A common barrier to people receiving self management support is often the clinicians hesitance to introduce it into the conversation.
A common barrier to people receiving self management support is often the clinicians’ hesitance to introduce it into the conversation during consultations. There can be a fear that by asking someone what they do to keep well, the person might wish to discuss some issues which the health professional feels they don’t have enough time to fully explore, or the knowledge to address it properly.
In 2010, a number of psychologists prepared a draft paper on how people with diabetes could benefit from psychology input and it was recognised that there had not been enough. As a result, NHS Lanarkshire, alongside four other Health Boards, were awarded three years of funding to provide Psychology in Diabetes training to all clinical diabetes staff.
The health professionals were not expected to replace psychologists but the training would provide the staff with the skills and confidence to have that self management conversation with people. “I learned a lot. The training gave structure and confidence. The early training made me sit down and reflect. Now I know I need to find out what the patient expects from me. Now I spend more time building up rapport. It has made me ask more open questions and elicit what is important for the patient. It is their agenda, not ours. Consultations are more enjoyable and productive. Nurses try to make everything right, now I sit back and let the patient make suggestions.” Health Professional, NHS Lanarkshire.
The training was ongoing in Lanarkshire until July 2015 and as a result of the staff moving towards this co-production approach there have already been excellent outcomes such as improved emotional well-being and improved diabetes self-management while staff feel more able to help people self-care, and are now routinely sign-posting to specialist services. “Consultations have become more patient led allowing discussion on the patient’s agenda, rather than focusing on my own priorities. This allows for more informed decision making from patients even if I don’t necessarily agree with the patient’s choice. I have become more accepting of what I can help change and what I cannot.’’