Graham Prestwich: Patients as Project Managers

Graham Prestwich is a lay member of the Improvement Academy’s Expert Advisory Group for Medicines Safety and a strong local and regional advocate for the patient voice in commissioning and clinical decision making. Graham outlines the role of patients as project managers below.

We are seeking motivated and determined project managers with a keen interest in health and wellbeing to join our professional team of doctors, nurses and pharmacists to improve the health and wellbeing of our population. You will be working on a voluntary basis, and there is some support available if you can find it. You will need to devote some time each day to the job, occasionally this may involve travel, though this is usually fairly local. We do not pay travel expenses though assistance with transport is occasionally possible. You will be expected to organise and complete various activities in a timely manner and ensure that you attend meetings for reviews and feedback.

There is no management accountability structure though you may find it helpful to organise and involve local resources such as family, neighbours and friends. A substantial part of your job will involve liaison with the NHS and organising various activities and services to support the delivery of your project. The job title is Patient and we currently have 1000s of vacancies. No need to formally apply, just start when you are given a prescription and see how you get on. Recruitment is open until further notice.

When a person is diagnosed with a long term condition and handed a prescription by their doctor, the reality is that this is also a formal request to apply for the important management job of Patient.

Is it a coincidence that the better project managers get the best results? I suspect not. As our Health and Social Care systems are striving to work more closely together to achieve improvements in health and wellbeing for the whole of our local populations, it prompts the question, “what else do they need to do in order to successfully improve health and wellbeing outcomes and reduce inequalities?”

To achieve a good health outcome for the whole population there are a number of widely recognised and critically important activities that need to take place. These include:

  • Timely patient presentation and accurate diagnosis
  •  Effective and affordable treatment consistently accessible to everyone
  •  Timely ongoing treatment maintenance and reviews
  • Access to the right urgent care services at the right time based on need
  •  Patients adjusting their lifestyle to optimise the effect of interventions

The list is not complete but serves to illustrate that at each point in health and care service provision the patient can have a significant positive or negative effect on the health and wellbeing outcomes. This ranges from presenting early and accurately describing symptoms, right through to seeking appropriate and timely help in an emergency. The list of critically important activities shows why being a good project manager makes all the difference. The list also shows why the patient has to project manage a diverse and seemingly independent set of actions that only when effectively coordinated lead to a good outcome.

That is all well and good if you are a competent, motivated and dedicated project manager, but what about all those people who do not have the skills, knowledge, experience or the desire? A poorly managed project fails to deliver, it does not achieve the goals and it usually means additional and expensive resources and effort being made by others, often at short notice, and often too late to rescue the project delivery ……sound familiar?

It is reasonable to conclude therefore, that the scope for considerable improvement in population health and wellbeing is supporting those with the greatest need to become more capable project managers and to help them develop a genuine interest in improving their own health and wellbeing.

If we are in broad agreement that project management skills are a significant part of the solution, looking to doctors, nurses and pharmacists for large scale training and coaching solutions in managing projects is not really working to the current skills and strengths of the NHS. It indicates that additional skills and capability are needed in the primary care environment in order to have the biggest impact on reducing health and wellbeing inequalities. That additional coaching capability will enable those with the greatest need to get the support and encouragement they require to more effectively manage their own health and wellbeing project.

If this approach is applied to prescribed medicines, it enables appropriate support, coaching and encouragement to be focussed on an individual and their unique needs and priorities, developing a truly patient centred approach to the effective and safe use of medicines.

Support, coaching and encouragement, where does all this come from? Who pays, who does it, who enables it, who measures the impact and outcomes?

For those patients who have the basic skills and desire, it is for everyone who comes into contact with that person to recognise that the patient is in charge. Everyone else has a part to play and a contribution to make and that includes friends, family and carers. So health professionals and friends and family need to acknowledge who the project manager is, and listen to them, support them and communicate with them.
All those who struggle to deal with this challenging management role require help; the dedicated time of someone who understands the situation, someone who understands behaviour change, someone who is a skilled coach, and someone who can win the hearts and trust of people with complex needs. These people are all around us and don’t usually realise how good they are and valuable they could be. These are the generous, warm, supportive and caring people we meet every day, people who derive genuine satisfaction from preventing problems rather dealing with problems.

What therefore must happen for this approach to work?

  1.  Recruit health and wellbeing management coaches into primary care
  2. Whole system working to achieve agreed goal(s) for each individual
  3.  Access to timely and effective services that help prevent problems
  4.  Identify those with the greatest need and ensure they experience skilled coaching and support to help them become better project managers.

How it happens is through effective and authentic patient involvement, working with people to understand their problems and issues, to design a solution together and review the outcomes and achievements to reinforce the positive. Then do it all even better next time round. Recent developments in the design and implementation of a social prescription approach demonstrates the interest and willingness to move in this direction.

So the next time you write a prescription for a patient, or hand them a paper bag with their name and address on the label, ask yourself the question, “what additional skills, knowledge and understanding does this patient need to effectively manage this project and who is going to provide that coaching?”

Graham Prestwich


For more information on Medicines Optimisation please click here.

For more information on Patient & Public Engagement (PPE) support, please click here.