Personal Health Plan (PHP) Baseline Assessment

8/9/2019 Personal Health Plan (PHP) Baseline Assessment

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Capgemini Consulting is the strategyand transformation consulting brandof Capgemini Group

Personal Health Plan (PHP) Baseline Assessment

April 23rd 2009

Version 7


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2Copyright 2009 Capgemini. All rights reserved.

PHP Baseline Assessment Contents

Introduction & Purpose of PHP Baseline Assessment

East of England PHP Pilot Background & Context

PHP Baseline Assessment Tool

PHP Baseline Assessment Stakeholder Participation

PHP Baseline Assessment Engagement Methods

High Level Summary of Findings & Phase 2 Considerations

Summary of Participant Quotes to Support Findings & Phase 2 Considerations

Key Next Steps for the PHP Pilot

Critical Success Factor Analysis

1. Personal Health Plan Tool

2. Shared Understanding

3. Resource Implications

4. Leadership and Organisational Alignment

5. Relationships and Communications

6. Skills and Knowledge

7. Behaviours and Culture Gaps

8. Systems and Processes

Appendix

- The Personal Health Plan

- The Personal Health Plan Guidance

- Stakeholder Questionnaires- Workshop Design

Thank you


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Introduction & Purpose of the PHP Baseline Assessment

Capgemini were asked by the East of England SHA Personal Health Plan (PHP) Pilot Lead and PHP

Steering Group to conduct a Baseline Assessment across sixteen PHP pilot sites. Working collaboratively with representatives from the East of England SHA and the sixteen PHP pilot sites,

Capgemini has engaged with four key stakeholder groups:

1. People with Long Term Conditions

2. Carers

3. Key workers

4. Pilot site coordinators

- Capgemini has also engaged with marginalised groups across the PHP pilot sites, including the elderly,people with learning difficulties, people with mental health problems and prison based key workers.

The purpose of the Baseline Assessment has been to collect initial baseline level data from PHP pilot sitesfocusing on initial thoughts and perceptions about the PHP, the PHP tool itself and the PHPs initial use/preparation for use across pilot sites.

This Baseline Assessment is a part of a wider learning process being undertaken by the East of EnglandSHA. Currently the East of England SHA is gathering insight and learning from key stakeholders on the buildup to wider PHP implementation in 2010. The East of England is moving to fast targets to offer PHPs to twoLTC groups across all East of England PCTs by March 2010 and to a further 3 LTC groups by September

2010, whilst the national target is to offer PHPs to all LTC groups by December 2010. The sixteen chosen PHP pilot sites are geographically dispersed across the East of England in a variety of

locations including primary, community and secondary care and one in a prison (HMP).


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East of England PHP Pilot Background & Context

The timeline above illustrates the PHP pilot progress to date. Due to practical and logistical issues associated with PHP pilot kickoff there was an initial two week delay. Pilot sites commenced on March 16th 2009 following two initial multi-stakeholderconsultations in 2008 receiving over 100 responses. The stakeholder consultations informed iterations to the version of the PHPtool to be piloted which was formally introduced at the PHP pilot launch event on February 12th 2009. A key purpose of the PHPpilots is to identify clear adaptations required within the PHP tool prior to wider PHP roll-out.

Capgeminis Baseline Assessment is one of two key components produced during phase 1 High Level Design. Workconducted during this phase has also included the development of a Blueprint Learning Framework to support the roll out ofPHPs. This phase is not statistically significant, although engagement with 55 stakeholders has been achieved. All findings willbe validated during phase 2 at the end of the PHP pilots.

Many pilot sites began PHP roll-out later than March 16th raising data gathering challenges, in additionphase 1 was conducted under tight timescales.

Sept 08 Oct 08 Feb 12th 09 Mar 16th 09 June 09 By Dec 2010

MultiStakeholder

Consultations

PHP PilotLaunch

PHP PilotKickoff

Three month PHP pilot


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PHP Baseline Assessment Tool

Capgemini devised a data gathering tool to analyse and review gathered data for the Baseline Assessment.

The tool was presented to the East of England PHP Steering Group on March 16th 2009. The principles behindthe tool were approved at the Steering Group meeting to support the analysis and review of gathered data forthe Baseline Assessment. Each of the eight segments represented within the tool are critical success factorsthat together represent PHP success.


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PHP Baseline Assessment Stakeholder Participation

People with LTCsKey Workers Carers

CommunityMental Health

Nurse

CommunityMatron

NursePractitioner

RespiratoryNurse

Diabetes

Wife

Husband

Closefriend

COPD

Asthma

Emphysema

CVD/CHD

Hypertension

Mental

HealthDisorders

Spinal Injuries

NeurologicalDiseasesHMP

HealthcareNurses

GPs

CardiacRehab

Nurses

Cross Roads

Capgemini have engaged with multiple key workers, carers and people with LTCs during the BaselineAssessment as well as PHP pilot site coordinators and marginalised group representatives.


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PHP Baseline Assessment Engagement Methods

A total of 499questionnaireswere sent to all 16PHP pilot sites for

key workers,carers and peoplewith LTCs

23 questionnaireswere returned:

- Key worker (6)

- People withLTC (12)

- Carer (5)

Questionnaires

Fifty-five stakeholders were engaged in the Baseline Assessment using a mixed method approach.

Content analysis was conducted on the collated qualitative data.

14 one to onesessions wereconducted:

- Key worker (3)

- Pilot sitecoordinator (9)

- East ofEnglandSubject MatterExperts (2)

Focused One to Ones

Telephone and e-mailcorrespondencewas made with all

16 pilot sites In addition, sites

4, 6, 7, 9, 12, 14,and 16 respondedto the BaselineAssessmentthroughquestionnaires orfocused one to

one sessions

Pilot Site Contact

14 peopleattended thestakeholderworkshop

- Key worker (4)- People with

LTC (2)

- Carer (2)

- Other (6)Representatives from PCTs,and Central

Surgery

Workshop

Ethical approval was not obtained for conducting one to one sessions with people with LTCs andcarers, however both stakeholder groups were consulted through a mixed method approach.


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Critical Success Factor Analysis: 1a

Phase 2 considerationsPhase 2 streamSummary of findings

1.1 There was a general consensus amongstall stakeholders that the PHP was too long,although some key workers saw it in itscurrent state as comprehensive. The length ofthe PHP led to mixed views about the needfor the medication section. Whilst some feltthis section was useful, others saw it as lessrelevant, viewing the PHP as a non-clinicaldocument. Nonetheless the key purpose ofthe PHP pilots is to adapt the PHP tool.

1.2 People with LTCs saw the PHP as a non-

clinical document, additional sections weresuggested to help personalise the PHP,including a diary section for thoughts andfeelings and a section on diet, exercise andwellbeing.

1.3 There was concern from key workers that

the PHP should not be a static document. Keyworkers suggested the use of an A5 ring

binder in order to add pages of information tothe PHP, whilst others championed a bookletform. One person with an LTC suggested a

card/driving licence option, so that the PHPcan be carried at all times by the person.

1.4 How the PHP is introduced to people withLTCs and how it is rolled-out nationally were

key concerns amongst all respondents.

1.1 Consider revising the length of the PHP.Also consider, the development of clearcommunication messages on the length ofthe PHP tool across PHP pilot sites e.g. optout of completing specific sections such asmedication or end of life planning.

1.2 Review the value of adding additionalmore personalised sections to the PHP,

perhaps to replace other more clinicallyfocused sections already held in patientsgeneral medical records.

1.3 Develop the look and feel of the PHP

across PHP pilot sites to ensure that thePHP is not viewed as a static document.

1.4 Develop a clear communications plan tosupport the PHP tool, its purpose and how itshould be used.

Personal HealthPlan Tool

Look and feel ofthe PHP

PHP Tool Revision

Comms plan

PHP Tool Revsion

PHP Tool Revision


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Critical Success Factor Analysis: 1b


1.1 Key workers expressed mixed messages onthe About Me section, from calling it clear and

defined, to suggesting that it is a potentialduplication of existing medical records At the

moment this is probably held repeatedly inhospital & GP setting and is known by thepatient themselves.

1.2 Key workers felt that the My Preferencessection was clear but potentially too personaland that the Important Information section wasgenerally clear. People with LTCs did not

comment on the first three sections of the PHPtool.

1.3 Key workers felt that there was limitedspace in the How I Am Now section. Oneperson with an LTC commented that they didnot understand this section.

1.4 Key workers felt that the My Health ActionPlan section was useful, although people withLTCs responded in the questionnaire by tryingto answer what they would put in their PHP and

did not comment on the section itself. Oneperson remarked that If you dont know theanswer, how can I comment.

1.1 Consider potential revision to the about mesection to reduce duplication.

1.2 Consider leaving the my preferences andimportant information sections but ensurethat these sections are understood clearly bypeople with LTCs.

1.3 Consider adding extra space for changes todates for flare ups and changes in peoplesconditions within the how I am now section.

1.4 Ensure that the health action plan section isclearly understood by people with LTCs. Thissection may require a lot of guidance from keyworkers.

The PHPTool Sectionswithin thetool

PHP Tool Revision

PHP Tool Revision

PHP Tool Revision

PHP Tool Revision


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Critical Success Factor Analysis: 2


1.1 There was limited understanding about thepurpose of the PHP amongst people with LTCs andtheir carers. Many people with LTCs saw the PHPas a document for clinicians.

1.2 There was uncertainty across all stakeholdersabout who owns the PHP. This also included where

the PHP document will be kept and by whom e.g.will a copy be held by people with LTCs and theirkey workers or by people with LTCs only.

1.3 All stakeholders were unclear about the PHPs

frequency and location of use e.g. whether the PHPwill be used in all consultations, by the patient only,or via an individual assessment, and where it willbe used e.g. medical vs. non-medical settings.

1.4 Amongst key workers and pilot coordinatorsthere was general understanding that the PHP willhelp to support patient involvement, responsibility,and self management although the extent of thissupport remains unclear at baseline.

1.5 Key workers raised concerns that the PHP maybecome a wish list for people with LTCs, which

could lead to unmet patient expectations. This pointwas associated with lack of shared understanding

of the liability and legal ramifications for keyworkers in the instance where patients complete

medical sections inaccurately.

1.1 Re-issue PHP pilot sites with conciseinformation about the purpose of thePHP, especially for dissemination topeople with LTCs and their carers.

1.2/1.3 Develop clear and defined

communications around the ownership,and use of PHPs. Produce a

communications plan with tools to

disseminate information.

1.4/1.5 Develop an engagement plan

with measures to explain the benefits ofPHPs across key stakeholders andengender motivation to use the PHP.

1.5 Build, disseminate and test guidancefor PHP pilot sites to clarify all liability

and legality concerns raised by keyworkers, for example FAQs.

SharedUnderstanding

Comms plan

Comms plan

EngagementPlan

EngagementPlan


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1.1 Key workers and pilot coordinators feltthat change to existing job descriptions will berequired. Changes suggested by key workersand pilot coordinators include the need for

staff to offer PHPs to people with LTCs, theperceived need to run and attend interactivetraining sessions and workshops for the useof PHPs, the need to manage an enhancedadministrative workload, and the need tosupport the wider roll out of PHPs.

1.2 There was a strong consensus from keyworkers and pilot coordinators that extraresources will be required across PHP pilot

site in order to meet national PHP targets.The potential requirement of new roles tosupport the PHP roll out was a widely heldsuggestion amongst key workers, includingthe introduction of trainers specificallyemployed to support PHP roll out.

1.3 A range of financial concerns were raised

about the ability to fund PHP roll out within

health, social care and the third sector inparticular. A key uncertainty held by keyworkers was the lack of clarity around DH

funding to support PHP implementation dueto its impact and drain on current resources.

1.1 Build and test a workforce plan withinthe East of England including considerationsof the roles and responsibilities of KeyWorkers, necessary changes to current job

descriptions and ways of working to makePHPs a success.

1.2 Consider using existing resources moreeffectively to champion and support widerPHP roll out.

1.3 Formalise funding support for the PHPpilots and wider PHP roll out across the East

of England or communicate clearly if fundingis not required.

Resource

Implications

Workforceand

StrategicAlignment

Workforce

andStrategicAlignment

Workforceand

StrategicAlignment


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1.1 There was general support from keyworkers regarding the principles behind PHPsand its fit within the personalisation agenda.

1.2 There was limited feedback from keyworkers and pilot coordinators about theleadership of PHPs, although championswithin organisations such as clinicians andother key workers were readily mentioned in

responses.1.3 No clear reference was made from key

workers and pilot coordinators regarding howPHPs will fit into existing organisational

structures, such as World ClassCommissioning and LTC Pathway re-design.However, key workers mentioned objectives,

target setting and the personalisation agenda.

1.4 There was general uncertainty from keyworkers and pilot coordinators about how thePHP will align to independent and third sector

organisations. In addition, there wasuncertainty from key workers and pilotcoordinators about the effectiveness of PHPsin hospital and care home settings because itwas felt that such institutions have their own

ways of doing things.

1.1 Engage with key stakeholders across the PHPpilot sites via regular and succinct disseminationof information about the link between thepersonalisation agenda and the PHP to supportongoing organisational alignment.

1.2 Use existing champions amongst PHP pilotsites to help lead and enthuse organisations touse the PHP. This will help to support thedissemination of good practice to help inform otherkey stakeholders engaged in the PHP pilots.

1.3 Develop and test the introduction oforganisational alignment guidance to helpintegrate PHPs into existing organisationalstructures. Also include ways to align widerstakeholder organisations supporting PHPimplementation.

1.4 Build and test a PHP implementation toolkit fororganisations involved in the PHP pilots, with a

key focus on the use on the third sector to helpdeliver PHPs to people with LTCs as key partnerorganisations to successfully embed PHPs.

Leadership &Organisation

al Alignment

Workforceand

StrategicAlignment

Comms plan

EngagementPlan

EngagementPlan


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1.1 Positive responses1.11 People with LTCs felt that the PHP would help toadd a personal point of view, encourage more informedand focused communication, help to prepare people with

LTCs for consultations and provide a means of personalinformation for out of hours doctors.

1.12 Key workers felt that the PHP would encouragepatient preference, challenge, openness and honesty.

1.2 Mixed responses

1.21 At the workshop there was a perception that PHPswill have a positive impact on relationships and

communications between key workers and people withLTCs. Questionnaire responses were less positive asmany people with LTCs felt that changes to relationshipsand communications are dependant upon existing

relationships and communications with their healthcareprofessionals. From both the workshop and thequestionnaires, carers felt that there will be no change asmany felt that they a lready have good relationships and

communications with the person they care for.

1.22 Key workers felt that it was too soon to say whetherthere would be a difference to relationships andcommunications with patients. Many key workers

expressed anxiety that the PHP may lead to raisedexpectations and false promises and have an impact ontrust especially in relation to End of Life care planning.

The increased time potentially required for one to onecommunications was also a concern. Such concernsreflect a significant change to existing ways of working amind shift change.

1.1 Build an engagement planincluding ways to champion positive

responses from key stakeholdersinvolved in the PHP across all PHPpilot sites during the PHP pilots.

1.2 Build capability and skills todevelop relationships andcommunications to encourage trust,openness and honesty. Considerchanges to current ways of workingincluding coaching and development ofinterpersonal skills etc.

Relationshipsand

Communications

EngagementPlan

Building theCapability


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1.1 Key workers feel that they are only partiallyable to demonstrate the behavioursunderpinning the 7 Common Core Principleswhen interacting with people with LTCs. Whenasked to assess the behaviour of their keyworkers, the perceptions of individuals withLTCs and their carers are slightly better. Themajority of those surveyed believe key workersdemonstrate the behaviours often or on afrequent basis.

1.2 The initial perception of individuals is that the

PHP is an NHS owned tool and that key workerswill have the greatest influence over the PHPand any decision-making associated with it.Equally, many key workers perceive the PHP tobe a poor duplication of existing medical recordsrather than a care plan.

1.3 There is a perception that some key workers

lack listening and relationship buildingbehaviours. A quote from an individual with anLTC illustrates this point a lot of doctors arenot human, they are machines - they don't talk toyou as a person.

1.1 Develop training tools for key workersacross the PHP pilot sites to ensure thatthey are able to demonstrate the 7 CommonCore Principles of Self Care consistently.

1.2 Design and build learning anddevelopment solution for key workers,people with LTCs and their carers to ensurethat there is an understanding that the PHP

is a a patient-owned document. Whilst thisconcept has been highlighted before, as thisrepresents a mind-shift change andtherefore requires repeated discussionwithin all patient-clinician/key workerinteractions regarding the PHP.

1.3 Champion the importance of listeningand relationship building behavioursconveyed by key workers across PHP pilotsites. The aim of this will be to ensure thatmore key workers are aligned and engagedwith the benefits of the PHP for people withLTCs.

Behavioursand Culture

Gaps

Building theCapability

Workforceand

StrategicAlignment

EngagementPlan


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1.1 Many key workers expressed concernsabout the time implications associated with the

use of PHPs.

1.2 No clear reference was made by keyworkers and pilot coordinators about the PHPsfit within existing PCT systems and processes.This may indicate a lack of understanding

around how the PHP fits with PCTcommissioning strategic plans for example.However references were made by key workersand pilot coordinators about a possible futurelink between the PHP and the QOF.

1.3 Key workers and people with long termconditions felt that the PHP is a repeat ofexisting systems and processes. People withLTCs felt that personal information was alreadyheld within their GP and hospital medicalrecords. Key workers felt that there was a large

overlap with existing assessments, such assingle needs assessments and the CPA. Keyworkers also expressed fears that the PHP willbe viewed as just another form.

1.1 Understand the impact of the PHP on currentroles and job descriptions and develop existing

workforce skills to become strategically alignedto help make PHPs are success. Also consider

additional resources to help mitigate against thepotential impact of PHPs may have onconsultation times.

1.2 Build and distribute supporting guidance onexemplar ways that PCTs may choose tointegrate PHPs into existing organisationalsystems and processes, such as performancemanagement measures, targets, incentives(including the QOF), and potential additionalrewards for changes in behaviour.

1.3 Devise a communications plan to inform allPHP pilots that the PHP is not just a repetitiousdocument and that it is a unique documentdesigned to support people with long termsconditions to become more involved in their

personal care planning.

Systems

andProcesses Workforce

andStrategic

Alignment

Workforceand

StrategicAlignment

Comms plan


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Key Next Steps for the PHP Pilot


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APPENDICES Key Related Documents

1. The Personal Health Plan

2. The Personal Health Plan Guidance

3. Stakeholder Questionnaires

4. Workshop Design

5. The East of England Learning and Cultural Alignment Framework


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Thank you

Capgemini would like to thank the East of England SHA for the opportunityto conduct the PHP Baseline Assessment. Capgemini would also like tothank all people with LTCs, their carers, key workers, pilot co-ordinatorsand other health and social care professionals who have supported this

engagement. Capgemini look forward to working with the East of England tofurther support the roll out of PHPs.

Personal Health Plan (PHP) Baseline Assessment

Documents

Transcript of Personal Health Plan (PHP) Baseline Assessment