What do patients value in care? Being treated with dignity and respect Having confidence & trust in providers Courtesy & availability of staff Continuity & transitions Coordination of care Pain management & physical comfort Respect for preferences Emotional support Joffe et al. (2003) J Med Ethics Jenkinson et al. (2002) Qual Saf Health Care
I couldnt have faulted the technical care but...
What affects quality in health care? The level of quality in hospital environments is affected by: (1) the quality of technical care; (2) the quality of interpersonal relationships; (3) the quality of hospital amenities and the environment (Potter et. al, 1994. Int J of Health Care Qual Assur, Vol 7, pp.4–29).
Leading with words & actions We need to think of the patient and their family as integral members of the healthcare team. Once youve gotten mileage out of your systems, then the next level of improvement you can only do by engaging the patient Professor Tom Delbanco, Inaugural Chair, Picker Institute, BIDMC Physician, Boston Harvard Medical School
Benefits of Patient Based Care Refocusing care delivery around the patient Improves patient care experience.... Improves clinical and operational-level outcomes: improved patient adherence fewer medication errors decreased adverse events improved staff satisfaction enhanced staff recruitment decreased length of stay decreased ED return visits And the bottom line.
High performing organizations Hospitals with high levels of patient care experience reported by patients provide clinical care that is higher in quality across a range of conditions. Jha A et al (2008) N Engl J Med 2008; 359:1921-1931.
Impact on the hard stuff... Patient Based Care links to improved safety: Decreased mortality 1 Decreased rates of hospital-acquired infection 2 Decreased surgical complications 3 Higher quality clinical care/best practice 4 Improved patient functional status 2 1.Meterko M et al (2010) Health Services Research 2.DiGioia A M et al (2008) Agency for Health Care Research and Quality 3.Murff et al (2006) Qual Saf Health Care 4.Jha A et al (2008) New England Journal of Medicine
What do > patients say? X% inpatients rated overall care excellent (NSW av. 34%); Y% poor-to-fair X% inpatients rated staff team work excellent (NSW av. Y%) X% inpatients reported that they were always treated with dignity and respect* (NSW av. 81%) – NB: a main influencing factor for poor care X% inpatients rated room cleanliness as excellent (NSW av. 25%) (Bureau Health Information – Insights into Care, 2009)
What do we know about who our patients are? XX% born overseas (from….??) YY% speak English as their first language X% non-English speaking background (which languages…..??) Y% indigenous population What do we know about Australians? 60% have low health literacy
Patient feedback as a predictor... Safety: patient feedback about hospital cleanliness is a positive predictor: for staff participation in activities like hand- washing for MRSA infection levels Catheter-related bloodstream infections occur 56% more frequently in hospitals with low ratings for nurse or doctor communication Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354 Edgcumbe - (2008) J. Hosp. Infection Reed K. (2012) Health Grades Patient Safety and Satisfaction
Clinical unit level – frequency of patient involvement (CEC Quality System Assessment - NSW)
Walk in My Shoes: Patient Story Introduced by > >
The importance of learning from patient experience
Communication skills Before we talk about patient-focused techniques.......... Who would like to volunteer to talk to...? Role play: Mrs Schulz (32) presented to ED with pain on the right side of hip following a fall. X-ray attended, confirming a right hip fracture. Otherwise healthy, former gymnast. Plan: Analgesia for pain. Surgery to repair hip.
ISBAR – communicating about a patient with peers Introduction Situation Background Assessment Recommendation
Communicating with a patient Acknowledge the patient – ask them how they would like to be referred to? (Mr/Mrs/First name etc) Introduce yourself and explain your role Discuss plans: procedure/process/wait Explain what will happen/any risks/ questions? Tell me what is important to you today as the patient?
Teach back What is this technique? Discuss next steps with patient and then invite them to convey back to you in their own words what they will do. Inform you about what has been understood and taken on board E.g. Medication safety/discharge
Armed with new patient- focused skills? Part 2 – Would anyone like to volunteer? Role play: Mrs Schulz (32) presented to ED with pain on the right side of hip following a fall. X-ray attended, confirming a right hip fracture. Otherwise healthy, former gymnast. Plan: Analgesia for pain. Surgery to repair hip.
Relationship-based care: the quality of interpersonal relationships
Caring for the Care Givers Satisfied Staff, Satisfied Patients Work place culture Visibly celebrate successes Develop skills to build your own capacity as a health care professional
What do patients & family expect when things go wrong? Shared dialogue about what went wrong (two way communication; value own account of events) More follow-up support Input into when time is right for closure More information about subsequent improvements