Making a Great Planning Process
Thinking about Outcomes in Four
steps:-- new ways of relating to
achieve a new relationship and a
fully owned personal health plan.
Making a great planning process-Critical
Factors...
Feeling that something different is possible,
and having hope that it could be made real
Knowing the money and the “deal”
Believing that there will be sufficient
information and support to enable me to both
manage the money and put the plan into
action effectively.
Having an agreed way to measure how the
process, and the planned outcomes are
working, in an ongoing way.
Tilting the balance of power
 Its about shifting power and creating an
improved relationship, with changes on both
“sides”.
 Central focus is improving the dialogue
between the citizen and the professional to
create:
Greater mutual respect & understanding
Better quality decision-making
Better outcomes
 This should produce a Personal Plan which is
co-signed by the citizen and professional
Step one- developing a trusting relationship
So how does the support planning lead to outcomes and
action? What are the steps of the process to agree
outcomes and actions?
 We need to start with the person’s unique view
of their life and health condition
 We need to actively listen and quieten our own
usual ways of working, and not assume we know
immediately what will work best, even if we’ve
worked with hundreds of people with the same
diagnosis
 We need to trust people to have a good
understanding of what is working and not
working in their lives. This is where we start.
Step one- developing a trusting relationship
 For people with long term health conditions –
their health needs are woven through their life:they are not a separate thing and so we needn’t
worry that people will talk about random or
irrelevant things when they identify what’s
working and not working well in their lives.
 This is a new way of talking together. The point
at which the health professional’s views are
incorporated is really important.
 The health professional’s view is NOT put in at
the very beginning nor at the end .....
Step two: actively engaging
 The first step is exploratory discussion, active
listening and respectful questioning and
reflection- finding out the most important things
which are working and not working.
 The next step is to consider together, within
those things, what is important to the person in
terms of what matters most to them, and also
what matters for their health.
Step two: actively engaging
• The person themselves is the only one who can know
what matters to them; and the person themselves,
(unless perhaps newly diagnosed), will also have a good
idea of what’s important for their health.
• What matters most to some-one can be accepted- it
simply does! We can of course ask, and it will be useful
to understand, what it is about that something which
matters – but we should avoid being drawn into debate
about whether something should or shouldn’t matter, or
describing some things as wants and some things as
needs.
Step two-Synthesis not two tracks
 If it matters it matters- but we do need to understand
more about the essence of what matters, in order to be
able to write a specific outcome and an action plan
linked to that.
 In thinking together about what’s important to and
important for some-one, the health professional can
helpfully contribute, where necessary, their expert
knowledge about the specific “important for” information.For example- the person may be well aware that they need to keep
their blood sugar at a certain level- the professional can give specific
detail about the correct level for their particular illness, age and
context.
 So it is at this second stage where the health
professional can most usefully begin to input their ideas
and expertise.
Step three: developing a deeper understanding
and identifying emerging outcomes
 Having started with listening hard to what’s working and
not, and then going on to consider what’s important to
and for some-one, some clear priorities will begin to
emerge.
 What we need to ensure is that all of the priorities and
the outcomes which flow from these, are the person’s
own outcomes.
 We cannot add on “health outcomes” at the end just as
we can’t impose them at the beginning.
 If the outcomes are not recognised and owned by the
person then this isn’t their plan and something has gone
wrong with the conversation. We need to talk more.
Step three: developing a deeper understanding
and identifying emerging outcomes.
 The prioritising stage will pull together, from the
conversation, what are the joint priorities agreed by the
person and the health professional. There will have been
a synthesis of ideas, and a clarification of top priorities
for action, including risk enablement/contingency
planning.
 The health outcomes need to come from the person. The
health professional’s role is to help support the
identification of the person’s own outcomes and to
contribute to making them as specific and individually
relevant as possible.
 The actions which follow are then fully and clearly linked
to the specific outcomes
Step four: agreeing outcomes and actions
 The ideas about how to achieve the outcomes will again
be a bringing together of what some-one has come up
with as their own solution, is willing to commit to and is
motivated to do; with the health professional's expertise
about what might have proved useful for others and what
research suggests too.
 We need to trust people’s own solutions-. This is at the
heart of the shift in the relationship – people exploring
what matters and finding their own ways to achieve
change/maintenance, actively and fully participating.
 This can be seen to be a significant shift from the
traditional assessment/prescription/ passive recipient
model.
Starting somewhere different to end somewhere better.
To summarise:
Step one- Developing a trusting relationship:- listening with empathy
and respect, to the person’s experience of their health condition. Helping
some-one describe what’s working and not working in their life.
Step two,-Actively engaging- Developing an understanding of what’s
important to and for some-one –exploring what helps and hinders their
health. Offering in professional knowledge about specific relevant
aspects of an emerging outcome.( but not telling some-one what they
should do).
Step three- Developing a deeper understanding-Linking and integrating
individual issues and problems into themes and priorities. Identifying
emerging outcomes.
Step four- Agreeing outcomes and Action planning to meet them.
Supporting the person to identify clear outcomes linked to the priorities
and move through creative thinking, problem solving and decision
making to a clear plan of specific actions.
Having a live in PA
Not seeing enough of my
family and friends
The physiotherapy and
exercise that help my
stamina
My stamina not being what I want
it to be
Less hospital stays
The pain in my hands
Playing wheelchair rugby
Living in a shared
environment
and not having any privacy
My social life has improved
What are your priority issues
Important to important for Working /not working
Decision making
If I could I would
Perfect week
Relationships
What I bring
Good day bad day
Priority Issues
Person centred outcomes
Creative solutions
Costed Plan
Priority Issues
Improving my fitness and stamina
Finding a place to live
Managing my pain
Improving my general health and avoiding hospital admission
Maintaining and developing my independence
Seeing more of my family and friends
Developing outcomes
Beware thinking of services and therapies too
soon! Outcomes are not services, treatments or
therapy nor attending those.
Outcomes are changes in or sustaining of
physical behaviours, or mental states/emotions.
We need to describe clearly what we’re aiming
for- in specific terms. - What will be working
better or be avoided?
This can include what we’re hoping for even in a
deteriorating health condition, or at the end of
life.
How I receive my additional oxygen is not working for me as it is
stopping me going out of the house
To be able to spend
time with my friends
each week when I am
well
To maintain my
oxygen saturation
at above 96%
When I am well to go out and spend time with my friends twice a
week and maintain my
oxygen saturation at above 96% when I am out.
Improving my fitness and stamina
To be strong enough to
use a
manual wheel chair all
the time.
To be able to do more
than one thing per day
without getting too
tired
To improve my
general
health through
exercise
Not to get socially
isolated because I am
too tired to see family
and friends
Not being too tired to
go out in the evenings
To be able to tolerate 12-14hrs per day in my manual
wheelchair without being too tired and having to go to bed.
This would enable me to do more things during the day and evening