Sustaining shared decision making in practice

Implementing shared decision making will take time and effort so there needs to be a commitment to making sure that effort leads to long term, sustainable changes.

The learning from individual projects – having evidence of how it works locally – can be invaluable for encouraging others to take up the challenge too and spread a positive collaborative culture.

The considerations about where to start shared decision making can be applied to questions about where to spread it to next as well; who is ready for the change and where would impact be greatest.

The NHS Institute for Innovation and Improvement has developed a model, along with guidance, to support the delivery of sustainable change. The model is a way of assessing how likely a team or organisation is to sustain change, based on a number of factors, and can then support those teams to take targeted action where necessary.

Organisations committed to implementing shared decision making may want to ask:

  • What training and development is required for staff? – from ensuring every member of staff has a basic awareness of the principles of shared decision making, to creating a team of ‘expert leaders’ who can support others to continue striving for excellence.
  • How committed is the leadership of the organisation to the change – are other tasks, conflicts or challenges likely to mean they stop prioritising shared decision making?
  • What strategies has the organisation got in place or planned that align with, or potentially conflict with, shared decision making?
  • How will the benefits of implementing shared decision making be continually measured and fed back over time so that standards are maintained, staff can see the difference they are making and commissioners can reward best quality?
  • Is shared decision making included in recruitment and induction policies so that as new staff join they are introduced to a collaborative culture from day one?
  • Is shared decision making always on the agenda – at team and board meetings? Once it has been implemented, is it truly embedded? In routines and documentation as well as general principles? Is it a way of working, a culture, considered an integral part of all care, not just a tool to use occasionally?