Some key approaches to supporting clinicians and embedding self-management support in clinical practice include:
Training whole teams to create a self-management support culture
Training whole teams or whole groups of clinicians from the same service is key to:
- ensuring everyone has a common understanding of self-management support and understands the core tools and techniques
- creating a common language and culture
- creating a critical mass of trained clinicians within a team or service in order to generate and maintain momentum
- improving the ease with which self-management support can be tested and adopted, i.e. a way to improve its ‘trialability’
- enabling clinicians to support each other through the process of change.
Developing supportive systems and processes
Within teams, the things which make people feel the environment is supportive of self-management support include:
- having a senior clinician model and champion self-management support
- focusing on one aspect of self- management support in monthly team meetings
- putting reminders on computer screens
- building discussions about the use of self-management support skills and tools into supervision and audit
- changing paperwork to support self-management.
The influence of the wider organisational and policy environment is also important, in particular the extent to which Trusts are generally supportive of self-management, and how it fit with strategic priorities and policy drivers.
Utilising influential clinicians
Influential clinicians can, either by visibly practising self-management support or by actively promoting it, influence others to attend the Practitioner Development Programme and develop self-management support in their own practice. This ‘observability’ (i.e. making self-management support visible within the clinical community) is one of the key characteristics which can affect the successful uptake of an innovation.
Clinicians can be supported in their self-management support skills through routine clinical supervision. For example, in the Guy’s and St Thomas’ diabetes secondary care service, all the consultants have undertaken the Practitioner Development Programme and, because they are a teaching hospital, self-management support skills are now being passed on and encouraged in the registrars who pass through the service.
Several sites involved in the Health Foundation’s Co-creating Health programme established buddying systems. In Ayrshire and Arran, clinicians were offered a Practitioner Development Programme tutor as a buddy. They could get support and advice from their buddy by email and could sit in on one of the buddy’s clinics to learn more about putting self-management support skills into practice. In Torbay, the buddies were experienced self-management support clinicians who volunteered to sit in on newly trained Practitioner Development Programme clinicians’ consultations and give them feedback.
Action Learning Sets
Sites varied in how helpful they found action learning sets. In Calderdale and Huddersfield, Action Learning Sets worked well with therapy staff, partly because they used them to link clinicians’ training and service improvement work, but they were much less successful with GPs. In Torbay, Action Learning Sets were very active, in part because Torbay Care Trust paid for locum cover for the GPs attending the session.
A number of sites developed refresher sessions which picked up a theme or topic from the Practitioner Development Programme and the session was run around it.
Some sites offered clinicians one to one support, often provided by the clinical development lead, Local Co-creating Health implementation team members or Practitioner Development Programme tutors. In Cambridge, they have been looking at identifying self-management support champions, whilst in Ayrshire and Arran they are linking into the Train the Trainers programme with the aim of having one person in each team of services who can take on this support role.
Several sites have recognised the potential of e-learning to support participants post-Practitioner Development Programme. Ayrshire and Arran have developed a flexible programme which clinicians can either go through systematically from start to finish or they can dip into the topics that are most relevant to them. Support is available at any point for any of the modules, and there is also e-learning support post-Practitioner Development Programme for those who have attended the course in a more conventional way.