The Patient Based Care Challenge – How can I really make it happen? >

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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?

CASE STUDIES

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 – 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 Int J Quality in Healthcare Vol 23(5):

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 Circulation American Heart Association Lee et al Crit Care Med Vol. 35, No. 2 Kleinpell 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 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 Int J Quality in Healthcare Vol 23(5):

Sustainability Embedding strategies within policies & processes Identifying to staff benefits gained by both staff and patients Committed leadership continually promotes improvements *Luxford et.al Int J Quality in Healthcare Vol 23(5):

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)

Uptake by Local Health Districts

Consumers and/or carers participate in the evaluation of patient feedback data (S2.9)

Tea Break