“Self-management is a planned, collaborative step on the ladder of care – not an alternative treatment option” Dr Andrew McCulloch
Of all the health service care areas, self-management (self-care), is one of the most commonly and easily misunderstood. By general definition it refers to any “necessary regulatory function which is under individual control”, but when translated to a healthcare setting this does not mean that where self-management is practiced, patients must manage their own care outright – far from it. When used effectively, it is the name given to the process of helping people to help themselves.
It’s about balance
There is evidence to suggest that supporting people to self-manage can improve their motivation to look after their own health and positively impact how they engage with services. This approach can be seen as one of two things; a suite of techniques and tools used to support patients to choose healthy behaviours, and as a “fundamental transformation of the patient care-giver relationship into a collaborative partnership.” (de Silva 2011). Understanding the need and value of working in partnership with patients, is key. Self-management must not be used as an unmonitored alternative to clinical treatment. To be effective it must be used in collaboration with services, sitting as part of a long-term ladder of care, no step more important than the other, but all necessary to achieve the top step goal of better long term health and a quality experience.
Whether administered by the patient themselves, or the care provider, treatment must be planned and reviewed at all stages, as both parties work together to set goals that will lead to better health.
Supporting people with bi-polar disorder for example, to recognise the signs of mental deterioration, and to understand how they can contain or manage symptoms independently, will prevent breakdown and support people to rely less on services and more on themselves, leading to better long term engagement with clinical services in general.
Patient dignity and independence
This is particularly pertinent for the chronic condition community – of which there are over 15 million members in England alone. As the most frequent users of health care services – accounting for approximately half of all GP appointments and almost 70 per cent of all inpatient admissions (King’s Fund), supporting these people to manage their own conditions not only provides much needed relief for over-burdened A+E services, reducing repeat hospital admissions in the process, but essentially puts the service user in the driving seat of their own care. People with long term conditions understand their illness better than anybody, therefore with support, information and resources, could self-manage.
Diabetes and Sickle Cell Disorder are good examples of conditions where a consistent level of self-management and autonomy are essential for people to maintain their quality of life and have some independence. Supporting people to go from an anxious, helpless; “my condition controls me/my life” mentality, to feeling they at least have a level of control; “I control my condition.”
Staff have a key role to play
Significant work has been done around supporting service users to understand the value of managing their own care, but less so to educate clinicians about their role in the process. Improving the way patients engage with self-management is as reliant on changing healthcare staff attitudes and providing them with the skills to better support people to self-manage, as it is on the development of more patient-centred interventions. Existing fears around clinical outcomes, compliance and more irrational concerns over losing control of their patients, have led some in the profession to reject the concept. However, blocking such developments will ultimately be counter-productive. The wants and needs of service users sit at the heart of any effective person centred healthcare system. For this to be sustainable it has be built on a balanced combination of clinical care, peer support and self-management, preventing long term service saturation and enabling high quality patient experiences in the process.
Whether a patient wants to take a more active role in their care journey, or prefers to rely on clinical support, they should be encouraged and supported to take the option they feel most comfortable with, and feel confident and in control of the decisions they made, at all times.