1. Sustainability & Spread
Maureen Fallon
Assistant Director Innovation & Improvement,
Cardiff and Vale University Health Board

2. Sustainability
Means…….Holding the improvements and evolving as required ALTHOUGH…….. history tells us that 1/3 of all major improvement initiatives in healthcare fail to achieve the sustainable changes needed to meet their planned objective. Take 2 minutes to discuss possible reasons WHY with your neighbour?

3. Session objectives 1 2 3 Introduce the Sustainability Tool
Factors influencing SDM uptake 2
Top Tips for embedding, sustaining and spreading SDM 3
Life beyond MAGIC in Cardiff and Newcastle – ‘walking the talk’

4. Sustainability Tool

5. Sustainability Tool Process Staff Organisation Or, put another way,
Credibility of
the evidence
Adaptability
Benefit beyond
helping patients
Monitoring
progress
Behaviours
Training and
involvement
Senior leaders
Clinical leaders
Fits with the
goals and
culture (internal
and external)
Infrastructure
Or, put another way,
the Micro (local team level);
the Meso (the department/practice level)
the Macro (the organisation level)

6. Team level ingredients
Does your team agree that
SDM is important?
Do you have support from
the key members in the
team?
Have you got an interested
patient advocate?
Are you able to access SDM
skills training?

7. Dept/Practice level ingredients
Credibility of the evidence – be able to demonstrate a positive impact on staff and an improved patient experience e.g. what are the benefits beyond helping patients?
In South Tyneside CCG, shared decision making was a key component of the referral management scheme (project focused on improving the quality of referrals). Focus on General Surgery, Orthopaedics and Gynaecology. The results included:
reduced referrals
improved patient satisfaction and engagement with secondary care
£500k savings in one year.

8. Patients’ knowledge post diagnostic consultation
Measuring impact of change in clinical practice (Option Grid)
Patients’ knowledge post diagnostic consultation
Here you can see the difference in knowledge at the end of diagnostic consultation between the first and second sets of data.
Massive improvement between two sets of data.
A few possible explanations:
Small numbers
Particularly intelligent group of patients ;-)
Team galvanised by seeing first set of data
Option Grid
The only two questions that the majority of patients are still not getting right – effect of radiotherapy on breast size and length of time for radiotherapy – are NOT included in the Option Grid. 8

9. Dept/Practice level ingredients
SUREScore
Monitoring progress –
be able to demonstrate
that patients are
involved in their care
and that their views are
listened to e.g. simple
tools such as
SUREScore or more
detailed tools such as
DQM’s (Cardiff) and
SDMQ’s (Newcastle)
Did you discuss the different treatment options for you?
Did you discuss the risks and benefits of the different options?
Did you discuss what is important to you in your treatment?
Yes No Unsure

10. Organisation level ingredients
EXTERNAL
INTERNAL
Fits with the organisation’s
culture: ‘Caring for people,
keeping people well’.
QI agenda – patient
centredness
CQUIN
‘A promise to learn – a commitment to act’
‘…patients and their carers should be PRESENT, POWERFUL and INVOLVED at all levels of healthcare organisations’

11. Summary & Top Tips Ensure the ‘conditions are right:
Identify your aim – does it fit
with the direction of travel?
Going it alone rarely works….
remember Renal…Adopt a
team approach.
Access to training/ AGILE
Engage your Patient
Experience/PALS teams at the
outset
Evaluation – how will you know
a change is an improvement?
Organisation levers

12. Life beyond MAGIC
Both Newcastle and Cardiff are engaged in an Evaluation study, sponsored by the Health Foundation;
The teams continue to collaborate to ensure Sustainability and Spread;
Newcastle has well established links with Health Education North East in the undergraduate curriculum. Opportunity to expand across all levels of inter-professional education as part of a regional strategy;
Cardiff is engaged in discussions with Public Health Wales with a focus on SDM as a pillar of the Welsh Co-Production agenda
The Health Foundation continue to play an important role in enabling ‘Walking the Walk’