Shared decisions and planning care

• How is the workforce supported to partner with a patient or their substitute decision-maker to plan, communicate, set goals and makes decisions about current and future care?
• How does the healthcare service review the use and outcomes of systems and processes for partnering with a patient or their substitute decision-maker?
• How does the healthcare service demonstrate that patient are supported to be actively involved in their own care?

• Develop processes to involve a patient or their substitute decision-maker in planning, communication, goal setting and decision-making for their current and future care, and review workforce compliance with these processes.
• Identify any communication barriers and areas for improvement and implement solutions to overcome these. Consider engaging consumers in this review process by establishing a focus group or seeking feedback from patients. 
• Encourage healthcare providers to create an environment in which patients feel confident asking questions and healthcare providers respond positively to patient needs; this may involve speaking with patients in a neutral environment, away from the clinical setting.
  • During the delivery of health care, provide consumers with access to information and resources in a format that meets their needs; this may include
  • general information about their health, condition and healthcare arrangements
  • information about how they can be involved in their own care
  • information that has been developed specifically for them regarding tests and treatment options
  • provide patients with timely and open access to their healthcare record, test results and other clinical information relevant to their care.
• Implement ways to support patients self-manage their health care.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• A documented process, templates or other tools to support shared decision making, care planning and the development of goals of care, including supporting communication and interpersonal skills, shared decision making, and planning current and future care as well as advance care planning, where required
• Documentation in patient healthcare records, or observation that demonstrates 
  • information was provided to patients and carers about care options
  • patients and carers, or substitute decision-makers, were involved in screening and assessment processes, decision-making, developing goals of care and given information about the treatment to be provided
  • a plan for care was developed with patients and the workforce, and provided to patients to review and retain a copy 
• Patient information packages or resources about care options are provided to patients in different languages and formats consistent with the diversity of the consumer population and local community
• De-identified examples of patient notes and electronic healthcare record entries that demonstrate the engagement and discussions regarding planning and involvement in care
• Results of patient and carer experience surveys about involvement in shared decision making, care planning and actions taken to deal with the issues identified
• Use of technology such as mobile and tablet apps to interact and share information with patients before, during and after their care.

Commission resources

• Identifying goals of care – access to a number of resources describing different approaches to identifying goals of care. 
• NSQHS Standards User Guide for health service organisations providing care for patients with cognitive impairment or at risk of delirium – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. The principles and strategies outlined in this resource are broadly applicable. 
• NSQHS Standards User Guide for health services providing care for people with mental health issues – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. The principles and strategies outlined in this resource are broadly applicable. 
• Top Tips for Safe Health Care – this can help consumers, families, carers and other support people get the most out of their health care.

Other resources

• The Commission and Healthdirect Australia: Question Builder – a free web-based tool to help consumers prepare for a visit to the doctor. 
• La Trobe Support for Decision Making Practice Framework – a resource to guide healthcare services through the process of supporting people with cognitive disabilities to make decisions.

• Engage senior members of the workforce to act as champions for partnerships between healthcare providers and patients
• Provide enough resources to support healthcare providers to partner with patients in their health care
• Provide access to education and training to equip the workforce to partner with patients in their care. Education and training which develops the workforce’s skills to partner with consumers may include
  • communication and interpersonal skills
  • techniques for shared decision making
  • awareness of individual health literacy and the health literacy environment.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes or resources to support the workforce to partner with consumers in their care, such as policies for education and training on communication, interpersonal skills, shared decision making, health literacy and ways to actively involve the patient in their own care 
• Schedule of workforce education and training that includes communication and interpersonal skills, shared decision making and health literacy
• Training documents (for example, syllabus, attendance records and competency assessments) about partnering with consumers in their care
• Audit results of the proportion of the workforce who have completed education and training on partnering with consumers 
• Feedback from the workforce about their training needs
• Reviews and evaluation reports of education and training programs.

Resources­­­

• The Health Issues Centre and other state-based health consumer organisations that provide consumer engagement training for the health workforce.
• Point of Care Foundation: Patient and Family-Centred Care toolkit – provides a step-by-step method to help the workforce understand the importance of partnering with consumers.