DESMOND Newly Diagnosed Programme and Quality Development

Sue Cradock

presented on behalf the DESMOND National Training Strategy Group

DESMOND Newly Diagnosed Programme

Skinner TC et al. Patient Education and Counselling 2006;64:369-377

The purpose and objectives of QD...The challenge we faced:

• The need to describe the intervention – in order to test it (MRC Framework – Evaluation of complex interventions)

• The need to get patients engaged in learning (Ellis et al 2004 Meta-analysis and Meta-regression of Educational Programmes in Diabetes)

• The need to be clear about what we were expecting the educators to do - in order to specifically train then them to do it

• The recognition that training alone rarely results in healthcare professional behaviour change (Pill et al 1999Journal of Advanced Nursing; Anderson and Funnell 2005 Patient Ed & Counselling;)

How long has QD been in place?

• Since the start.......

QD Process

DESMOND Quality

DevelopmentCycle

IdentifyChanges

DataCollection

Define criteriaand standards

Assess performance

against criteria and standards

DESMOND Quality

DevelopmentCycle

IdentifyChanges

DataCollection

Define criteriaand standards

Assess performance

against criteria and standards

Criteria

Criteria and Standards

DESMOND Quality

DevelopmentCycle

IdentifyChanges

DataCollection

Define criteriaand standards

Assess performance

against criteria and standards

Data Collection

• Self and Peer Refection

• Using DOT (Desmond

Observational Tool) and DOS (Desmond observational sheet)

• External Observational Visit and feedback x2

QD Assessments so far..

• September 2005 – November 2008

 • 21 Active Assessors

 • 503 trained educators : 363 trained over 12 months ago and 140 within

last 12 months.

229 Educators are in the ‘active’ QD process

41 Educators are ‘accredited’

10 Educators have had 2nd visits and are being ‘revisited’

Numbers reaching percent of targets – the training works!

Identify Changes

Educator• Reflection, feedback and action plan from external visit• Ongoing support to maintain behavior change

Training• Changed delivery • More practice with action planning• Mirrors the delivery of programme – modeling key

processes • QD informs programme development alongside research

and biomedical outcomes

Standards and Criteria• Describe educator behaviours more clearly

The value in seeking to support behaviour change in educators

“ less educator talk in a session leads to greater change in participants beliefs about their diabetes”

Skinner et al., Diabetic Medicine 2008

Challenges

• Training …. Of assessors (we are now considering how to assess consistency across assessors) and of educators..in peer and self reflection

• Organising….people coming forward for QD and matching assessors to sites

• Analysing….data• Making Changes….what are the right next steps?• Making decisions if an assessment does not

‘meet the criteria’…role of the TSG• More and more educators being trained….

In conclusion

• The DESMOND QD process is not just a check list for ‘adherence’ but a complex ‘well’ designed part of the development programme for ongoing diabetes educator training

• The DESMOND QD process is a key factor in the development of reflective practice in educators and trainers.

• The DESMOND QD process allows for ongoing refinement of the patient programme

• BUT the approach we have taken is complex and demanding and we are seeking ways to refine the processes without losing the observation/feedback and reflection....