Transcript Equality impact assessment - Healthcare Conferences UK Ltd

Essence of Care
-Moving Forward
Maureen Morgan, Department of Health
13th November 2008
Two Main Themes
• The value of
benchmarking the
environment
• EoC and the new
quality landscape
Context
• In 3rd stage of 10yr plan to reform health
care
• Underpinned by unprecedented levels of
investment
• First two stages concerned with access,
structures and systems
• Now, attention on quality, choice and
individualised, personalised care
So far – So Good
• Achieved national targets on reducing
mortality from cancer and cardiovascular disease
• On track to reduce MRSA by 50%
• Reducing waiting to 18 weeks
• HCC survey 92% of patients rated their
care as good or excellent [2007]
BUT……..
• Wide regional variation – SMRs /IMRs in some
parts of UK among best in EU – others among
the worst
• If 92% of patients rated care as good or
excellent – 8% did not!
• There is variation in clinical practice
• High profile cases [eg Maidstone] contributing
to loss of confidence that the NHS ‘cares’
• Patients feel ‘at risk’ in our care
Safe from....
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•
harm
indignity
hunger and thirst
being dehumanised
• being depersonalised
BBC Poll 30th June ‘08
Why the Environment?
• Earlier benchmarks
arose from patient
complaints &
untoward incidents
• Patients’ experience
of care can be
important as clinical
outcome
First Impressions Count
Patients will use what they
can see to make
assumptions about what
they cannot
Often, the first thing a
patient will see is the
building - before they
meet a nurse, AHP or
doctor
What you see tells a
story
• dirty, worn furniture says
– no-one cares
– staff don’t have very high
personal standards
– you could catch something nasty
here
– the kitchens and operating
theatres may be dirty
– I’m not safe here!
How people are made
to feel is vital
• Embarrassment can kill
• People may avoid
healthcare because of
embarrassment
• People are highly sensitive
to loss of dignity and
invasion of privacy
More than just an ‘extra’
Research identified
• how healing environments
shortened patients’ postoperative recovery
• That stress is a major obstacle
to recovery and that well-being
and recovery is directly
related to physical environment
• Picker Institute showed the
environment mattered to
patients
Environment Encompasses
how Care is Experienced
Little things matter
• the ambience
• the rapport with staff
• how staff behave
towards one another
• how they look
• cleanliness, tidiness etc
Environment of Care – 11th
benchmark
Launched November 2007 – covers
– access
– culture
– maintenance
– cleanliness
– infection control precautions
– personal environment
– linen and furnishings
• Crosses all disciplines and care settings
Environment Benchmark
• Access – consider how easy is it get there from leaving home to
arrival? Way-finding may be more difficult when one is worried
or stressed.
• Culture – norms of behaviour – ‘how we do things around here’ –
what sort of culture will generate feelings of safety, dignity and
personal care?
• Personal care environment – the space occupied by an individual.
People value being able to control their environment – closing
curtains, opening windows, operating lights.
What can be done by the staff themselves? What should be
brought to the attention of others who can take action?
Relevance of EoC to New
Approach to Managing
Performance
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From central targets to self-improving systems
Clinically focused and evidence based
Responsive to patients, public and staff
Stronger accountability
Emphasis on qualitative data
Externally validated by CQC
Summary
• Focus of reform now on quality & patient experience – service
transformation
• Strong performance management systems will require evidence
of continual improvement
• EoC can provide mechanism to improve fundamental aspects of
care
– harnesses enthusiasm of front-line staff
– combines efforts of nurses, AHPs, doctors and others – helps
to create effective health care teams that meet
expectations of patients, users and the public –
– help re-new trust and confidence in the NHS
• The environment of care is the visible sign quality care
NB – toolkit being refreshed and a new benchmark on pain launched
next year