Utilizing Indicator Management to Deepen the Culture of Shared Decision-Making in Healthcare Settings

Introduction:

We aim to create an atmosphere of shared decision-making through regularization and standardization, and to popularize shared decision-making techniques. We use index-based management, individual team counseling, and walk-around management techniques to help solve on-site implementation problems, and we make good use of largescale hospital-wide meetings and information to guide the public, to raise the importance of medical staff and the public,

and to cultivate a culture of shared decision-making implementation.

We analyze the current situation, troubleshoot problems, and work with surrounding resources, such as the Medical Council, peer hospitals, and hospital-wide e-learning courses, in order to develop and cultivate a culture of shared decision-making strategies.

METHOD:

Since 2020, we have intervened in the application of the medical and patient shared decision-making information platform, and have moved from manual paper collection to information-based indicator management. We can assist physicians in opening SDM medical orders through information, and QR codes can be used to assist in decisionmaking by providing text guides and video guides, while patients or their families can fill in decision-making images online and assist in the standardization of the medical record process.Under the leadership of the hospital director, a hospital-wide implementation announcement is made at the beginning of each year, with the goal of promoting the rate of activation of specialty SDM medical wills and the rate of correct implementation of specialty SDM, and monthly results are summarized and announced. We provide feedback to physicians to facilitate communication, and through the process of supervisor support and hospital-wide consensus, we continue to collect implementation issues for information process optimization, including:

1.SDM Execution Processes and Information Operations,

2. Wills System：Keyword Module Information to Assist Doctors in Making Medical Orders

3.Add a video paramedic guide

4.Successful Case Sharing and Announcement

5.Monthly Indicator Tracking

RESULTS:

1. 27 specialties and 99 decision aid topics are in clinical use across the hospital through December 2023.

2. The number of SDM activations (including will opening and navigation) in all specialties will increase annually from 415 in 2019 to 6103 in 2023.

3. The number of correct SDM cases (including the opening of medical wills, guidance, and completion of decisionmaking questionnaires) in all hospitals will increase year by year, from 2004 in 2021 to 2966 in 2023.

4. Collection and analysis of the evaluation of the effectiveness of public participation: The percentage of "not sure,can't decide" decreased by 4.6% (105/2302) before and after the intervention of doctor-patient sharing decision-making,and the options of "very much and quite a lot" of the "degree of anxiety" both decreased significantly. 5.6% (130/2302)

5.To be awarded the national level Practice Excellence Award in the category of Healthcare and Disease Sharing Decision Making Organisations for five years, including 2018~2021 and 2023.

CONCLUSIONS：

Satisfaction rate of the options collected and analyzed by the public participation in the effectiveness evaluation; among them, "10. Help you identify what you want to ask your doctor?" was the highest at 91.7%, "1.Prepared you to talk to your doctor about what you care about most? and "2. Prepare you for follow-up with your doctor?80% was the lowest.

After interviewing the medical staff, the feedback from the first time the medical staff guided the patients was mainly from the elderly, who mostly responded that "the doctor's decision is fine" or "my family is not here, so I have to explain to my family again".

In the future, we will focus on the promotion of shared decision-making between doctors and patients in order to increase the atmosphere of good.