EXCELLENCE THROUGH PATIENT AND FAMILY CENTRED CARE PROJECT

Averil Boon

RN, Grad Cert HInf, PG DipN Quality and Patient Safety Coordinator Bay of Plenty District Health Board

BOPDHB Objective - 2011 To establish a clear organisational plan, direction and scope with related priorities for organisational implementation of the core concepts of patient and family centred care (PFCC) across the continuum of care at Bay of Plenty District Health Board

Patient and Family Centred Care

“Patient- and family-centred care redefines relationships in health care. It places an emphasis on collaborating with patients and families of all ages, at all levels of care, and in all health care settings. Further, it acknowledges that families, however they are defined, are essential to patients’ health and well being and are crucial allies for quality and safety within the health care system.”

(Partnering with Patients and Families, 2006)

PFCC Core Concepts

Dignity and Respect Information Sharing Participation Collaboration

People are treated with dignity and respect Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

Patients, families, health care providers, and organisational leaders collaborate in policy and service development, implementation and evaluation

“When we want your opinion, We’ll give it to you”

Quality & Safety Challenge 2012

        Literature Review & Implementation Plan Presentations – anyone who would listen Self Assessments – Leaders / Organisation Identify Opportunities for Improvement / Action Plan Stakeholder Analysis / Communication Plan Site Visits, Conferences / Networking Developed Resources, guidelines, templates, training packages BOPDHB Recommendations / Framework / Strategic Plan

BOPDHB Values

Healthy, thriving communities Kia Momoho Te Hapori Oranga

C - Compassion A - Attitude R - Responsiveness E - Excellence

A health care system that actively reflects the needs and interests of the people it serves… the patients…..

Health Excellence

Benefits and Risks

When patients feel informed and empowered to participate in their own healthcare, the results can be:

• • Improved patient safety Better clinical outcomes • • People treated with dignity & respect Patients and staff report an enhanced experience of care • Reduced costs

The risk of not moving to patient and family centred care is greater than any perceived risks

Barriers

        No evidence Too costly Patients will have unrealistic demands Having patients / families at handovers / rounds / care meetings will inhibit staff from being open Families will interfere with care, creating delays, errors, and lapses in infection control More work / takes too much time Requires new construction / single rooms Patient access to health records violates confidentiality / privacy requirements

   

System-Centred

 The priorities of the system and those who work within it drive the delivery of health care.

Patient- Focused

 The patient is the focus or unit of care. Interventions are done to and for him/her, instead of with the patient. The patient is not viewed within the context of family or community.

Family-Focused

 While the family is the focus or the unit of care, interventions are done to and for them, instead of with them.

Patient- and Family-Centred

 The priorities and choices of patients and their families drive the delivery of health care.

Institute for Patient and Family Centered Care www.ipcc.org

Patient Experience The provision of care is not the same as the experience of the illness - both perspectives are needed Patients and families are part of their care and we as caregivers are part of their experience

Taken from Calgary Health Region Presentation- IHI 2007

It’s not going to happen overnight ….

      Patient and family’s voice is a powerful lever for system change and improvement. Can’t simply be rolled out Initiatives should be aligned with organisational priorities Leadership at all levels, especially executive is required to maximize benefits and sustain commitment. Partnership with key stakeholders enhances capacity, reach and spread message Not all change is an improvement – use improvement models and measures to track changes

Start before you are ready, or you will never start!

Organisational Self Assessment

Workshop objectives:

 Where do we stand now?   Where do you want to be?

Identify Care Improvement Opportunities:   How are we going to get there?

Develop Action Plan:  What is needed to do to get there?

 Who is going to do it?

 How are they going to do that?

BOPDHB Results

BOPDHB 1. DIGNITY & RESPECT 2. INFORMATION SHARING 3. PARTICIPATION 4. COLLABORATION

TOTAL

30/04/2012 Workshop 1

10 16 2.5

4

32.5

03/05/2012 Workshop 2

13 13 6 4.75

36.75

Two workshops held in same week, participants were:       Board members Executive Quality and Patient Safety Team Cluster Leaders Consumers Decision Support Analysts

Average

11.5

14.5

4.3

4.4

34.6

46%

BOPDHB Action Plan

  Volunteer Patient Advisors Priority projects:  Family Presence & Support - aka Visiting  Food options for different ethnic groups    Signage and way finding Family participation in ward rounds Patient goal setting and communication      Consumer Feedback Professional standards (Shared Expectations) Review of role descriptions Education, orientation, training and in-services Experience based co design projects    ED Clinical Physiology, Cardiac Nurse Practitioner nurse-led clinics, Medical Day Stay

What other doors opened?

           Admission to Discharge Planner Web page redevelopment Questions project Outpatient booking Bay Navigator Mental Health – “Working on Recovery” project Patient Education Information Orientation & Customer Service training – looking at including in all training Hospital information booklet Linking with “capturing the consumer voice” – surveys, patient stories, videos etc.

……… looking and hoping for more

Experience Based Co-design

Waitemata DHB – http://www.healthcodesign.org.nz

The Kings Fund http://www.kingsfund.org.uk/ebcd/ NHS ebd approach http://www.institute.nhs.uk/

Environment, Relationships and Challenges

Clinical Outcomes Measurement Orientation Excellence Education Values

BOPDHB Values

• Compassion • Attitude • Responsiveness • Excellence Professional Standards

Health Excellence

1. Leadership 2. Strategic Planning 3. Customer Focus 4. Measurement, Analysis and Knowledge Management 5. Workforce Focus 6. Operational Focus 7. Results Evidence Based Co-Design Policies & Protocols Patient Safety Resources

PFCC Concepts

• Dignity & Respect • Information Sharing • Participation • Collaboration Targets Stakeholder Analysis Remove Barriers Communication Plan

Patients & Families

Patient Advisory Group Recognise & Celebrate Success

Discussion & Questions

Our journey has been great fun, hugely successful so far and more progress achieved faster than I could have believed possible And is still gaining momentum!

Good Luck!

                

References

Australian Commission on Safety and Quality in Health Care (2011), Patient centred care: Improving quality and safety through partnerships with patients and consumers, ACSQHC, Sydney.

Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available on www.IHI.org

) Boyd H, McKernon S, Old A. 2010. Health Service Co-design: working with patients to improve healthcare services. Auckland: Waitemata District Health Board. (Available on www.healthcodesign.org.nz

) Charmel, P, & Frampton, S. (2008, March). Building the business case for patient centred care. Healthcare Financial Management, 80-85. Retrieved December 15, 2011 Conway, J et al. Institute for Healthcare Improvement and Institute for Family-Centred Care. (2006). A Roadmap for the Future. In Partnering with Patients and Families to Design a Patient- and Family-Centred Health Care System. Bethesda, MD: Institute for Family Centred Care.

Frampton, S et al. (2008). Improvement Guide. In Patient-Centred Care. Derby, CT: Picker Institute and Planetree. Retrieved December 14, 2011 Institute for Patient and Family Centered Care. Strategies for leadership. In Advancing the practice of Patient and Family Centered Care. Retrieved December 2, 2011 Johnson, B. et al. (2008). Recommendations and Promising Practices. In Partnering with Patients and Familes to Design a Patient and Family Centred Health care System. Bethesda, MD: Institute for Family-Centred Care. Retrieved December 14, 2011 Ministry of Health. 2000. The New Zealand Health Strategy. Wellington, New Zealand: Ministry of Health.

Ministry of Health. 2002. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health Ministry of Health. 2011. Whānau Ora: Transforming our futures. Wellington: Ministry of Health.

National Quality & Risk Managers. (2011). Draft - How to Guide: Capture the Consumer Experience. Wellington, New Zealand: Health Quality & Safety Commission.

National Research Council. 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. Washington, DC: The National Academies Press, 2004.

Planetree. (2009). White paper. In Patients as Experts, Patients as Partners: Integrating the Patient and Family Voice into Hospital Operations. N.p.: Author. Retrieved December 14, 2011, from www.planetree.org

Shaller, D. (2007). Revised report for joint publication by Picker Institute and the Commonwealth Fund. In Patient-Centred Care: What Does It Take. Stillwater, MN: Shaller Consulting. Retrieved December 10, 2011, from http://cgp.pickerinstitute.org/wp content/uploads/2010/12/shaller.pdf

The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centred Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

The NHS Improvement Plan. (2004). In Putting People at the Heart of Public Services. London, England: HM Government. Retrieved December 8, 2011, from http://www.dh.gov.uk/

Websites:

The Picker Institute http://pickerinstitute.org/

Planetree -

www.planetree.org/ The Institute for Patient- and Family-Centred Care www.ipfcc.org/

The

Schwartz Center www.theschwartzcenter.org/

The King’s Fund -

www.kingsfund.org.uk/

Websites (cont):

Institute for Healthcare Improvement -

www.ihi.org/

World Health Organization -

www.who.int/ The Health and Disability Commissioner Office – www.hdc.org

New Zealand Ministry of Health http://www.moh.govt.nz

NHS Institute for Innovation and Improvement

http://www.institute.nhs.uk/