Honor Wilson-Fletcher | What might a 'whole education' town or village look like?
Education for health The National Strategy for COPD It’s taking shape! Monica Fletcher Chief...
-
Upload
rudy-terrel -
Category
Documents
-
view
213 -
download
0
Transcript of Education for health The National Strategy for COPD It’s taking shape! Monica Fletcher Chief...
education for health
The National Strategy for COPDThe National Strategy for COPDIt’s taking shape!It’s taking shape!
Monica Fletcher
Chief Executive Education for Health
Chair European Lung Foundation
education for health
COPD care: a change in attitude
Diagnosing Predicting
Pessimistic Optimistic
Treating Preventing
The past few years have revealed an attitudinal shift in COPD care
‘From Unjustified Nihilism to evidence based Optimism’ (Celli et al 2006)
The COPD Vision:
To that everyone diagnosed with COPD receives equitable, responsive, high quality and effective health and social care services from the right person, at the right time, in the right place.
On going commitment is to ensure that all communities can expect better prevention strategies for COPD, quicker identification for those at greatest risk, clear standards of care and treatment that ensure dignity and respect that lie at the heart of the patient journey
education for health
The public consultation document contained 24 evidence based recommendations to improve care
Combined with NICE/BTS guidelines should be enough to kick start service delivery of high quality COPD and asthma care
Ministers currently considering how to turn it into an outcomes based strategy
education for health
Why do we need to wait for the DOH strategy
The political wheels turn very slowly
education for health
education for health
COPD in 40–65 year olds ages them and creates frustration
“I feel like I am old. I feel like I am really old, and I am 51.”
UK patient
“I hate not being able to do something and that my wife has to help me. It is infuriating.
I have never depended on anyone.” Spanish patient
“I’m totally disgusted with my life.”
U.S. patient
“The most important thing I’ve lost is probably getting together with my dad and
playing outdoors.” UK son
“We had a very big group of friends and relatives, but since my wife got ill only 2 or 3
people are left.” U.S. Spouse
“She is throwing her life away and she is throwing my life away.”
U.S. Spouse
“A bad day is when you need to sit down because you can’t handle it anymore but you need to make it to the office and deal
with 200 emails.” Spanish patient
Fletcher at al 5th IPCRG World Conference, June 2010,
The
Number of COPD patients diagnosed 900,000, but actual estimated prevalence 3.7million……..these are the “Missing Millions”
(Graph based on DH unpublished estimate, 2009).
Shawab et al Thorax 2006
Spectrum of COPDPrevention and Awareness toEnd of Life Care
Well At-risk With COPD diagnosis
No symptoms Symptoms but no diagnosis
MILDstage
MODERATEstage
SEVEREstage
The earliest point at which airflow obstruction may be detected by spirometry
Damage
Unaware of lung health
Aware of lung health
•Raising awareness of early signs and symptoms
VERY SEVEREstage
•Access to supportive care for patient and family through to bereavement stage
•Managed according to guidelines, e.g. Liverpool Care Pathway
DH focus for improving outcomes
Prevention & Health improvement
Early Accurate Diagnosis and Assessment
Chronic disease managementincluding self management, exacerbations and treatment
Palliative and ‘End of life’ care
Earlier identification: More proactive management: Care closer to home: Integrated care
What has been accomplished so far by DOH?
Published national consultation document Developed clinical leadership and joint partnership
working including with industry and patient organisations Gathered evidence on what is working well Testing different models of care Introduced measurement of performance Changes to system levers and incentives Funded pilot and research studies Aligned with new and emerging policies
education for health
DOH Practical help for youDOH Practical help for you
We have an approachable team at the DOH, with strong leadership
The NHS improvement Lung Improvement team and their website for inspiration
Worked on competences and a range of educational programmes with more on the way to support staff development
We have respiratory leads in every SHA who can share local benchmarking data
Implementation
SHA Respiratory leads
Paul Corris
Sharon Haggerty
John White
Mike Ward
Jane Scullion
Dermot O’Ryan
John Williams
June Roberts
Stephen Gaduzo
Colin Gelder
Sandy Walmsley
Tasks:• Set up high level steering group• Develop communities of practice• Support improvement programme• Benchmarking data• Annual report of progress
Steve Holmes
James Calvert
David Halpin Maxine Hardinge
Jo Congleton
Jo Wookey
Julia Bott
Tony Davison
Leanne Jongepier
Louise Restrick and team
education for health
Despite their widespread promulgation, there is unequivocal evidence that guidelines have: limited effect on changing physician behaviour, marginal improvement in patient outcomes and their cost effectiveness is called into question!
Lomas et al(1989), Woolfe et al(1993), Grimshaw et al 2004, Thomas et al (2005)
education for health
Why don’t physicians use guidelines?Why don’t physicians use guidelines?Cabana M. (1999)JAMACabana M. (1999)JAMA
Systematic review
5658 articles reviewed
76 published studies at least one barrier
76 articles included 120 different physician surveys
Identifying 293 potential barriers!!!
Clustered these into 7 main themes
Developed three groups: Knowledge, attitude and behaviour
education for health
KNOWLEDGE ATTITUDES BEHAVIOUR
Lack of
familiarity
Lack of awareness
Lack of outcome expectancy
Lack of self-efficacy
Lack of Motivation
External Barriers:
Patient Factors
Guideline Factors
Environmental Factors
Lack of Agreement with: Specific guidelines
Guidelines in general
Cabana 1999
education for health
Clinical ExperienceClinical ExperienceMaking the same mistakes Making the same mistakes with increasing confidence with increasing confidence over an impressive over an impressive number of yearsnumber of years
“If you always do what you have always done, you will always get what you always got”
education for health
Diffusion of InnovationsDiffusion of InnovationsRogers (1995)Rogers (1995)
EarlyMajority
LateMajority
EarlyAdopters LaggardsInnovators
2.5% 13.5% 34.0% 34.0% 16%
education for health
Achieving behaviour changeAchieving behaviour change
ACTIVITY
Inform
Educate
Engage
Enlist
VALUE
Behaviour
Commitment
Under-standing
Aware-ness
education for health
Implementation of change : Your roleImplementation of change : Your role
EDUCATION
SOCIOLOGY
PSYCHOLOGY
COMMUNICATIONS
MARKETING
education for health
Where are you at?
Where do you want to get to?
What is stopping you getting there?
So what are you going to do about it?
education for health
Questions to ask yourselfQuestions to ask yourself
Early outcomes or long term perspective
Tangible rewards or do you gain rewards in other ways
Naturally a doer or do you prefer to facilitate others
Do you personally prefer a high or low profile
Are you a follower or a leader
Happy on your own or in a team
education for health
Death of the Lone RangerDeath of the Lone Ranger Powerful
Charismatic
High achiever
High risk
Impersonal
Distant
Short term gains
education for health
The Wizard of Oz!The Wizard of Oz!
Scarecrow: The Brain
Tin Woodsman: The Heart
Lion: Courage
Dorothy..
education for health
BrainBrain
Conceptual thinker
Emotional intelligence
Systems thinker
Accomplishing tasks
Critical view of self
education for health
LionLion Challenge the status quo
Draw out and deal with conflict
Risk taker
Learn from failures
Instil courage in others to follow
Lead change
education for health
HeartHeart
Outstanding leaders appeal to the hearts of their followers – not just their minds
Passion and compassion
Mission driven
Relationships
Interpersonal
education for health
DorothyDorothy
Humanity
Strong communication
Ability to harness diversity
education for health
Others must……
Trust you
Have faith in you
Believe in you
Essentially you have to believe in yourself!
Be prepared to challenge!
Control the ‘I can’t’
Don’t take no for an answer
Be a boundroid
education for health
Enabling qualitiesEnabling qualities Sense of humour
Empathetic
Energetic
Passionate
Sensitive
Visionary
education for health
There’s no place like homeThere’s no place like home
education for health
There are three kinds of people:There are three kinds of people:
Those who watch Things Happen Those who wonder what happened Those who make things happen
Where do you fit???
Lee Lacocca
CEO Chrysler