Transcript WELCOME TO TCOE - Public Health Agency

Person Centred Care
Dr Pat O’Connor
Clinical Director of Research and Development NHS Tayside
Honorary Professor School of Business
Dundee University
Research Portfolio Healthcare Improvement and Innovation
Overview
• What is person centredness
• How can it be measured and delivered
Usual suspects....
 patient focus
 quality care and treatment
 patient participation
 communication
 patient feedback
 best use of resources
 respect and holism
 power and empowerment
 choice and autonomy
 empathy and compassion.
Person Centredness Quality Ambition
‘Mutually beneficial partnerships between patients,
their families and those delivering healthcare
services which respect individual needs and values
and which demonstrate compassion, continuity,
clear communication and shared decision-making’
People have told us they want ...
 Caring and compassionate staff and services
 Effective links between clinicians, patients and
others
 A clean and safe care environment
 Continuity of care and good
access to care Clinical excellence
 Clear communication and explanation about
conditions and treatment
How was the healthcare worker at?
 Making you feel at ease
 Letting you tell your “story”…...
 Really listening……..
 Being interested in you as a “whole-person”…..
 Fully understanding your concerns…...
 Showing care and compassionate ……..
 Being positive……...
 Explaining things clearly………
 Helping you to take control……..
 Making a plan of action with you……
Patient Enablement Instrument
(Howie et al 1998,1999)
 As a results of your visit to the today, do you feel you
are;
 1) Able to cope with life
 2) Able to understand your illness
 3) Able to cope with your illness
 4) Able to keep yourself healthy
 5)Confident about your health
 6) Able to help yourself
The Law
 “There will be mutually beneficial
partnerships between patients, their
families and those delivering healthcare
services which respect individual needs
and values and which demonstrate
compassion, continuity, clear
communication and shared decisionmaking.”
The Patient Rights (Scotland) Act 2011
Best service you have ever had?
In the next 5 mins discuss with your
neighbour
 What is the best service you have ever had
 What made it special
 What happened
 How can we create that in health?
Hold the thought
• How did you feel listening to this story?
What did you notice?
• What do you think / feel about Agnes and
her situation?
• Did you reach any conclusions about her
experience and her relationships with
staff?
Hold the thought
• How did you feel hearing May’s story?
What did you notice?
• Has hearing May’s story influenced your
thoughts about Agnes or her situation?
• Should it?
• Does it expose any assumptions made
previously?
Discussion prompts
• What have you learned from your reactions to
hearing Agnes and May’s stories?
• What do these stories tell us about some of the
challenges of ‘delivering’ person centred care?
• What actions would you like to take in
response to hearing the stories?
• What would be the main challenges of
‘measuring’ improvements resulting from your
actions?
Relatives Stories
Committees & Groups
Person Centredness:
Text about this section
PFPI
This section will be a link to the new site that
Laura and Allyson are working on it probably wont
be called PFPI.
Digital Patient
Stories
This section will be the patient stories information
that Lisa Dempster has been populating already
Complaints
This section will contain information for staff
relating to the complaints process. The group will
work with Hazel to ensure the relevant information
is published
Patient Feedback
This section will contain information on the tools
available in obtaining patient feedback including
the toolkit
Interpretation &
Translation
This section to contain information for staff relating
to I&T
Equality & Diversity
A link to the internal E&D site
Patient Information
Leaflets
A link to the Patient information leaflets internal
site
A list of the various
groups & committees
relating to person
centredness e.g. Patient
Info Group, Better
Together . Here we can
publish minutes,
agendas, papers etc and
link with the “other
committees” section
under corporate
governance
Take
out???
Person centred care
Outcome
Aim: Improve the
care experience for
all patients
receiving healthcare
in NHS Tayside
Primary Drivers
Provide care in
partnership with people
using services and other
core services
Feedback from patients,
carers and families
improves care, and local
service delivery
High Level
Outcome
Measures for 1st
September 2012
•
95% of patients describe the
service as being person centred
•
70% of nurses time spent in
direct patient care (after
implementing RTC)
•
50% reduction in complaints
related to patient experience
•
95% of patients recall having a
daily conversation with the SCN
•
100% spread of real time
feedback in clinical areas
Healthcare staff provide
person centred care to
every patient every time
based upon the 7C’s
Feedback from patients,
families and carers
informs NHS Tayside
strategies and future
direction
Secondary Drivers
•Use of information to improve outcomes for patients
•Improve Health literacy
•Evaluate patient resources to support patient involvement in their
own care
•Increase independent advocacy
•Increase identification, and role of carers
•Implement patient /carer feedback and undertake actions in all
clinical areas
•Use complaints, feedback and incidents to inform local
improvement plans
•Identify service partners to obtain feedback
•Include patient experience in all medical revalidation and staff
appraisal plans
•Implement patient experience on the dashboard
•Raise awareness and provide support in the tools available to
capture patient feedback
•Incorporate person centredness and 7Cs in all training
opportunities
•Implement Releasing Time to care
•Implement Leading Better Care
•Implement Caring Behaviours Programme
•Include person centredness within all staff KSF profiles /
revalidation plans
•Improve the health and well being of the workforce
•Culture and leadership commitment to person centredness
•Ensure Policies contain evidence of patient/public participation
•Ensure patients stories are heard at the Board and are used in
development of strategies
•Include a description of how patients/public will be informed,
engaged and consulted within all Board papers.
•Include patient experience within Board Development Events
Good Questions for Your Good Health
Every time you talk with a doctor, nurse, or pharmacist, use
the Ask Me 3™ questions to better understand your health.
1
2
3
What is my main problem?
What do I need to do?
Why is it important for me to do this?
Emotional touchpoints
 Using emotional touchpoints (Bate and Robert 2007)
as way of learning about the patient and family
experience of being in hospital and using this to help
staff recognise and celebrate positive care practices
and develop the service. Touchpoints refer to
important stages/events in their care.
Emotional Touchpoint
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Developed a series of emotional touchpoints
e.g. coming into hospital, mealtimes, personal
care, going for tests and a bank of positive and
negative emotional words e.g. powerless,
happy, included, numb.
Invited patients/relatives to take part in
sharing their experience including providing
written information and obtaining written
consent 24 hours before the discussion took
place.
Asked the patient/relative to select the
touchpoints that were relevant to them and
invited them to identify any other touchpoints
(one relative though being here at night was a
key touchpoint for her so this was added).
Taking each touchpoint in turn, we asked
them to select an emotional word(s) that
summed up how they felt about the particular
experience.
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Asked the patient/family why they felt that
emotion. A relative said for example that they
felt ‘out of their depth’ being on the ward at
night as they did not know the routine and
what they could and could not do. They also
felt ‘privileged’ as they were given the space on
the ward and support from the nurses to
laugh, cry and talk with their family about
what a lovely life their father had had.
When a negative point was raised we asked the
patient/relative what they thought we could
do to improve things and if appropriate ask if
they would like to be involved in this (for
example a family member is helping to
develop an information sheet to support
families who are on the ward at night).
Following the interview we type up the notes
from what the patient/family have said and
with their permission share this with staff on
the ward.
We ask staff to tell us what they have learnt
from reading the story and if there are any
actions we would like to take forward.
Improvement
 Staff more at ease move away from blame
 Better relationships when developing improving
service
 Directly sources how individuals ‘feel’ about care
 Actions taking based on meaningful evidence
 Staff moved and motivated by transparency and
inclusiveness
What can you do ask ?
Today would have been
better if .......
 The power of words video
References
 http://www.napier.ac.uk/fhlss/NMSC/compassionatec
are/practicemethods/Pages/EmotionalTouchpoints.as
px
 http://www.kingsfund.org.uk/events/person-centredintegrated-care
 http://www.bridgingthegap.scot.nhs.uk/values-andprinciples,-policy-and-practice/person-centredcaring.aspx
 http://www.evidenceintopractice.scot.nhs.uk/leadingbetter-care.aspx
References
•
Bridges J et al (2009) Best Practice for Older People in Acute Care
Settings: Guidance for Nursing Staff Nursing Times RCN Publishing /
City University London
•
Nolan M et al (2006) The Senses Framework. Improving care for older
people through a relationship-centred approach. Getting Research Into
Practice (GRIP) Report No. 2, University of Sheffield
•
Patterson M et al (2011) From Metrics to Meaning: Culture Change and
Quality of Acute Hospital Care SDO
•
Tadd W et al (2011) Dignity in Practice: An exploration of the care of
older adults in acute NHS hospital trusts. PANICOA Publication
From where I’m Standing
Looking along the beam and looking at the beam are very different
experiencesC.S.Lewis
 In emergency admissions, In the outpatient department
 At the here-we-go-again clinic, In yet another waiting
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room..
From where I’m standing
There’s nothing worse that being treated as an illness
From where I’m standing
There’s nothing worse that it all flaring up again
From where I’m standing
There’s nothing worse than not knowing whether to laugh
or to cry
Except dealing with people who Act like they never laugh or
cry