Monday, 8 September 2014

Self-Management: It isn't just for patients

Last week I had the honour of delivering a lecture at the College of Medicine Summer School, 'Self Care & Resilience: How can we care?'. This blog post is a summary of my lecture.... 

The aim of my lecture was to share some of the skills that students can employ as healthcare professionals to help support their patients who are living with long term health conditions. But I also feel that these are a universally applicable set of skills that can help them build resilience and manage the challenges of their roles as HCP within the NHS. After all, we are all in the same boat facing challenges, its just that the exact nature of those challenges is different whether you are a patient, or professionals. The same skills and approaches can still be helpful! 

For me, self-management is about finding a sustainable way of living with my long term health conditions. The working conditions of the NHS aren't going to change either, and it is important that we can support students to manage that sustainably in the long term - since their careers should be spanning decades. 

There are four key tools for this approach... 

1. Tell me about the things that you are already doing to look after your health?  
Acknowledging what someone is already doing is crucial to cement the foundations to then go on and discuss further changes. Never underestimate the effort it takes to do the little things each day. For students, this is a great way to learn about the different ways that people manage their health that don't normally get mentioned in a text book.                                                                 
For you as a professional facing a challenge, ask yourself "What am I doing already to manage this situation?" Give yourself time to acknowledge what you are already doing before always thinking about the endless list of things that you should be doing to cope better!

2. Goal setting 
It can often be hard to actually get down to doing the things that you mean to do, whether that a patient doing physio exercises or a healthcare professional doing their e-portfolios or personal tasks like going to a new exercise class. This is where goal setting comes in - it can help people with the motivation and structure to get started on these things.  The basics of goal setting are that it is something that is important to you (this ensures that we are going to be motivated to work on it), you are specific about what you want to do (what, when, how much, how?), and you feel confident about doing it (i.e. it is achievable and realistic). There are more detailed resources on goal setting here and here
Goals don't have to health related, so are just as applicable for you as a framework to help you make changes, personally or professionally.  

3. Goal Follow-up 
"Tell me how you've got on with your goal...?" 
Following up on goals is important. If the goal has been achieved, this is an opportunity for praise. Patients are not attention seeking children, but a little bit of praise (said in the right tone!) can go a long way. While what a patient achieves as their goal maybe an everyday thing for you, don't underestimate the effort it has taken and what a big deal it might be to them. 
If the goal hasn't been achieved, this is an opportunity to check the importance to them, and to problem solve.  
This process can be helpful for you as professionals, when looking at goals you have set yourselves, either personally or professionally. 

4. Agenda Setting 
This tool can set the tone for the appointment to be the most helpful use of time for both the patient and the healthcare professional. Of all the self-management skills this has been the one I've used most widely in 'normal life', in meetings etc.

More details of all of these tools are on the Health Foundation Practitioner Development Programme

There are two reasons why I feel this approach is important. Firstly, I need my healthcare professionals. I don't want them to burn out! Secondly, I hope that seeing the power of these approaches in their own personal lives will help them use them and champion them when working professionally with people with long term conditions, to effectively support them with their self-management. 

I know that I am personally guilty of falling into the "us and them" trap, creating an article divide between patients and professionals. Whilst there are clearly differences between these two 'roles', there are probably more similarities. We are all facing challenges that require us to find ways to manage with them sustainably since they aren't going to disappear overnight (either health conditions or the conditions of the NHS). The same toolbox can be used! 


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  2. I really enjoyed your workshop at the Summer School. What I learnt has helped me enormously, thank you.