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Clinical Services Redesign Program Improving the patient and carer experience.

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Presentation on theme: "Clinical Services Redesign Program Improving the patient and carer experience."— Presentation transcript:

1 Clinical Services Redesign Program Improving the patient and carer experience

2 Clinical Services Redesign Program Patients take journeys through the health care system. They involve a series of steps in the delivery of health care. These steps should be predictable, with decision points along the way The journey may be short with a few steps. For people with chronic illness, the journey may take a lifetime with continuous stops along the way. Patient Journey

3 Clinical Services Redesign Program Patient and Carer Experience patient + carer perspective of journey shaped by information; the way it is given what they see, feel, hear all affects their choices includes “gaps” between clinical care different from patient satisfaction

4 Clinical Services Redesign Program 3 reasons why it matters 1. NSW State Health Plan Strategic Direction 2 CREATE BETTER EXPERIENCES FOR PEOPLE USING THE HEALTH SYSTEM

5 Clinical Services Redesign Program 2. CSRP Objective Deliver better patient journeys by improving Access Safety Patient and carer experience

6 Clinical Services Redesign Program CSRP Work Orders "How the Proposed Project will understand and improve patient and carer experiences"

7 Clinical Services Redesign Program 3. Because you care VEM High Level Stakeholder Study Consumer Involvement Audit

8 Clinical Services Redesign Program Patient experience – isn’t that just customer service??

9 Clinical Services Redesign Program Basis of good customer service Who are your customers? What do they value? What types of value give a competitive edge?

10 Clinical Services Redesign Program Which partner said this? Governments are at a critical juncture for service success. Leading executives recognize they have “reached the limit” with their current approaches to customer service. They are re-assessing and re-crafting their customer service strategies, not just to satisfy citizens, but also to create lasting value. They are also veering away from a “best practice,” one-size-fits-all template—and putting the “custom” back in government customer service.

11 Clinical Services Redesign Program Today’s purpose To learn how to Really understand patient and carer experience Monitor change in patient and carer experience

12 Clinical Services Redesign Program What is the “carer”? person who supports the patient on their health care journey. involved in decision making has information about patient and their journey may or may not be “carer” when patient is back home

13 Clinical Services Redesign Program What do patients and carers value? 1.Access to Care 2.Respect for Patients values, preferences, and expressed needs 3.Coordination and integration of care 4.Information and education 5.Transition and continuity 6.Physical comfort 7.Emotional support and alleviation of fear and anxiety 8.Involvement of family and friends

14 Clinical Services Redesign Program When we redesign patient journeys, we can embed systems and processes that contribute to better patient and carer experiences.

15 Clinical Services Redesign Program In your project Have you talked to patients and carers to identify opportunities for improving the patient and carer experience? How will you know if you achieve this?

16 Clinical Services Redesign Program After morning tea What method are you using to understand/measure patient and carer experience? What do you see as the pros and cons of this method?

17 Clinical Services Redesign Program What we need for clinical redesign Data – something we can measure and compare results over time “Juice” – detailed insights into what is not working from patient and carer perspective. Information that informs practical solutions

18 Clinical Services Redesign Program Measuring Patient Experience Richness of detail for CRU projects (juice) Data, results comparable over time

19 Clinical Services Redesign Program Patient Experience Measures Richness of detail for CRU projects (juice) Patient story Good insight into patient experience but how valid is this story? Data, results comparable over time

20 Clinical Services Redesign Program Data, results comparable over time Richness of detail for CRU projects (juice) Recognised tool. Annual data can be compared across AHSs and internationally. Great for the dashboard. Not much “juice” for Clinical Redesign and not regular enough for project evaluation. Patient Satisfaction survey

21 Clinical Services Redesign Program Richness of detail for CRU projects (juice) Patient story Patient Satisfaction survey CRU tool delivers data and juice suitable for redesign projects Use Picker categories to align these tools Data, results comparable over time

22 Clinical Services Redesign Program An example

23 Clinical Services Redesign Program Patient Experience of Waiting Patient and Carer’s Perception of timeliness of care Overall the perception of timeliness of care received is good, with the majority of respondents ranking timeliness of care as good or better. Waiting room patients/ carers are markedly less positive in their perception of the timeliness of their care than that of the observation area patients Have you been waiting too long? Again, the majority of patients, overall, do not feel they have been waiting too long for treatment. Waiting room patients are more likely to feel they have been made to wait too long for treatment. Overall, patient and carer satisfaction survey results are encouraging with the majority of respondents reporting a positive experience. However, when there is a breakdown between waiting room and observation area respondents a clear distinction becomes apparent between the two groups in the perception of care, with the waiting room respondents far less than satisfied with the timeliness of care and level of communication causing more negative emotions.

24 Clinical Services Redesign Program Feelings generated by waiting. Although there was a proportion of Observation area respondents who felt they were waiting too long for treatment, waiting room patients/ carers are the only respondents to express anger at waiting for care. How well have we communicated with you about what is happening in your stay? Waiting room patients/ carers were far less satisfied with the level of communication received. Waiting room respondents the only ones to report poor communication. Patient Experience of Waiting Actions taken from these survey results include - An awareness and education program highlighting the need for ongoing and regular communication with patients and carers located in the ED Waiting Room. Continuing work by the triage Working party to address these issues. Identification and training of nurses ready for the CIN role. Further to these actions, it is anticipated that the recent appointed Advanced Practice Nurse should help to address the issue of prolonged waits for low, clinical priority patients.

25 Clinical Services Redesign Program Fast Access to reliable health care Attention to Physical + Environmental Needs Clare says she is used to waiting hours, sometimes days in the ED for a psychiatric registrar to arrive. All that time under fluorescent lights – she says you never know if it’s night or day…. Clare once spent 6 days in a hospital ED waiting for a bed. (Clare – Mental Health)

26 Clinical Services Redesign Program How do we understand and improve patient and carer experience? For each journey being redesigned: 1.At the beginning, ask patients and carers about their experience 2.Analyse areas for improvement 3.Respond with solutions that will improve patient and carer experience* 4.Re-evaluate post-implementation by asking a new group of patients and carers

27 Clinical Services Redesign Program Morning tea

28 Clinical Services Redesign Program CRU trial method for measuring patient and carer experience

29 Clinical Services Redesign Program The CSRP method Focuses on patient experience, not satisfaction Qualitative method (discourse analysis, background narrative enquiry) Requires skilful facilitation Delivers “juice” and data for Clinical Redesign Projects

30 Clinical Services Redesign Program Based on….. Learnings from… Picker Institute VEM CSRP Evaluation tool Literature PLUS Common sense Commitment to practical, achievable method for CSRP

31 Clinical Services Redesign Program Step by step 1.Identify and invite individual patients and carers to a discussion 2.Set up discussions 3.Facilitate the discussions 4.Record and analyse insights 5.Present the results 6.Use the knowledge: design solutions 7.Remeasure to see what’s changed

32 Clinical Services Redesign Program Method Not compulsory Trial by willing CRUs Aug-Dec 2006 Support, knowledge sharing and resources provided by CSRP

33 Clinical Services Redesign Program

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35 Lunch break

36 Clinical Services Redesign Program Remember our motivation: to understand and improve patient and carer experience

37 Clinical Services Redesign Program Step by step 1.Identify and invite individual patients and carers to a discussion 2.Set up discussions 3.Facilitate the discussions 4.Record and analyse insights 5.Present the results 6.Use the knowledge: design solutions 7.Remeasure to see what’s changed

38 Clinical Services Redesign Program Step 1 Identify and invite individual patients and carers to participate

39 Clinical Services Redesign Program Step 1: Invite patients and carers Define target population Invite them to take part How many to interview? Avoiding bias

40 Clinical Services Redesign Program Step 2 Set up the discussions

41 Clinical Services Redesign Program Step 2: Set up the interviews Where to interview Who should interview How long will it take?

42 Clinical Services Redesign Program Step 3 Facilitate the discussions

43 Clinical Services Redesign Program Step 3: Facilitate the discussions Introductions Skilful listening and questioning Identifying “best” and “worst” aspects of experience Ending the discussion Consent form Note: CSRP has a workshop available to practice these skills

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46 Step 4 Record and analyse insights of patients and carers

47 Clinical Services Redesign Program Step 4: Record and analyse the insights of patients and carers Enter your notes from discussion record into webform on archi and receive summary Enter data into MS excel spreadsheet

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50 Step 5 Present the results

51 Clinical Services Redesign Program Step 5: Presenting the results Data – graphs of top issues Analyse what improvements patients and carers would value most, and what is already working well “Juice” – constructive comments that point to practical solutions

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55 Clear comprehensive information "They gave me lots of printed information about what I considered the less important stuff, and not enough about the risks of the procedure. I received nothing written about the risks. The surgeon rattled off a set of risks as fast as you can speak and in a monotone. I pulled out my notebook and started writing down notes and asking questions. It wasn't all clear and I had to clarify the risks. I'd like to see the percentage of each risk that was given to me verbally written down. The psychologist actually asked me if I knew the percentage of risk of death from this procedure - if I hadn't written it down, I wouldn't have remembered. Violet – elective surgery

56 Clinical Services Redesign Program Clear comprehensive information I could not fault my care and treatment from all providers….but after moving from the Critical Care Unit to the step-down ward, communications and getting information about my condition and progress became more and more difficult (Alex – Cardiac Care)

57 Clinical Services Redesign Program Continuity of care + smooth transitions Each doctor was focused on his or her bit of Terry, sometimes to his detriment. The neurosurgeon had apparently said that Terry could start to move about (although no one came and told Terry or Ros that for some time). The orthopaedic surgeon said that Terry shouldn’t move because of his pelvis. Staff could not clarify the situation until the orthopaedic surgeon came to look at the x-rays. It took a week for him to come and look at the x-rays. (Terry: Critical Care, as told by mother Ros)

58 Clinical Services Redesign Program Fast Access to reliable health care Attention to Physical + Environmental Needs Clare says she is used to waiting hours, sometimes days in the ED for a psychiatric registrar to arrive. All that time under fluorescent lights – she says you never know if it’s night or day…. Clare once spent 6 days in a hospital ED waiting for a bed. (Clare – Mental Health)

59 Clinical Services Redesign Program Step 6 Use the knowledge to improve patient and carer experience

60 Clinical Services Redesign Program Step 6: Using the knowledge to improve patient and carer experience Any other data sources? Target the top problems Use “juice” to design solutions Discuss your solutions with other patients + carers before and during implementation Who else needs to know what you found?

61 Clinical Services Redesign Program Step 7 Re-measure to see if your solutions worked

62 Clinical Services Redesign Program Step 7: Remeasure to see if your solutions worked Immediately after implementation Then periodically, to see if your solutions “stick”

63 Clinical Services Redesign Program Our commitment CSRP will support you with Tools and resources – archi.net.au Practical coaching – Jane and Karen Discussion group on archi - sharing knowledge and lessons learned Practical training on facilitating discussions Sharing knowledge and lessons learned

64 Clinical Services Redesign Program

65 What next? 1.Is this method practical and do you think it will help you improve patient and carer experience? 2.Are you prepared to try it in your current/next project – and help perfect the method?


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