SPOT analysis: Putting patients first

This is the SPOT (Strengths, Problems, Opportunities, Threats) analysis for Putting patients first, as discussed at the Leading Clinical Commissioning event held by NHS Birmingham East and North on 20 and 21 July 2010.

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Strengths

• Reduces ’silo’ working
• Improves patient choice
• Partnership working
• Better service design
• Developing pathway approach
• Service user views
• Rich skill mix
• Better access to info
• Co-products
• Health and social care one system
• Patient chooses less follow-up/less risk adverse
• More explicit competition – asthma patients vs. COPD patients
• Pre existing relationships
• Skill mix and good will
• Carer/patient voice – working together
• Dignity and care
• Core commitment to big goal
• Typologies/profiling
• PPI database/mircosite
• Household survey
• Personal health budget pilot
• Track record on involvement
• Local intelligence

Problems

• Paternalism preferred by some patients
• Making patient-centred decisions on behalf of large populations
• Current systems are not patient-centred,
• Disparity between individual choice and ‘mass production’ pathways
• Access, equity and equality
• Capturing patient experience
• Making shared decision making a reality
• Patient willingness to take responsibility for care
• Lack of data about clinical systems
• Clinical skills (preferred consultative style)
• Tyranny of the majority
• Rare specialities
• Professionals not always listening
• Not taking care of carers
• Working in isolation (whole picture)
• Responsibilities of citizens & communities
• Not utilising our ‘soft’ intelligence
• Choice has opportunity cost
• Bias towards more informed and articulate and currently well
• Limited good info for public
• To allow choice there must be spare capacity
• Financial interests will always dominate

Opportunities

• Improves patient education
• Gives patient responsibility
• Encourages appropriate resource usage
• Opportunity for major re-design
• Consortia can design local services that patients want
• Change?
• Improve health outcomes
• Maintaining quality workforce
• Different ways of working “outside the box”
• Reducing waste
• - focus prevention
• - patient choice design deice around need of patient
• Complex adaptive systems
• Telehealth
• Internet, mobile phones
• New GMS contract
• Travel for procedures
• Over-treatment/use debate
• White paper strengths patient voice
• Seamless care between health & social care
• Potential for new ways of working
• Providers/commissioners ready to listen
• Quality innovation efficiency, good leadership (ingredients)
• Informed choice with education
• Take seriously the notion of patient control, not just choice
• Use new relationship with LA to access political influence and awareness
• To help “health watch” to have real teeth
• Greater focus on patient experience to improve satisfaction
• Unemployed managers will be able to help!
• Change to medical training – emphasis on patient

Threats

• Inappropriate expectations
• - demand/resource mismatch
• Pressure groups
• Overspending
• Might increase inequality
• Change can be a problem
• De-motivated staff
• Maintain focus on quality
• Potential threat to further integration
• Managing expectations
• Democracy of voice
• Fragmented and incoherent – loss of illusion of control
• Lack of cohesive patient voice
• Fragmentation – time taken to develop new relationships
• De-motivation /defection of good personal effect on remaining staff?
• Managing change, potential for fragmentation
• Raising patient expectations
• Changing population, demographics – timescale rapid change
• Patient carer fear of negativity (things can’t improve)
• Too much emphasis on institutional ‘menu’ rather than real control
• Professional resistance to loss of control ( of risk & paternalism)
• Lack of concern for the vulnerable
• Lack of availability (and willingness) to engage
• Lack of resource results in limited choice & cuts in services
• Profit driven commercial marketing to patients e.g. Herceptin

See also: LCC SPOT write-up (Word doc) – plus comments