staff and regularly reviewing the impact of shared decision making is vital for this.


Who knows best how patients experience a service and how it could look better for them? Patients as partners in healthcare system design can be our greatest asset and representatives should be included at all points in the process; helping to design and evaluate any changes.