Leadership for self-management support (SMS) needs to take place throughout the organization on an ongoing basis if effective SMS is to be sustained. SMS issues and opportunities should be addressed at board meetings, executive team meetings, budget meetings, and should be an integral part of the regular agenda of staff meetings. Many clinical team have said that SMS needs to become so well integrated, so that it feels like part of the team or organization’s DNA. To get there takes sustained advocacy by system leaders.
The Business Case
When working to persuade others in your practice or organization of the merits of SMS, you will find yourself wanting to point out positive
outcomes that others have achieved as a result of their SMS initiatives. This will typically include evidence of improvement in patient satisfaction, time saved, and quality of care improved. These benefits may directly support your organization’s strategic priorities and are often enough to justify investment of time and resources in SMS.
Also important, however, is the impact on a practice’s bottom line. In the New Health Partnerships initiative, (internal link to page in Best Practices) 70% of project participants reported that the lack of reimbursement for self-management support activities was a barrier to sustaining and spreading these services.
Different practice models are supported by different solutions to the business case. One resource that explores this issue in the fee-for-service environment is “Collaborative Self-Management Support Key to Care.” by Sheri Porter, which appeared in the June 13th 2007 issue ofAAFP News Now. Based primarily on an interview with David Swieskowski, M.D., vice president of Mercy Clinics Inc. in Des Moines, Iowa, the article includes information on the financial ramifications of SMS at Mercy Clinics. It looks at such things as the contribution made by Mercy’s use of health coaches and Pay for Performance revenue. Read More.
The Value Proposition
Most organizations that strive to improve self-management support do so regardless of an uncertain business case. They do so because the benefits to be gained align with other elements of the organization’s strategic priorities. Strong SMS can make a significant contribution to market differentiation, patient satisfaction, patient-centeredness, and staff satisfaction.
Measuring SMS
To be an effective advocate for the continuous improvement and expansion of SMS in your health care organization over time, you will need to cite measurable outcomes associated with your organization’s efforts. To generate good quantitative as well as qualitative data will require a well-considered measurement strategy and sustained attention and follow-through with the collection of data.
Your SMS measurement strategy may include two types of data.
1. Self-Management Activity
Improvement in the quality and quantity of self-management support activities, such as the percentage of patients with documented self-management goals, and the degree to which established self-management goals have been achieved. Other measures relate to assessment of patients’ preferences, follow-up, enhancement of patient problem solving skills, and formal and informal staff and patient SMS training activities. Essentially, any of the things talked about in this website can be counted and tabulated, if you choose.
Collecting data, on SMS activities, can be challenging because much of what you want to measure is new information, not something the practice or organization already collects. Many practices find that modifying forms they already use to document SMS during clinical encounters works better than creating additional paperwork for members of the provider team. Refer to the Resources (internal link) section for examples of Action Planning forms that may be used to document patient goals.
2. Outcomes Data
Clinical outcome data it is already well documented in the patient record. A strategy for demonstrating improvement associated with SMS is to compare clinical outcomes data for patients who have collaboratively set with those who do not. Expect at least 12 months of self-management support activity before you notice changes in clinical outcomes