Getting Knowledge into Action for Person-Centred Care Bibliotherapy in NHSScotland 23rd September 2013

Outline Strategic context and principles Knowledge into Action supporting person-centred care for individuals and communities. 2. Practical examples 3. National demonstrator projects

Library = “Healing-Place of the Soul” PSYCHES IATREION

Person-Centred and Relational Care: Individuals and Communities “People have ‘assets’ such as knowledge, skills, characteristics, experience, friends, family, colleagues, and communities. These assets can be brought to bear to support their health and well-being. “Co-production begins and ends with the person, placing them at the heart of any given service and involving them in it, from the creation and commissioning of that service through to its design and delivery.” Scottish Government, 2013: Co-Production of Health and Wellbeing in Scotland. “We are human beings; our patients or clients are human beings; and it is shared humanity that should be the basis of the relationship between us” (Curtin, 1979).

“The transfer of knowledge is care.”

Knowledge into Action Relational Knowledge Emotional Knowledge Person to person sharing of knowledge to support: Collaboration Shared decision-making Self-management Better care experience. Emotional Knowledge

Knowledge is social and relational “Knowledge is power” and….. Knowledge is generated through relationships and group processes. The Internet, social networking and social media offer new opportunities for co-producing knowledge. They help lay knowledge and citizen knowledge to take more power and shape society, including its health and wellbeing. = “Disruptive power” of knowledge and co-production. Gibbons – “New Production of Knowledge” 1994

Knowledge-Sharing Relationships Central to system-wide change in age of complexity: Network economy Health and social care integration Public services reform Distributed leadership Co-production for people and communities. Empathic and compassionate care experience.

“Condition of connectedness” Co-producing outcomes….. “The future is not some place we are going, but one we are creating. The paths are not to be found, but made. And the activity of making them changes both the maker and the destination.” ― John H. Schaar, Adviser to President Nixon

Practical Implementation Knowledge into Action: Person-Centred Care Work Strand Approaches to Sharing Knowledge and Generating Personal Meaning

Spectrum of approaches 1. Access to information 2. Checking for understanding 3. Encouraging questions 4. Co-production: Outcomes Questions Meaning 5. Facilitating choice and change.

Self-Management Resources

Aids to Shared Decision-Making Clarify service users’ evaluation of options based on what matters to them. Guide service users through deliberation to informed choice. Print, online, audio and video formats.

Teach Back Teach-back is a really simple way to check a service user’s understanding. It involves the clinician asking them to explain or demonstrate, in their own words, what they have discussed with them. that patients remember and understand less than half of what clinicians explain to them and the more information given, the more information is forgotten. Teach-back is a communication technique which health professionals can use to check that patients correctly understand the information or instructions they have been given. Within the United States, teach-back is endorsed by the Agency for Healthcare Research & Quality who consider it “one of the 11 most highly rated patient safety practices”. US research has shown that Teach-back is successful regardless of patients’ health literacy abilities Ayrshire and Arran, Lothian daptations 

Ask Me 3 What is my main problem? What do I need to do about it? 3. Why is it important for me to do this? Other possibilities: What are my options? Benefits and risks of each option? What matters to me? Adaptations from US model.

Talking Points Practitioner-Service user/Carer conversations focused on defining outcomes that matter to the individual, and how to achieve those outcomes. Emphasises the strengths, capacity and resilience of the individual. Builds upon natural support systems and wider community based resources.

Patient Information Navigator 1. Patients meet with a ‘Patient Information Navigator’ prior to appointments in their care pathway. 2. Prepare using SCOPED - critical reflection to help people to think, talk, read and write about decisions. Situation Choices Objectives People Evaluation Decisions 3. Record consultation and note key points so that they can follow up, e.g. with wider community information and support.

Creative reading “Reading as healing.” Using an individual's relationship to books, poetry, even films, to uncover personal insight into health and wellbeing issues. Co-creates meaning Shown to be effective in the treatment of depression and other conditions. Reduces isolation Builds creativity, coping and problem-solving skills.

Health Behaviour Change Generic eLearning Course http://elearning.healthscotland.com/course/category.php?id=85 For staff across public and voluntary services.

Health Behaviour Change Interview Process

Knowledge into Action National Demonstrator Projects Combining these approaches to achieve sustainable improvement at scale.

1. Implementing Knowledge to Support People with Multiple Conditions Purpose: To support people with multiple conditions through developing Knowledge into Action skills among general practice Information Navigators / Link Workers, as the core of a multi-agency network of knowledge support in the wider community. Programme of learning opportunities and networking events among Navigators in 3-4 general practices. Support them to scope and facilitate development of a network of knowledge into action in the community, including public library, voluntary agencies and wider public services.

2. Implementing Knowledge to Support Co-Production Purpose: Support the Co-Production Network and related networks (e.g. Discover The Third Sector) to use Knowledge into Action tools and methods to find, share and apply knowledge to support co-production. Links to key tools and resources for co-production. An online health literacy toolkit. A programme of learning for Co-Production and other networks. Tests of change, in partnership with the Person-Centred Care Collaborative.

Library = “Healing-Place of the Soul” Transfer of knowledge facilitating personal insight, choice and change for people and communities. PSYCHES IATREION

Aims for today Inspire and inform: Deeper understanding of bibliotherapy techniques. Raised awareness of activities in Scotland. Identifying opportunities for engagement and collaboration.

Getting Knowledge into Action for Person-Centred Care Bibliotherapy in NHSScotland 23rd September 2013