Michael Hallsworth and Hannah Burd of the Behavioural Insights Team explain how two new guides aim to deliver more effective person-centred care.
The key to delivering person-centred care is to start simple.
Toby* was struggling to manage his latest episode of bipolar disorder and wanted to take greater control of his condition. He knew he wanted to put support in place to avoid a crisis – he didn’t want to be hospitalised again. But he was falling at the first hurdle: getting in touch with his mental health support worker – Steve – who had first told him about the community support networks and self-management courses that could help Toby.
Toby booked a GP appointment just so that he could ask his doctor to find Steve’s contact number in the Care and Support plan he had been given. This plan was supposedly a person-centred document, designed with his involvement and preferred course of action at its heart. In practice, it served practitioners within the system rather than people like Toby. It collected all the possible contacts involved in Toby’s care into one impenetrable pack which Toby was then unable to use. Not only did it fail to help Toby, it forced him to go back to his GP and use further NHS resources.
Our example illustrates how the UK’s current approach to person-centred care isn’t always working as well as it could. We have published two guides which aim to help health and care commissioners, managers and practitioners take a new approach. The guides are written by the Behavioural Insights Team following 18 months of learning from five person- and community-centred organisations, expert patients, switched-on practitioners and champion commissioners. The guides form part of the Realising the Value Programme, which is led by Nesta and the Health Foundation, and focuses on enabling people to take an active role in their own health and care.
How can behavioural insights help?
The guides have a simple mission: connecting people to ideas and evidence-based tools which draw on behavioural insights that are easy to incorporate into existing practice.
The first guide, ‘Supporting self-management’, suggests making simple ‘if-then’ plans which are created by the person themselves using a memorable formula, e.g:
- If I meet a new support worker, then I will save their contact number directly in my phone
- If I experience a worsening of my condition, then I will call my support worker’s number
This approach realises the value both of the patient and the supportive community he has relationships with. It is a behavioural insights approach which has been found to shift the dial on health behaviours ranging from rehabilitation from injury to healthy eating. Decades of research into human behaviour have been synthesised by the Behavioural Insights Team over the last five years into the EAST framework, which provides a memorable way of applying behavioural science to real-world issues. The core insight of EAST is that if you want to encourage a behaviour, you should make it Easy, Attractive, Social and Timely.
Another suggestion in the guide is to make healthcare more social by incorporating peer support into the pathways, which patients take through the health and care system. This approach has an evidence base which is increasingly strong: people share experiences and solutions to living with similar health conditions and report better experiences as a result. Peer support workers have also been found to experience improved clinical outcomes (such as reduced blood glucose levels if they are diabetic). Its value is increasingly clear.
Now we have simplified, how can we spread?
Pockets of great practice exist, and the guides collect many inspiring examples together. Yet the question that follows for champions of person-centred care, policymakers and commissioners tends to be, “how do we spread this system-wide?” The second guide, ‘Spreading change’, holds some answers. We provide evidence and examples where champions have:
- Reframed the risks of change
- Changed mindsets
- Spread change via peer networks
- Incentivised whole groups of clinicians to improve as one
Many of the individual activities listed throughout the guides sound like no-brainers: they are simple. And yet, our observations during this programme suggest they cannot be taken for granted. Keeping changes small in the first instance will not only make it more likely that movement will start, it will also pay dividends across millions of contacts with the health, care and community systems.
*Names have been changed to protect patient confidentiality.