Transcript Training for POhWER ICAS staff

PATIENTS FOR PATIENT SAFETY Pilot
PROJECT
My Background
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Previously a lecturer in Social Work
Chair of the Royal Brompton & Harefield NHS Trust PPI Forum
Sit on Trust Board with observer status, Audit and Risk
Committee, Complaints Committee & Equality and Diversity
Committee
Member of DOH’s Information & Clinical Governance Subgroups Professional Regulation & Patient Safety Programme
Manager of the PfPS Project
Just completing PhD on ‘Medical Harm & Patient Empowerment
within the NHS’
WHO Patient Safety Champion
Just appointed to a research post at Kings College in their Patient
Safety & Service Quality Research Centre
Key Policy Drivers for PPI in Patient
Safety
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‘Around the world, healthcare organisations that are
most successful in patient safety are those that
encourage close cooperation with patients and their
families’ (Safety First, DOH2006).
The report also recommends:
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Each board should ‘make it clear how they intend to ensure that patients
& carers play an integral part in all initiatives to introduce a patient safety
culture change within the NHS’ (Rec 8);
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‘The active involvement of patients & their families should be promoted by
establishing a national network of patient champions who will work in
partnership with NHS organisations & other key players to improve
patient safety’ (Rec 13).
Key Policy Drivers for PPI in Patient
Safety
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There is a need to involve patients and the public in all
aspects of planning, organisation and delivery of
healthcare:
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‘To be involved the public had to be empowered’.
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E.g. given proper info to formulate views, be listened to
and have views acted upon (Bristol Report 2001).
Key Policy Drivers for PPI in Patient
Safety
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‘There is an increasing recognition that patients should be seen
not as “passive” recipients of healthcare interventions chosen &
delivered by health professionals, but as active participants with
their own values & beliefs. Patients & carers therefore have a vital
role to play both in helping to define what counts as “quality” in
healthcare …… and in drawing attention to unacceptable
standards of care’ (Safeguarding patients, HM Govt 2007- response to
Shipman & other inquiry reports).
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A specific duty on all organisations to involve
patients/public in the planning & development of
services.
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(Section 11 of the Health & Social Care Act 2001).
Evidence of a Lack of PPI in Patient
Safety:
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Only 24% of Trusts routinely informed patients
involved in a reported incident and 6% did not
involve patients at all
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(House of Commons (2006) Select Committee on
Public Accounts)
Evidence of a Lack of PPI in Patient
Safety:
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The following reports found that PPI in clinical
governance processes in hospital Trusts and Primary
Care was limited.
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Achieving Improvements through Clinical Governance
(NAO 2003).
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Improving Quality and Safety: progress in
implementing clinical governance in primary care.
Lessons for the new Primary Care Trust’s (NAO 2007).
Evidence of a Lack of PPI in Patient
Safety:
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In a review of strategies to involve patients in
improving the quality of healthcare, the Picker Institute
noted about patient safety that:
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UK has had a major programme to improve
patient safety since 2001, but with little
recognition of patients' potential to take an active
role
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(Picker Institute 2007)
Background to The Patients for
Patient Safety (PfPS) Pilot Project
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Joint initiative between the National Patient Safety
Agency & the charity, Action against Medical Accidents
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Aims to develop the role of patients and the public in
patient safety work in the NHS
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Funded for two years by the NPSA from April 2006 to
March 2008
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Project Managers: Josephine Ocloo and Louise Price
Key Project Objectives:
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To build a network of patients & the public (including
those affected by medical harm) wanting to be involved
in patient safety work & to develop good practice.
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Develop a core training module for network members
on key aspects of patient safety
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Develop local strategies for PPI in patient safety by
working with 2 NHS sites:
The Project’s Methods:
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To identify good practice eg’s of PPI in patient safety
through letter to NHS Trusts;
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Holding meetings with 4 NHS Trusts & working closely
with 2 in more depth;
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Developing a Patient Safety Network for Patients & the
Public;
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Running a Training Module for Patients & the Public;
Some Key Findings: Trust A
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Some very serious PSI’s had occurred over recent years,
providing the momentum for looking at the way the Trust
responded to such incidents:
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The Trust eventually agreed to focus primarily on the area of
suicide and to identify key issues and factors:
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From the perspectives of relatives/carers bereaved through
suicide
From the perspectives of staff involved with the aftermath of a
suicide and dealing directly with bereaved relatives, And;
To look at the implementation of the Being Open guidance when
an incident occurred.
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Workshop with Patient Relatives
and Carers
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22 relatives identified by Trust for contact
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2 relatives expressed interest in being involved (later
contacted by a 3rd person)
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2 relatives provided written accounts
experience but did not wish to participate
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3 said did not wish to be involved
15 did not respond & unable to contact by telephone
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of
their
Possible reasons for non-response:
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Families/carers unable to obtain resolution and closure
Unresolved issues with the Trust
No ongoing relationship with the Trust
Patients/relatives feeling there is not going to be any personal
benefit to them as a result of their input or that time/expenses will
not be properly compensated
Going back 3 years may have been a factor in being able to
contact families
How families are identified and the dangers of screening out those
seen as too difficult to work with, whose experiences might well
provide invaluable learning for the Trust.
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Strategies for the Future
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Might include:
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Seeking the views of patients/relatives/carer's through individual
interviews
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relatives invited more informally to share their experiences with
staff or to attend a meeting with staff members
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Written stories.
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Involving people at risk of suicide & carers. This might act as an
incentive to get involved if it will help patients manage their own
situation more effectively as well as helping others.
Workshop With Staff: After a
Suicide
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Staff often devastated as often knew patient well
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Staff blamed themselves as felt might have prevented the suicide
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Staff feared being blamed by others, or through a formal inquiry
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Staff found involvement with families after a suicide exceptionally
difficult because of high level of emotions/concerns involved &
concern about saying the wrong thing & a fear of litigation
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Staff felt they or their colleagues often not offered enough support.
But acknowledged they found it difficult to take up support if they
thought it would put pressure on other staff
Follow-up Workshop with Staff
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Key Aims:
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To develop ways of supporting staff following a
serious PSI;
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Implementing Being Open guidance
Follow-up Workshop with Staff: Key
findings
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Staff need space to debrief and reflect upon their feelings after an
incident which can be facilitated in different ways deemed most
appropriate by staff (through counselling, group support or one to
one sessions with a supervisor.
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Staff felt not always properly informed on what was happening
after an incident or interviewed and therefore could not properly
and appropriately support relatives
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Staff/teams affected by an incident were not always part of a wider
investigation or RCA analysis after an incident so did not know
what was happening, about key outcomes and learning from PSI.
Follow-up Workshop with Staff:
Implementing the Being Open guidance.
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Staff wanted to know who was responsible for implementing Being
Open and exactly how open they should be. For example who
should give information to families/carers, how much and what
type
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It was felt that this process needed to be clearer at team level, so
that everyone knew 'who knew what' and 'who was doing/saying
what’.
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It was seen as important to involve families in any RCA’s or
investigations, & for clarity on how this was done, & who was
doing it and feedback given to the staff team.
Some Key Findings: Trust B
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To explore a model for PPI in patient safety
work based upon empowerment.
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To introduce another strand into the Trust’s
patient safety programme.
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To identify patients & the public to become
involved in the Trust’s patient safety work.
Empowering PPI in Patient Safety: Key
Questions/Points from Launch Event:
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Is an empowered patient a safer one?
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Partnership - The importance of seeing patient/carers
as part of the team and their needs at its centre
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Addressing imbalances of power in patient/staff
relationships
How individuals can be made passive as patients
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Supporting staff as part of empowering patients
Attempts at Empowerment:
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The Hand Hygiene Project
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Working with those with a poor healthcare
Experience (eg affected by a PSI’s or who
have made a Complaint)
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Workshop with Patient Governors
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Working with those with a Poor Healthcare
Experience: Some Questions to Consider
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How do we feel about working with those with poor
experiences of healthcare ?
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What are our fears about this involvement ?
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How can we address these fears ?
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What are the barriers in our Trust to this involvement ?
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How can we address these barriers in the future ?
NPSA Model for Working with those Affected by
Harm
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To not put patients and staff together too soon in the process
Bring together a mixture of patients from different Trusts & have a
workshop off site
Identify Trust area's most likely to cause harm to patients and then to
select/profile patients according to these areas
Draw upon voluntary/community sector to identify diverse patient groups
Staff attending workshops there to listen only and not to defend the Trust
Focus of the workshop is on learning rather than on accountability. This
should not preclude patients from expressing what they think went wrong
Independent facilitators are used
Permission letters from patients to indicate if want further involvement
Learning from workshops to be shared more broadly with Trust staff to
see if stories resonate & to allow for reframing & clarification of the
problem(s).
Workshop with Governors on
Developing PPI in Patient Safety
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Some Points made:
Staff don’t always ‘hear’
Patients unable to make their points
Need to understand role, function of committee and
what is required of patients & the public
Jargon, language can be a problem
Problems of tokenism & not feeling valued
Communication needs to be more two way and in
partnership
PPI reps need to be informed about follow-up action
Tackling barriers to involvement on
committees: Some guidelines
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Need for proper Induction
Terms of reference of committee & other relevant information
should be given well in advance of meeting
At least 2 patient reps should be invited to avoid tokenism
Patient reps should be properly introduced to committee members
Training should be offered if appropriate
The meeting should be conducted without the use of unnecessary
jargon or terms should be explained or the patient given info after
the meeting
Patient reps should be encouraged to participate in the discussion
& not be penalised if they challenge issues
There should be proper reinbursement of expenses which might
include travel, childcare & for time incurred
The Patient Safety Network
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Over the life of the project various meetings were held
with PPI representatives on a range of issues to do
with patient safety
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This included holding a 1day training event on patient
safety, follow-up event on PPI in clinical governance &
1 day conference on complaints/regulation & the AHC
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Meetings were well attended by PPI representatives
from patient forums, voluntary groups & by individuals
directly affected by medical harm.
The Patient Safety Network: Some
Key Findings
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PPI representatives were well informed on health issues, but not
on Trust Patient safety work
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Expressed a strong interest in safety, but viewed the safety
agenda as about regulation & accountability as well as learning &
improvement
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Were keen to get involved but needed proper help to do so, eg
clarity on opp’s for involvement, info, training, expenses
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Wanted to see a partnership approach with h/care professionals
where their views would be listened to, taken into account & acted
upon
The Way Forward
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More needs to be done to develop a range of
strategies for involving, supporting & empowering
patients/public in the patient safety agenda
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Involving & learning from those with poor experiences
of healthcare/ affected by PSI’s is particularly important
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Staff need to be supported to work in partnership with
patients/public
Developing a Model for PPI in Patient
Safety
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A starting point to think about PPI on different
levels, with different strands
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Organisations should provide info on risks &
safety to the public, work with individual
patients & develop involvement at a strategic
level
Developing a Model for PPI in Patient
Safety: Some Questions To Explore:
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What are patient safety concerns within the organisation from
patients’ perspectives?
What are patient safety concerns within the organisation from staff
perspectives?
What are the key components of a patient safety culture in the
organisation
How can patients and the public engage with and be involved with
this agenda and what are the barriers to this involvement?
How might different groups be affected? Are people discriminated
against and disempowered? What about those who have had
adverse experiences of healthcare?
Messages from Bristol
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‘The public are entitled to expect that means exist for
them to become involved in the planning, organisation
and delivery of healthcare’
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‘For a healthcare service to be truly patient-centred it
must be infused with the views and values of the public
(as patients past, present or future). The public must
be involved. To be involved, the public must be
empowered……’
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(Bristol Report 2001: 400)