Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

Case studies of applying the personalised, patient-centred Realistic Medicine approach across Scotland.

Healthcare Improvement Scotland (HIS)

Initial thoughts

Healthcare Improvement Scotland has welcomed Realistic Medicine and will play a key role in the Realisation of this philosophy nationwide in the coming years.

What have we done so far?

HIS engaged with Realistic Medicine early and this influenced the development of strategic planning - identifying multiple commitments towards Realistic Medicine from HIS.

HIS will emphasise the value of the wider concept and key messages for health and care professionals in our work. We will continue to support the building of QI skills' capacity and capability through our work with NES including the Scottish Quality and Safety Fellowships, the Scottish Clinical Leadership Fellowships and other developments.

Our expertise in quality control, external assessment, accreditation, audit and inspection as 'tools for improvement' cannot be understated and can be related to Realistic Medicine. We consider that the focus on 'habits of an improver' offers opportunity to ensure that all three elements of Juran's trilogy.

With the advent of Quality of Care Reviews we are actively involving doctors at all levels in the design and operation of the quality framework and the future delivery of reviews.

A number of the challenges set out in Realistic Medicine relate to clinical guidelines. These challenges are recognised and are being explored and considered by organisations including the Scottish Intercollegiate Guidelines Network ( SIGN). All of our evidence programmes actively involve patients and public partners and we ensure that shared decision making is at the centre of our designing of these programmes. We produce products specifically to support the shared decision making discussions to take place and these have been amended in the light of the findings of the EU funded DECIDE project (

Our work programmes around palliative care, safe use of systemic anticancer drugs, the Area Drugs and Therapeutic Committees ( ADTCs) Network and other related areas aim to reduce variation, reduce harm and support decision making around risk. Our contribution via the Scottish Medicines Consortium around the clinical and cost effectiveness of new medicines in Scotland and new procedures or non-drug interventions via the Scottish Health Technologies Group ( SHTG) continue to actively involve patients and the public.

Nearly all of the HIS Improvement Hub (ihub) programmes contribute to the realisation of the vision set out in Realistic Medicine specifically via the Scottish Patient Safety Programmes and support for the Scottish Quality and Safety Fellowship.

What next?

The potential effects of Realistic Medicine will be difficult to measure and HIS would be interested in working with Scottish Government to develop a measurement framework around Realistic Medicine. We will work to further explore the development and use of guidelines and related products in the era of Realistic Medicine in support of better informed and shared decision making.

Our new improvement programme, Effective Care Programme ( ECaP), which has been heavily informed by Realistic Medicine. ECaP has been commissioned by the NHS Board Chief Executives and is designed with a primary focus on supporting the reliable implementation of agreed standards of care in segments of pathways where there is evidence of high levels of unwarranted variation that, if addressed, would improve outcomes and reduce costs. It delivers these aims through an approach that is inclusive of a focus on outcomes, a shift to shared decision making and an understanding that unwarranted variation includes delivery of interventions that individual patients would not have chosen had they been fully informed on the balance of risks versus benefit, supporting a step change in the use of data and evidence to drive improvement. ECaP offers a vehicle for studying and reducing variation, improving care and reducing cost and we are working closely with SAMD and territorial health boards to put ECaP into practice.

Final thoughts

We see Realistic Medicine more as a thread that runs through all work to improve and change care and is constantly referenced, rather than a stand-alone concept. As a paradigm shift it should enable a focus on programmes that are already going on that fulfil its objectives and lead to re-prioritisation.


Email: Catherine Calderwood

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