approx. 50 mins. Documentation Meeting 3 Health Plan Begin Cancel
This is what we will be doing over the course of the next 50 minutes:
Get an introduction to the term Health Plan.
Share lessons from everyday life.
Discuss improvements.
Strengthen the partnership in our professional practice.
Talk about what we can promise ourselves going forward.
The group leader reads aloud
This is the third course session of the documentation module. We will be given an introduction to what the term Health Plan means and we share with each other what we have learned from our everyday lives. We also have to agree on changes to start working with in our professional practice.
We will be given an introduction to how we can continue working to strengthen documentation in our professional practice and how we can measure the change.
Listen together and follow the text below
The health plan is an agreement between the patient, often their relatives, and healthcare, rehabilitation or social care professionals. It can encompass what will happen in the next few hours up to what will take place further ahead in the future. Although it is a collective document, the health plan is primarily for the benefit of the patient.
A health plan can be written in various ways, but it should contain four important areas: the patient’s own goals, what the patient needs to do to achieve them, what resources the patient has themselves and what support the patient needs. In a bit more detail, a health plan could have the following headings:
1. My goal
This is what I would like, want to be able to, want to do, or want to feel – both in the short and long term.
2. What I have to do
This is what I have to do to reach my goal – how and when I will do it.
3. My own resources
These are the abilities, qualities and resources I have to help me.
4. The support I need
This is the support I need – who is able to help me and when.
The health plan is to be seen as a living document that is updated. The situation and the circumstances may change, or perhaps the goals are changed. The most effective are digital health plans that professionals and patients can follow up and update in real time. If it is not possible to use digital health plans, each unit must find its own way of working with the health plan so that it works well for them and their patients. It may be as simple as a document that is filled in together with the patient, who is given a printed copy of it.
The goal is always to make the patient as active in their own care as possible so that they can live a healthier life.
During the previous meeting, we each chose a situation where we would practise the Health Plan. We focussed on the assertion:
F. Health plan
Together with the patient, we decide health goals and the steps needed to get there. These are clearly and understandably documented in a health plan.
We are now going discuss in groups how together we can become better at working with the health plan together with the patient. What can we start doing differently?
We will soon have finished module 3 on documentation and will start making these changes in our day-to-day work. We will now get some tips that can help us along the way.
Listen together and follow the text below
1. Make your situation map visible
Put your situation map and list of changes in a place where they can be seen so that you can remind yourselves and each other. It is also a good idea to talk to other colleagues about your reflections regarding the situation map and about the changes you have agreed on. The more of you there are who are working towards the same objective, the easier the work will become and the greater the difference you will make. Your colleagues will surely also be able to add to this with more good ideas and suggestions.
Listen together and follow the text below
2. Remember that it is a journey
Change often happens in small steps. Sometimes it is two steps forward and one step back. In which case, it can be good to remind yourself that it is a journey and that every little change can make a big difference. As a group, you can help by encouraging and reminding each other.
In this training module, you have chosen specific situations that you are to change. It is also a good idea to come back to the situation map after a few weeks. Perhaps you want to swap a pink Post-It for a yellow one, or a yellow Post-It for a green one? Perhaps you have come up with something else that works a lot better? It is important to stop and reflect in order enable you to improve and celebrate.
Continue to think about whether there are other situations where you can become more person-centred. Person-centering on the person is not about working in a specific way in an individual situation, instead it is a comprehensive approach. We can always find situations and methods that help us become more person-centred.
Apply trial and error and remember to share what you learn with each other.
Listen together and follow the text below
3. Set objectives and measure change
What is the objective of what we are doing? How do we know whether what we are doing is actually an improvement? It is always good to be as clear as possible about what we want to achieve and systematically follow up how we are doing.
Start by identifying your objectives. Perhaps one of the objectives is to ensure that the patient narrative is a clear part of the medical records. Or having made a shared health plan. Or that the patient is able to understand their medical records, appointment letters and other communications. Or saving time thanks to the documentation being clear and painting a comprehensive picture.
Then come to an agreement about what is to be measured and how this can be followed up. It may be that you ask patients verbally or using a simple form with simple questions: Do you understand your medical records? Does the health plan help you understand your goals and the steps you need to take in order to achieve them? Do you feel that you are more involved in your healthcare? Or other questions that help us understand. Another way of following up is to ask the professionals. This can be a checklist for what we document and in what manner. Or more open-ended reflections and discussions we have together over a cup of coffee.
You can also measure more tangible events: How often do patients get in touch because they have questions about something entered in their records or results they have received in the post? How often do patients need to ask about what is going to happen?
Finally, you should decide who is responsible for follow-up and for ensuring that lessons learned are shared with colleagues. It is a good idea to get help from your head of department or the person responsible on your unit when deciding on this. Also ensure that you are measuring and evaluating the current situation so that you have something to use for comparison once you have begun making changes.
We are now at the end of the training programme in person-centred care. The time has come to reflect on what you want to bring with you going forward. Think about what you promise yourself you are going to start doing or do differently in the future.
We will now share our individual promises with the group. It is a good idea to keep what you have written down as a reminder.
The group leader reads aloud
Well done!
We are now finished the final module. We hope that you have learned a lot and that you find it fun to change and revitalise your professional practice. Good luck with the work ahead!