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In a previous post we forshadowed an open-source GP-based collaborative lifestyle project for patients to improve their fitness and lose weight.

Thanks for all the feedback I have received.

The project is based on what we have learned about system change.
Improvements are best made in incremental steps, measuring as we go to make sure that change is an improvement.

We aim to make it easier for us to help our patients improve their lifestyle in a sustainable way.

The project will use all the skills we have in our practice teams – doctors, practice nurses, receptionists, practice managers, exercise physiologists, dietitians and diabetic educators.

We had a tentative title of ‘FancyName’. The current leading contender for a new title is …………

“The stepUp program”
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It is envisaged that it will work something like this. (remember this is an ‘alpha’ work in progress and the final outcome will depend on your contributions and suggestions)

A patient presents to you, their GP, requesting advice about health, or fitness, or weight loss.
“Ah ha”, you say, “you’ve come to the right place. I can enroll you in our ‘stepUp’ program.

You outline the program to them. You tell them to ask the desk to make an appointment to see Leanne (your nurse) about the stepUp program.
You say “Take this *stepUp card* with you, have a read, fill in the form attached and bring it with you when you come to see her.
Don’t worry, step by step we’ll get you in good shape”.

The program then is systematic. Each week (?fortnight ?month) the stepUp enrollee comes and sees a member of your team for their new personalised *stepUp card*

Each *stepUp card* has one change in each of three categories that they are to make for that period – “Eat Better, Do More, Think Healthily”

ie One change will be dietary – “Eat Better”(eg This week, substitute wholegrain bread for white bread. Wholegrain bread has a low Gi etc etc)
One change will be activity – “Do More” (eh This week, wear your pedometer gain and increase your steps each day by 1000 from your readings last week)
One change will be in healthy thinking “Think healthily” (eg This week, think of a person that you know who is always fit and healthy. Imagine what they would do in any circumstance and what they would eat during the course of the day”)

Patients will continue on the program for as long as it takes (and as many ideas as we can all come up with), making just three small changes each time.

The program will learn as it goes – patients will evaluate each card at the end of the week. make suggestions, and the activities associated with that card will be improved.

There will be a stepUp wiki (like wikipedia) where practices can add their own ideas for stepUps, or adapt/improve/extend other’s suggestions.
You will then be able to download a set of *stepUp cards* and instructions to make a systematic lifestyle medicine program in your practice.

The *stepUp* program will be ‘open source’, which means that it will be owned by all of us to use at no charge.

You’ll be able to start contributing your ideas ‘real soon now’ (within the week) at <http://practiceimprovement.com.au>

I look forward to your suggestions.

Happy Christmas,