Engaging patients & carers “Patients and carers as active partners”
Source: Patient Experience Leadership Survey, HealthLeaders Media, October 2010
Leaders making patient based care a top priority Survey of over 300 US healthcare leaders 80% strongly agree that patient experience is a business imperative as important as clinical quality 71% rated patient experience as more of a priority this year than last year 82% provide employee training with an increased focus on patient experience Top ranking motivation? “producing better quality outcomes” (Health Leaders M edia Survey, Oct 2010)
Leaders making patient based care a top priority 21% of health leaders in USA (n=332) responded that patient experience is the responsibility of the CEO (up from 14% in 2011). 84% of leaders placed patient experience in their top 3 priorities. Health Leaders Media – Patient Experience and H-CAHPS (Aug 2012)
Committed senior leadership “The mission to improve patient care experience in most leading organizations arose from the Board or CEO, with senior clinicians also in strong support.”
Engaging staff - Organisational story telling Skill of effective leaders Useful to drive change How to re-engage with original values? History of narrative in medicine & nursing Atul Gawande
Sharing a patient-based vision Illustrate your values in your personal story Gain staff commitment (beyond a ‘control’ culture) Access discretionary effort by staff Reconnecting staff with ‘original values’ Why did you start to work in health care?
Medical College of Georgia Case Study 632 bed tertiary medical centre 22,000 admissions per year; 455,000 outpatients Breast cancer unit redesigned by patients. Moved ratings from 40 th to 74 th percentile in a few years Neuro ICU renovated (USD$1m). Introduced 24/7 visits. Moved ratings from 10 th to 95 th percentile in 5yrs. Cut LOS by 50%. CEO “saw business case” MCG Health overall staff vacancy rate fell from 8% to 0%. Now have long waiting list 2011+ – planning for new cancer centre with patient input into design
“Success feeds on success” staff satisfaction staff retention rates market share mortality LOS preventable harm
“When [the CEO] first came, he really tagged the phrase, “Patients first.” You’ll hear employees talk about that all the time. That really focused the organization – remember, that’s why we here. It’s not about the nurses, or the physicians. It’s about the patients.” (Chief Nursing Officer) *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
What makes a difference? Leading the change – strategic priority Being transparent -public reporting Gaining a better understanding of the patient experience Improved communication (with patients and between staff) Everyone is a caregiver! The cleaner and the neurosurgeon
How do you demonstrate that families and carers are welcome members of the ‘care team’?
Open visitation? Open Visitation is positively associated with: Decreased septic complications Decreased cardiovascular complications Reducing emotional distress and anxiety Decreased stress hormonal profile Lower mortality rates Fumagalli et al. 2005. Circulation American Heart Association Lee et al. 2007. Crit Care Med Vol. 35, No. 2 Kleinpell. 2008. Crit Care Med Vol. 36, No. 1
Why open visitation? Family and friends visiting decreases patient stress (whilst staff visits often do the opposite) Provides support without ‘getting in the way’ does not negatively affect performance of clinicians (Bauchner et al, 1996). Range of models: Unrestricted visiting hours ‘Care Partner’ US Exemplars
US Presidential Memorandum on Hospital Visitation (2010) “..addresses the right of a patient to choose who may and may not visit him or her. The President pointed out the plight of individuals who are denied the comfort of a loved one, whether a family member or a close friend, at their side during a time of pain or anxiety after they are admitted to a hospital. “
Where to start.. Evidence Gap analysis Facilities Existing policies Engage consumer advisors LHD / local executive sponsor Local clinical champions Patient / Family views
S Frampton Griffin Hospital’s Quality Outcomes Recognized for providing superior patient care defined by exceptional clinical outcomes in the top 1% of all hospitals in the United States.
Source: The Commonwealth Fund’s WhyNottheBest.org Data accessed 11.01.10 S Frampton Designated Sites Demonstrate Improved Outcomes Medicare Core Clinical Measures Comparison of U.S. Planetree Designated Hospital Average and CMS National Average January 2009-December 2009
Internal organizational ethos Branding the organization Personal motivation (‘aha’ moment) “Why?... Because it’s just better healthcare” (CEO) Motivation *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
Sustainability Embedding strategies within policies & processes Identifying to staff benefits gained by both staff and patients Committed leadership continually promotes improvements *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
Experience Economy: Disney does not provide a service. They provide an "experience.” “Hospitals would do well to emulate the most vital things that earn Disney the love of their guest and employees.”
Taking it to the next level “We need to think of the patient and their family as integral members of the healthcare team. Once you’ve 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
Staff training – capacity building (S2.6) Planetree retreat Frampton S
Informing consumers about the organization’s S&Q performance (S2.7)
The Challenge for health services Recent survey of over 3500 hospital/health senior executives across Australia. From the survey, 39.2% of the respondents said that Partnering with Consumers is by far the most challenging aspect of the NSQHS standards. Partnering with Consumers Survey respondents: public 75.3%, private 24.7%. Source: Criterion
Models for Consumer Partnerships Patients as Advisors (PFAC, etc) Patients as Teachers (service design & professional education) Patients Accelerating Practice Change Service improvement initiatives with priorities identified through patient feedback Patients informing Policy development
Consumer partnerships Determine attributes: ‘fit for the job’ Aim to improve patient care through positive contribution Objective and constructive manner Willing to speak up -in the right place in their journey Adequately prepared – orientation;expectations Cultural fit – organisation/committee believes consumer involvement is integral to QI Responsive: suggestions acted upon
Power of the n=1 Using individual patient stories to drive change Political tactic Powerful tool for engendering emotion Use to complement clinical focus
Challenges? Squeaky wheel syndrome Advocacy Vs sharing experience Supporting ‘seat at the table’ Which ‘consumers’ have the time?
Which core action item in Standard 2 had the highest ‘Not Met’ rate?.... 2.2.2 Consumers actively involved in decision making about safety & quality 49% - Highest ‘not met’ rate in ACHS pilot audit of standards with 46 hospitals
Building partnerships ‘Fear of the unknown’ by providers is the greatest barrier to involving patients in safety improvement work Robert Wood Johnson Foundation
Consumer engagement in Safety & Quality (at CEC) (S2.2) “The consumer tends to see the problem and solution so much more simply and they ask reasonable questions – whereas the healthcare professional tends to drown in the complexity / what cannot be done” “Helps to focus a clinical group on the purpose of initiatives”
Perceived Role of CEC Consumer Advisors in Safety & Quality
Access to orientation and training for consumers (S2.3) Consumer Safety & Quality Training – open to LHD Consumers on S&Q Committees since 2012
Caregivers and patients co-creating a shared agenda for improvement Strategies for scaling up consumer engagement: o Focus Groups with patients, families, staff, etc. o Patient and Family Advisory Councils o Patient engagement on safety, quality and other organizational committees o Patient participation in hiring and evaluation o Patients as faculty o Patients to develop/act in simulations for staff training
Culture Assessment: Listening to the voices of patients, families and caregivers PersonalizeHumanizeDemystify
The ‘generic’ patient? About 60% of Australians (15-74yrs) have limited health literacy* 1 in 3 NSW residents were born overseas 1 in 4 speak a language other than English at home *2006 Adult Literacy and Life Skills Survey, ABS
Consumer feedback on patient information publications (S2.4) What is your health services policy on health literacy? How are you assessing and breaking down barriers for patients?
How are you addressing health literacy barriers?
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