Transcript Improving the patient and carer experience

Clinical Services Redesign Program
Improving the patient and
carer experience
Clinical Services Redesign Program
Patient Journey
Patients take journeys through
the health care system.
They involve a series of steps in
the delivery of health care.
These steps should be
predictable, with decision points
along the way
The journey may be short with a
few steps.
For people with chronic illness,
the journey may take a lifetime
with continuous stops along the
way.
Patient and Carer Experience
•patient + carer perspective of
journey
•shaped by information; the way it is
given
•what they see, feel, hear all affects
their choices
•includes “gaps” between clinical care
•different from patient satisfaction
Clinical Services Redesign Program
3 reasons why it matters
1. NSW State Health Plan
Strategic Direction 2
CREATE BETTER EXPERIENCES
FOR PEOPLE USING THE
HEALTH SYSTEM
Clinical Services Redesign Program
2. CSRP Objective
Deliver better patient journeys by
improving
• Access
• Safety
• Patient and carer experience
Clinical Services Redesign Program
CSRP Work Orders
"How the Proposed Project will
understand and improve patient
and carer experiences"
Clinical Services Redesign Program
3. Because you care
• VEM High Level Stakeholder
Study
• Consumer Involvement Audit
Clinical Services Redesign Program
Clinical Services Redesign Program
Patient experience – isn’t that just
customer service??
Basis of good customer service
• Who are your customers?
• What do they value?
• What types of value give a
competitive edge?
Clinical Services Redesign Program
Which partner said this?
Governments are at a critical
juncture for service success.
Leading executives recognize they have
“reached the limit” with their current
approaches to customer service. They are
re-assessing and re-crafting their customer
service strategies, not just to satisfy
citizens, but also to create lasting value.
They are also veering away from a “best
practice,” one-size-fits-all template—and
putting the “custom” back in government
customer service.
Clinical Services Redesign Program
Today’s purpose
To learn how to
• Really understand patient and
carer experience
• Monitor change in patient and
carer experience
Clinical Services Redesign Program
What is the “carer”?
• person who supports the patient
on their health care journey.
• involved in decision making
• has information about patient
and their journey
• may or may not be “carer”
when patient is back home
Clinical Services Redesign Program
What do patients and carers value?
1. Access to Care
2. Respect for Patients values, preferences, and
expressed needs
3. Coordination and integration of care
4. Information and education
5. Transition and continuity
6. Physical comfort
7. Emotional support and alleviation of fear and
anxiety
8. Involvement of family and friends
Clinical Services Redesign Program
Clinical Services Redesign Program
When we redesign patient journeys,
we can embed systems and
processes that contribute to better
patient and carer experiences.
In your project
• Have you talked to patients and
carers to identify opportunities
for improving the patient and
carer experience?
• How will you know if you
achieve this?
Clinical Services Redesign Program
After morning tea
• What method are you using to
understand/measure patient
and carer experience?
• What do you see as the pros
and cons of this method?
Clinical Services Redesign Program
What we need for clinical redesign
• Data – something we can
measure and compare results
over time
• “Juice” – detailed insights into
what is not working from
patient and carer perspective.
Information that informs
practical solutions
Clinical Services Redesign Program
Measuring Patient Experience
Data, results
comparable over
time
Richness
of detail for
CRU
projects
(juice)
Clinical Services Redesign Program
Patient Experience Measures
Data, results comparable over time
Richness
of detail for
CRU
projects
(juice)
Good insight
into patient
experience but
how valid is
this story?
Patient story
Clinical Services Redesign Program
Data, results
comparable
over time
Patient
Satisfaction
survey
Recognised tool. Annual
data can be compared
across AHSs and
internationally.
Great for the dashboard.
Not much “juice” for Clinical
Redesign and not regular
enough for project
evaluation.
Richness
of detail for
CRU
projects
(juice)
Clinical Services Redesign Program
Data, results comparable over time
Patient
Satisfaction
survey
Use Picker categories
to align these tools
CRU tool delivers
data and juice
suitable for
redesign projects
Richness
of detail for
CRU
projects
(juice)
Patient story
Clinical Services Redesign Program
Clinical Services Redesign Program
An example
Patient Experience of Waiting
Overall, patient and carer satisfaction survey results are encouraging with the majority of respondents
reporting a positive experience. However, when there is a breakdown between waiting room and observation
area respondents a clear distinction becomes apparent between the two groups in the perception of care,
with the waiting room respondents far less than satisfied with the timeliness of care and level of
communication causing more negative emotions.
Perception of timeliness of care
80
70
60
%
50
Observation
40
Waiting Room
30
20
Patient and Carer’s Perception of timeliness of care
• Overall the perception of timeliness of care received is
good, with the majority of respondents ranking timeliness
of care as good or better.
• Waiting room patients/ carers are markedly less positive
in their perception of the timeliness of their care than that
of the observation area patients
10
0
Poor
Good
Very Good
Excellent
Waiting too long?
80
70
60
%
50
Obsveration
40
Waiting Room
30
20
Have you been waiting too long?
• Again, the majority of patients, overall, do not feel they have
been waiting too long for treatment.
• Waiting room patients are more likely to feel they have been
made to wait too long for treatment.
10
0
Yes
No
Clinical Services Redesign Program
Patient Experience of Waiting
How do you feel about the wait?
Feelings generated by waiting.
80
70
60
%
50
Observation
40
Waiting Room
30
20
10
•Although there was a proportion of Observation area
respondents who felt they were waiting too long for treatment,
waiting room patients/ carers are the only respondents to
express anger at waiting for care.
0
Angry
Inconvenient
Don’t mind
Communication
How well have we communicated with you about what is
happening in your stay?
60
50
%
40
Obs ervation
30
Waiting room
20
10
0
Poorly
Ok
Well
•Waiting room patients/ carers were far less satisfied with the
level of communication received.
• Waiting room respondents the only ones to report poor
communication.
Very
Well
Actions taken from these survey results include •An awareness and education program highlighting the need for ongoing and regular communication with
patients and carers located in the ED Waiting Room.
•Continuing work by the triage Working party to address these issues.
•Identification and training of nurses ready for the CIN role.
Further to these actions, it is anticipated that the recent appointed Advanced Practice Nurse should help
to address the issue of prolonged waits for low, clinical priority patients.
Clinical Services Redesign Program
Fast Access to reliable health care
Attention to Physical +
Environmental Needs
Clare says she is used to waiting hours, sometimes
days in the ED for a psychiatric registrar to arrive. All
that time under fluorescent lights – she says you
never know if it’s night or day…. Clare once spent 6
days in a hospital ED waiting for a bed.
(Clare – Mental Health)
Clinical Services Redesign Program
How do we understand and improve
patient and carer experience?
For each journey being redesigned:
1. At the beginning, ask patients and carers
about their experience
2. Analyse areas for improvement
3. Respond with solutions that will improve
patient and carer experience*
4. Re-evaluate post-implementation by asking
a new group of patients and carers
Clinical Services Redesign Program
Clinical Services Redesign Program
Morning tea
Clinical Services Redesign Program
CRU trial method for measuring patient
and carer experience
The CSRP method
• Focuses on patient experience,
not satisfaction
• Qualitative method (discourse
analysis, background narrative
enquiry)
• Requires skilful facilitation
• Delivers “juice” and data for
Clinical Redesign Projects
Clinical Services Redesign Program
Based on…..
Learnings from…
• Picker Institute
• VEM CSRP Evaluation tool
• Literature
PLUS
• Common sense
• Commitment to practical,
achievable method for CSRP
Clinical Services Redesign Program
Step by step
1. Identify and invite individual patients
and carers to a discussion
2. Set up discussions
3. Facilitate the discussions
4. Record and analyse insights
5. Present the results
6. Use the knowledge: design solutions
7. Remeasure to see what’s changed
Clinical Services Redesign Program
Method
• Not compulsory
• Trial by willing CRUs Aug-Dec
2006
• Support, knowledge sharing and
resources provided by CSRP
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Lunch break
Clinical Services Redesign Program
Remember our motivation:
to understand and improve patient and
carer experience
Step by step
1. Identify and invite individual patients
and carers to a discussion
2. Set up discussions
3. Facilitate the discussions
4. Record and analyse insights
5. Present the results
6. Use the knowledge: design solutions
7. Remeasure to see what’s changed
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 1
Identify and invite individual patients
and carers to participate
Step 1: Invite patients and carers
• Define target population
• Invite them to take part
• How many to interview?
• Avoiding bias
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 2
Set up the discussions
Step 2: Set up the interviews
• Where to interview
• Who should interview
• How long will it take?
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 3
Facilitate the discussions
Step 3: Facilitate the discussions
• Introductions
• Skilful listening and questioning
• Identifying “best” and “worst”
aspects of experience
• Ending the discussion
• Consent form
Note: CSRP has a workshop available to
practice these skills
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 4
Record and analyse insights of
patients and carers
Step 4: Record and analyse the
insights of patients and carers
• Enter your notes from
discussion record into webform
on archi and receive summary
• Enter data into MS excel
spreadsheet
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 5
Present the results
Step 5: Presenting the results
• Data – graphs of top issues
Analyse what improvements
patients and carers would value
most, and what is already
working well
• “Juice” – constructive comments
that point to practical solutions
Clinical Services Redesign Program
TOUCHPOINT - Fast access to reliable health care
12
2
0
Positive
Negative
Neither
Clinical Services Redesign Program
TOUCHPOINT - Co-ordination and continuity of care
11
3
0
Positive
Negative
Neither
Clinical Services Redesign Program
ALL TOUCHPOINTS
14
12
10
s
nt
e
ti
#
Pa
8
6
4
2
0
Positive
Negative
Neither
Fast access to reliable health care
Effective treatment delivered by trusted professionals
Involvement in decisions and respect for preferences
Clear comprehensible information
Attention to physical and environmental needs
Emotional support empathy and respect
Involvement of and suport for family and carers
Continuity of care and smooth transitions
Clinical Services Redesign Program
Clear comprehensive information
• "They gave me lots of printed information about what I
considered the less important stuff, and not enough about
the risks of the procedure. I received nothing written about
the risks. The surgeon rattled off a set of risks as fast as
you can speak and in a monotone. I pulled out my
notebook and started writing down notes and asking
questions. It wasn't all clear and I had to clarify the risks. I'd
like to see the percentage of each risk that was given to me
verbally written down. The psychologist actually asked me
if I knew the percentage of risk of death from this procedure
- if I hadn't written it down, I wouldn't have remembered.
Violet – elective surgery
Clinical Services Redesign Program
Clear comprehensive information
I could not fault my care and treatment
from all providers….but after moving from
the Critical Care Unit to the step-down
ward, communications and getting
information about my condition and
progress became more and more difficult
(Alex – Cardiac Care)
Clinical Services Redesign Program
Continuity of care + smooth
transitions
Each doctor was focused on his or her bit of Terry,
sometimes to his detriment. The neurosurgeon had
apparently said that Terry could start to move about
(although no one came and told Terry or Ros that for
some time). The orthopaedic surgeon said that Terry
shouldn’t move because of his pelvis. Staff could not
clarify the situation until the orthopaedic surgeon came
to look at the x-rays. It took a week for him to come and
look at the x-rays.
(Terry: Critical Care, as told by mother Ros)
Clinical Services Redesign Program
Fast Access to reliable health care
Attention to Physical +
Environmental Needs
Clare says she is used to waiting hours, sometimes
days in the ED for a psychiatric registrar to arrive. All
that time under fluorescent lights – she says you
never know if it’s night or day…. Clare once spent 6
days in a hospital ED waiting for a bed.
(Clare – Mental Health)
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 6
Use the knowledge to improve patient
and carer experience
Step 6: Using the knowledge to
improve patient and carer experience
• Any other data sources?
• Target the top problems
• Use “juice” to design solutions
• Discuss your solutions with
other patients + carers before
and during implementation
• Who else needs to know what
you found?
Clinical Services Redesign Program
Clinical Services Redesign Program
Step 7
Re-measure to see if your solutions
worked
Step 7: Remeasure to see if your
solutions worked
• Immediately after
implementation
• Then periodically, to see if your
solutions “stick”
Clinical Services Redesign Program
Our commitment
CSRP will support you with
• Tools and resources – archi.net.au
• Practical coaching – Jane and Karen
• Discussion group on archi - sharing
knowledge and lessons learned
• Practical training on facilitating
discussions
• Sharing knowledge and lessons
learned
Clinical Services Redesign Program
Clinical Services Redesign Program
What next?
1. Is this method practical and do
you think it will help you
improve patient and carer
experience?
2. Are you prepared to try it in
your current/next project –
and help perfect the method?
Clinical Services Redesign Program