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
Define criteria
and standards
Identify
Changes
DESMOND
Quality
Development
Cycle
Assess
performance
against criteria
and standards
Data
Collection
Define criteria
and standards
Identify
Changes
DESMOND
Quality
Development
Cycle
Assess
performance
against criteria
and standards
Data
Collection
Criteria
Criteria and Standards
Define criteria
and standards
Identify
Changes
DESMOND
Quality
Development
Cycle
Assess
performance
against criteria
and standards
Data
Collection
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....