An Overview of MAGIC

Richard Thomson/Maureen Fallon

On behalf of MAGIC Cardiff and Newcastle

Models of clinical decision making in the consultation

Paternalistic Informed ChoiceShared Decision Making

Patient well informed (Knowledge)

Knows what’s important to them (Values elicited)

Decision consistent with values

SDM is an approach where clinicians and patients make decisions together using the best available evidence. (Elwyn et al. BMJ 2010)

“Shall I have a knee

replacement?”

“Shall I have a prostate

operation?”

“Shall I take a statin tablet for the

rest of my life?”

“Should I use insulin or an alternative?”

“I would like to lose weight”

“I would like to eat/smoke/drink

less”

Spectrum of SDM to SSM

TO

OL

S

SK

ILL

S

Are patients involved?Patients who would like more involvement in decisions about

their care (source: NHS Inpatient Surveys 2002 - 2011)

45 46 47 47 48 49 48 48 48 48

0

10

20

30

40

50

60

70

80

90

100

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Per

cen

tag

e

So why aren’t we doing it?• Multiple barriers

- “We’re doing it already”

- “It’s too difficult” (time constraints)

- Accessible knowledge

- Skills & Experience

- Decision support for patients / professionals

- Fit into clinical systems and pathways

Lack of implementation strategy

Key features of the MAGIC programme

Key elements: Phase 1• Effective engagement of multidisciplinary clinical

teams - clinical champions, skills development, trained facilitators, and embedding change into clinical pathways and practice

• Awareness, attitude, skills development• Drawing upon what we know works in change

management and professional behaviour change, whilst testing some additional innovative elements

• Used decision aid tools: both decision-specific and generic

• Rapid action learning and feedback (implementation monitoring)

• Patient and public involvement

MAGIC – Phase II Moving from pilot departments and general practices to

hospitals and health communities: embedding and sustainability

Leadership and organisational engagement, including new commissioning structures (Newcastle) and Welsh Govt (Cardiff)

Expanding and accelerating clinical engagement and impact, by testing learning from Phase 1

Enhanced patient and public involvement, including an emphasis on patient activation and the wider community.

More efficient ways of delivering education and training

Quality metrics: demonstrating value to commissioners and primary and secondary care organisations. 9

Key learning from the MAGIC programme: headlines.

“When we want your opinion, we’ll give it to you”

Key learning

• Attitudes and skills (DT)• Patient “activation” (MS)• Accessible decision support (RT)• Fit to pathways or pathway re-design (RT)• Clinical engagement/champions (MF)• Commissioning and system issues (MF)• Metrics and measures/”black box”