How we can make shared decision making happen – supportive systems

Involved patients and prepared professionals need to have a system around them that supports the use of shared decision making for maximum success. A supportive system might include;

  • appointment systems that allow opportunity for decisions to be discussed and reviewed or revisited – not always face to face necessarily but using telephone or email too
  • information systems that make it easy to provide patients with decision support
  • patient record systems that enable shared decisions and patient preferences to be documented
  • evaluation systems that allow staff to measure how well they are involving patients with decisions, what decisions patients are making (especially useful for commissioning the appropriate levels of service) and how the service as a whole is being impacted.
  • the provision of health literate patient information which meets people’s functional literacy and numeracy (reading and maths skills) as well as their health literacy i.e. the ability to make sense of it and apply it.

Exactly what a system needs to support shared decision making is likely to differ between services, depending on whether they are primary or secondary care, general or specialist services, community based or in hospital clinics.

Commissioners should:

  • look at all the requirements they are placing on services and how they support or prevent shared decision making. Tariff-driven models may create perverse incentives for example, discouraging clinicians to offer options if they are likely to mean fewer patients electing for certain procedures.
  • Think about how systems interact across pathways, and how this may help or hinder shared decision making.

If patients experience shared decision making in one part of their treatment but not in another, this can lead to frustration and a more negative experience. For this reason, the commissioning of shared decision making should not be standalone, but should be integrated into wider service design with the involvement of patients and the public.

Understanding what is required may not be immediately obvious and may change over time too, as shared decision making expands from a pocket of excellence in one team to the pervading culture across an entire organisation. Applying a structured improvement methodology, such as the Institute for Health Improvement’s Model for Improvement, involving all stakeholders, and rigorously evaluating progress can enable a quality system to develop and spread sustainably.