Clinical Scenarios and how you might use them
Background to clinical scenarios
Clinical scenarios served a number of functions in our work with ICS teams identified as early implementers of the PCSP standard, including:
-
Providing a starting point for discussion with key transformation contacts about the design of an appropriate workshop model for the Stocktake
-
Clarifying what type of cases were in/out of scope and most relevant to the participating clinical teams
-
Providing a base line narrative from which develop simulation models
A suite of about seven very brief vignettes or personae was narrowed down to two hypothetical user cases which were developed into extended narratives with accompanying outline care plans. On further consultation one ICS specifically requested some scenarios more closely aligned with their experience at the point-of-care and worked with our internal clinical expert to co-create three scenarios for use in the stocktake workshops.
These more developed scenarios were used to:
-
Stimulate discussion by health and social care professionals using the guiding questions below
-
Capture insights about culture, practice and technical infrastructure in from the ‘as is’ perspective
These scenarios, combined with insights contributed during the stocktake workshops, were used to identify key ‘touchpoints’ in the clinical relationship when information might be generated, stored or shared, which in turn informed simulation models of human and machine-readable care plans which would be useful to system developers and data architects.
As training and modelling resources the clinical scenarios were not conceptualised as ‘best practice’, ‘exemplars’ or statements of how care and support should be delivered now or in the future. In all eight workshops participants were first invited to reflect and comment on the scenarios (see guiding questions below). In line with the priorities of the PCSP standard implementation initiative questions focused on how, when and by/with whom key care planning information was shared or accessed. The main focus of the Stocktake workshops was to identify the ‘as is’ position.
Points to consider...
Scenarios developed as training materials to stimulate discussion are unlikely to reflect ‘best practice’- their purpose is to provoke debate. Care should be taken when sharing them with people not previously involved in the design and preparation of the intended training or consultation events so that their expectations are managed. An output from subsequent workshops could be collaboratively written ‘good practice’ exemplars. This would both validate professional experience, challenge poor practice, and empower professionals to own ‘best practice’ solutions.
Co-created scenarios risk losing coherence, especially if the collaborators are from different professional cultures. There is a perennial discussion about whether patients, service users, clients or people is the most appropriate nomenclature, and similarly, there is a perceived disconnect between ‘medical’ models and ‘recovery’ models. Different stakeholders will have different views, and this is potentially something to discuss in future workshops and resolve through moderated co-creation of materials.
Guiding questions to stimulate discussion workshops
• Is this scenario familiar to you? Does it reflect your current experience?
• What are the key moments in this scenario/relationship?
• What is the nature of interaction?
• What are you doing with or for the user?
• Who are you liaising with?
• What information are you relying on?
• Existing information
Creating or collecting new information
• What is the format and source of the information?
• How easy is it for you to access, input and share the information?
• What and who is missing from this scenario?
• What's most important to you in care planning?
• What do you most need from a care plan?
• What are the differences between care planning and care plans?
• How do you use Dialog/+, ReQoL or similar tools as part of assessment or care planning process? What elements of care and care planning are not addressed through Dialog/+, ReQoL or similar tools?
• What else is important to this discussion?
Using scenarios to deliver practitioner-led process review
An aspiration of this approach, as discussed with pilot partners, was to model the use of scenarios in a way that would prompt local teams to create their own context-relevant versions. Locally embedded clinical teams will potentially have more scope for co-creating such materials with community contacts, carers and service users than we had as a non-clinical project team. The caveats above about managing expectations are relevant here as the wider cohort of stakeholders may well use colloquial language or make personal assumptions that do not align with established expectations of regulated clinical or professional practice, or political correctness. Teams will need to be very clear about the use and purpose of such co-created material, who else may have access to it, and the unintended consequences or conclusions that may be drawn out of context.
Working on scenarios as described above also has potential to build capacity within teams to undertake practitioner-led process review using:
• Information modelling,
• Data analysis
• Business process review
Such activities should not be considered as substitutes for the above functions being undertaken by appropriately qualified specialists, but rather as part of a broader stakeholder engagement strategy to foster ownership of new solutions.
Simulation for Community Mental Health - a tool for data architects and system developers
Simulation is a useful tool for helping data architects and system developers work towards system interoperability and support the sharing of key data between systems. The individual simulations in the separate simulation pack:
a) take the example care plans from the user scenarios
b) map then them into data items defined in the PRSB PCSP standard
c) create machine-readable representation of the care plan (as a json file)
d) use a template (included in the toolkit) to recreate the human readable care plan from the json file.
Click here to view workshop cycle variation 1.
“These resources can be modified to reflect the locally developed user scenarios and care plan layouts, and the process allows architects and developers to get a shared understanding of how care plans map into the standard.”
“The simulation pack also includes a list of touchpoints for each user scenario, which can be used to establish exactly where in the story the care plan is created, looked at, or changed.”
