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“I couldn’t have faulted the technical care but...”

Patient Based Care Model

Overall Views of Health Care System, 2010 Percent AUSCANFRGER NET H NZNORSWESWIZUKUS Only minor changes needed Fundamental changes needed Rebuild completely Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

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, Int J of Health Care Qual Assur, Vol 7, pp.4–29).

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:

The evidence Improved patient experience is positively associated with: Objectively measured health outcomes Adherence to medications and treatments Health resource usage Technical quality of care & adverse events Doyle C et al BMJ Open Jan 20, 2013

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.

Organizational outcomes Business-case for Patient Based Care: Decreased malpractice claims Higher employee retention rates Decreased readmission rates Reduced operating costs Charmel PA, Frampton SB. Building the business case for patient-centred Care. Healthcare Financial Management 2008;March 1-6.

“The three dimensions of quality should be looked at as group and not in isolation.” “Clinicians should resist sidelining patient experience as too subjective or mood- orientated, divorced from the ‘real’ clinical work of measuring safety & effectiveness.” Doyle C et al BMJ Open Jan 20, 2013

Leaders in patient based care* Organisational characteristics: Strong committed senior leadership Communication of strategic vision Engagement of patient and families Sustained focus on staff satisfaction Regular measurement and feedback reporting Adequate resourcing of care delivery change Staff capacity building Accountability and incentives Culture strongly supportive of change and learning *Luxford et.al Int J Quality in Healthcare Vol 23(5):

Leadership commitment  Start each Board meeting with a story of patient care from your service  Arrange for board and executive members to visit wards to regularly talk with staff and patients  Involve patient advisors in strategic planning process  Demonstrate leadership commitment – communicate a patient-focussed mission to new staff at orientation

Lessons learnt – Inquiries.... Mid Staffordshire, UK Need for a common culture of ‘putting patients first’ “Every single person serving patients needs to contribute to a safe, committed and compassionate and caring service” Need for strong, patient centred healthcare leadership

Listening to patient feedback – use to drive change.... Catheter-related bloodstream infections occur 56% more frequently in hospitals with low patient ratings for nurse or doctor communication Reed K. (2012) Health Grades Patient Safety and Satisfaction

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 Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: Edgcumbe - (2008) J. Hosp. Infection

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

2.8 million patient surveys 4,610 hospitals

Red = low performance + high impact Driver matrix – US data

“Hospital improvement priorities do not seem to match up with what hospitals need to improve...”

BHI – Insights into Care, 2009

Challenges ahead Changing mind set of staff from ‘provider-focus’ to a ‘patient-focus’ Change takes longer than anticipated – it’s about transforming culture and care delivered “So for whatever reason, we had the attitude where the physician is king and the patient, ‘well, we’ll get to the patient when we have time.’” (COO) *Luxford et.al Int J Quality in Healthcare Vol 23(5):

Clinical unit level – frequency of patient involvement (CEC Quality System Assessment - NSW)

Just streamlining processes within a clinical/provider model is not truly engaging patients

Patients & their families and/or carers are viewed as integral members of the health care team 2011 – 2013 (strongly agree response)

Patient engagement: Not just the ‘soft stuff’ Service quality and interpersonal relationships are critical dimensions to support and promote not only improved patient care experience but also patient safety, treatment, recovery and wellbeing (Australian Commission on Safety and Quality in Healthcare [ACSQHC], 2010).

Mandatory for service accreditation from 2013

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