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Community currency personas facilitation pack
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- 2. HOW TO USETHIS PACK Personas are a tool used to understand the values, attitudes and behaviours of groups of users. They are fictional characters but have typical characteristics of the patient groups they represent. This pack is designed to introduce you to the seven community nursing personas and offer facilitation tips for how they can be used in clinical settings and at system level to design services that meet patient need while delivering value for public services. These tools are designed to encourage and provoke discussion about service provision, they are not a set of rules or specific recommendations. The personas will support teams to: ▪ identify opportunities for service improvement ▪ articulate the economic value added by community nursing ▪ consider service provision at a system level.
- 3. 3 | CONTENTS 1 Introduction •Aims of the project • Methodology 2 Facilitation notes • Step by step guide • Assembling your team • Ground rules • Sample persona • Facilitators ‘whiteboard’ 3 Patient personas and prompt questions • Patient segmentation • Children • Working Age Adults • Older Adults 4 Appendix • Meet the team • Further work
- 4. AIMS OF THEPERSONA PROJECT The National Community Nursing Fellows in partnership with NHS Horizons have developed a series of patient personas with the aim of: ▪ Demonstrating the complexity of patient interactions with community services ▪ Describing the wide-ranging benefits of community nurse teams in terms of the patient, the health and care sector and wider society ▪ Testing community currencies against real world scenarios for better resource planning
- 5. METHODOLOGY Draft Initially thepersonas were drafted based on staff stories from East of England community nursing teams. We took characteristics of typical patient interactions and anonymised the clinical and personal identifiable data. Clinical input The draft personas were introduced to clinicians with relevant expertise in order to further develop the patient stories and create authentic health and care journeys. We drew on clinical experience of patient interactions to develop patient goals. Test & refine Finally, the personas were introduced to a wider group of clinical and patient advocates to test the credibility and understand how each persona demonstrates the complexity and value of community nursing.
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- 7. GUIDE TO APERSONA WORKSHOP: IN ADVANCE • Select which personas you will work on in advance based on the needs of your service or system • Invite representatives from relevant teams and organisations – think quite broadly and offer dates far enough into the future that attendees can make the time • Share the persona in advance to give participants an opportunity to think ahead of time • Allow one hour for each persona broken down into three blocks of 20 minutes • Prepare the space you are using with flip charts, pens and sticky notes for action planning • If you are running the workshop virtually, consider using a Jamboard or similar online collaboration tool to support action planning.
- 8. GUIDE TO APERSONA WORKSHOP: DURING Encourage participants to introduce themselves, acknowledging the range of expertise in the room. Open the discussion with initial thoughts and reflections from participants on the persona they read in advance. Use open prompt questions to encourage deeper thinking and curiosity. Once the participants have had a good quality, broad discussion about the patient start to encourage them to think about the specific services within their locality and how they meet the needs of the patients. Refer back to the ground rules if you need to encourage the conversation to remain constructive and focused on solutions. Ask “what do we need to do to fix that?” if participants identify problems. Start to bring the group to a consensus on actions, acknowledging that there may be existing work happening. The group should agree collective responsibility even for actions that are assigned to a member or specific team.
- 9. GUIDE TO APERSONA WORKSHOP: FOLLOW UP • Thank all participants for their contributions • Be clear on who has responsibility for the actions and the time frame for review • Agree collectively how actions arising will be fed back to the group; who will be the core members of the project team and who will be kept informed • Decide when it suits your group to meet again for an update, this will depend upon the agree actions • Consider raising the profile of the work with an Executive sponsor for the project at organisation or system level; is there an existing committee that could sponsor and support the work?
- 10. ASSEMBLING YOURTEAM Health and carefor patients in the community is hugely complex and requires a multi-disciplinary, multi- agency approach so any persona workshop should adopt the same philosophy. The more perspectives the better!
- 11. GROUND RULES FOR AGREAT SESSION Create a safe and supportive space Everyone has a voice Contributions should always be constructive Be curious and kind Collectively take responsibility for the success of the session Focus on the future we want to create, rather than today Agree actions and ways in which you can follow up with others after today. Your team may already have a set of ground rules or ways of working so feel free to use your own or adapt these as it suits.
- 12. SAMPLE PERSONA 1. Healthindicators – these show areas of concern, in this example communication is the lowest score and therefore the greatest concern 2. What matters to me statement in the patients voice 3. Health history – these descriptions are intentionally brief to inspire deeper conversation about how our services might meet the patients needs 4. My network – the most important people to the patient, we wanted to spotlight that this is not always family 5. My goals – not necessarily clinical 6. Perspective from someone important in their network 7. Scenario – summary of patient history including impact on their life and network 8. Future – an opportunity to discuss in your workshop what the future might be for the person and ask questions about how we design services to meet their future needs. 1 2 3 4 5 6 7 8
- 13. FACILITATORSWHITEBOARD Each patient personais accompanied by a ‘whiteboard’ and notes from the design team to help you facilitate a discussion. It is important to emphasise that the personas are not designed to provide answers but rather encourage discussions within clinical teams and systems about service provision within their immediate locality. You will notice a question mark on each whiteboard to encourage curiosity from staff using the personas.The questions posed in this pack are just a guide and we would suggest adapting for your services.
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- 15. PATIENT SEGMENTATION The patientpersonas we have developed represent typical patient groups that have been segmented on demographics, clinical characteristics and psychographics. By analysing psychographics we begin to understand the patients values, attitudes and behaviours; you will note that the patients goals are not necessarily clinical outcomes, they are lifestyle goals which can be achieved through improved health. Patients grouped by psychographics have similar needs despite significant differences in their demographics and clinical diagnosis, for example carer crisis. You will see examples of these groupings on the next page. When discussing the personas in your workshop it is important to acknowledge clinical needs but these have been intentionally designed to have gaps that should provoke conversation in your team or system.
- 16. PATIENT SEGMENTATION Demographic Clinical Psychographic Children Workingage adults Older adults Frailty Mental health Paediatrics Complex Specialist care Skills transfer End of life care Safeguarding Carers crisis
- 18. Notes from thedesign team: In Zachary’s story we wanted to show the impact on the whole family unit with Mum not able to work and big brother skipping school; there is potential for this story to have a very sad ending if they are not supported. If you have time, consider the alternate endings and the impact that has on wider society, for instance if Mum can never work, Zachary is taken into care or Archie becomes involved in criminality. Zachary What services do we have in our locality to support Zachary and his family? Where are the gaps in our services that mean Zachary has unmet needs? What do we need to put in place for Zachary and his family to achieve their goals? How are these different to clinical outcomes? How well are we working as a system to offer joined up care and support? What agencies are involved? Where could these working relationships be strengthened? Consider the future for Zachary and his family, what are the short and long term benefits to getting it right for them? ?
- 20. Notes from thedesign team: In Preya's story we wanted to show that there are mental health challenges for Mum Anjali, her full-time carer - with addition to mental and physical challenges for Preya that she will need to be able to overcome with the right support. Preya will be supported with her tracheostomy change by her Teaching Assistant at school so that she doesn't have to be taken out of school for hospital appointments. We want to ensure Preya's needs are met throughout her childhood and adolescence life phases. Preya What support/ services could be offered to Anjali to ensure she is able to manage her wellbeing and mental health well? Being aware of Preya's possible body image issues as she gets older, will need to be considered Preya is from an ethnic minority and with her condition she is in an additional minority group – how will health inequalities in general society, impact Preya negatively? Preya's Health Education Care Plan will require routine review to ensure that she does not fall behind in her education and gets the support she needs. Have cultural barriers or beliefs effected Preya or her family's ability to cope with her condition well? Who has the responsibility to ensure that community nursing teams are scheduled to provide the necessary transfer of skills training to Preya's Teaching Assistant in a timely manner?
- 22. Notes from thedesign team: Jordan is a complex but not uncommon situation where a patient is “lost” during adolescence. We want to provoke conversation around how services support young people who might not have parental support to transition from children’s to adult’s services. We have intentionally been vague about Jordan “letting off steam” to suggest a substance mis-use problem for added complexity. Of all our patients Jordan cares the least about their health. Jordan Consider Jordan’s quote ”the hospital aren’t worried about me…I don’t meet the threshold for specialist care.” What message does this send? Can anything be done in our locality to offer support to vulnerable children through transition? What complexity might be added by Jordan “letting off steam”? How joined up are the teams caring for Jordan in our locality? What improvements could be made particularly for complex patients like Jordan? How would our system ensure safeguarding concerns are communicated across teams and services, and followed up on? Who holds responsibility? Consider the cost-benefit of support a patient like Jordan, what can be done in the short term that will prevent high dependence on health services in the future? ?
- 24. Notes from thedesign team: Steven and Mark’s situation represents a group of patients who were previously healthy and now find themselves in a new set of circumstances needing support to adjust. While Steven’s clinical care may have been exemplary to date it is likely to be the situation at home that leads to carer crisis or a further decline in his health. Steven What funding might Steven be entitled to and how does our system support him in applying for and making use of the funding? Consider Mark’s situation, what support services can he access in our locality to address social isolation and to enable him to be economically active? How might Steven’s needs evolve over time and how would our system respond? ? Consider the impact on both Steven and Mark, and the wider social and economic impact if they are not supported How joined up are the services Steven needs in our locality? How is information shared between the hospital and the community teams? What could improve this system working?
- 26. Notes from thedesign team: We hoped to convey Yolanda’s complex clinical and personal circumstances with sensitivity. The safeguarding concerns over her relationship with Gareth and what will happen to Kofi after her death should provoke conversation. We have intentionally not clarified who has parental rights over Kofi, again to provoke discussion on how this would be supported in your locality. Yolanda How does our system capture and escalate safeguarding concerns for patients like Yolanda across services and specialties? How do we support Yolanda to make plans for Kofi? What provisions could we put in place to ensure Yolanda has a dignified death in a place of safety? What additional support might clinical teams need in order to achieve this? What charity services do we have in our locality that could support Yolanda and who is responsible for linking her to them? ? How joined up are our services to co-ordinate Yolanda’s mental health and cancer care?
- 28. Notes from thedesign team: Mary's situation is one of physical frailty and mental health concerns. Mary is needing to move into residential care due to her mobility. Ensuring Mary stays well during and post her transition into residential care is key. Mary has Parkinson's Disease and so falls prevention is a priority. MDT (Multi-Disciplinary Teams) need to work in tandem to give Mary the best healthcare experience Mary With Mary's declining health, Have we considered what her future needs will be? Mary will need care and medical support from her GP, Pharmacist and Specialist Nurse in parallel. How will we ensure that the multi- agency process works for Mary effectively? Mary's emotional state will need to monitored closely, with the fact that she is leaving all that is familiar to her and having to deal with change Mary will need to consider giving her daughter lasting power of attorney to ensure decisions can be made on her behalf Start to gather information for her palliative care plan Mary has Parkinson's Disease and so we need to consider the possibility of Dementia occurring later down the line
- 30. Notes from thedesign team: Bob and Anne’s story is one of ageing well at home. We wanted to show that if patients are supported appropriately at home we can avoid hospital admissions and more costly health interventions. Anne is a carer in crisis but may not recognise her situation as such. We have included Bob’s voice via his advanced care plan and we have implied that there may have been a role reversal between him and Anne due to his dementia. Bob What charity or voluntary services do we have in our locality to support Anne as Bob’s carer? How closely do our services communicate regarding patients who are also carers like Anne? How would an advanced care plan be established and shared between services for a patient like Bob? Is it clear who has responsibility and how this information is shared? At what point after Bob’s diagnosis would we initiate an advanced care plan? How can we avoid hospital admission for Bob in future? ? What are the opportunities for population health management?
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- 32. MEET THE TEAM NHSHorizons Claire Shields Rupal Johal Community Nursing Fellows Charlotte Sumnall RN Sifiso Mguni RN sifiso.mguni@nhs.net @sifiso_mguni claire.shields3@nhs.net @Claire_Shldsy charlotte.sumnall1@nhs.net @charlysumnall rupal.johal@nhs.net @JohalRupal
- 33. FURTHER WORK While wehave attempted to capture a cross section of community patient groups we recognise there is scope for the personas to be adapted or extended to capture additional complexities of the patient journey, for example: Transition from children’s to adult’s services Population health Interaction with education, local authority, criminal justice and other public services The role of virtual wards The design team would be delighted to see future iterations of the personas incorporating different aspects of the patient journey and would encourage teams to adapt the characters to suit the specific circumstances in your locality.