Transcript Safer Systems Saving Lives

Patient Based Care and
Communication
Walking in the patients shoes
<<X>> Hospital
<<XX Hospital/ Service >>–
The Vision for Quality Care
General Manager/Chief Executive
Quality and safety programs
3
What do you expect good
care to look like?
<<Local senior staff member>>
What are your own
expectations of
‘good’ care?
What do patients value in care?
• Being treated with dignity and respect
• Having confidence & trust in providers
• Courtesy & availability of staff
• Continuity & transitions
• Coordination of care
• Pain management & physical comfort
• Respect for preferences
• Emotional support
Joffe et al. (2003) J Med Ethics
Jenkinson et al. (2002) Qual Saf Health Care
“I couldn’t have faulted
the technical care but...”
What affects quality in health care?
The level of quality in hospital environments
is affected by:
(1) the quality of technical care;
(2) the quality of interpersonal relationships;
(3) the quality of hospital amenities and the
environment
(Potter et. al, 1994. Int J of Health Care Qual Assur, Vol 7, pp.4–29).
Leading with words & actions
“We need to think of the
patient and their family as
integral members of the
healthcare team. Once
you’ve gotten mileage out
of your systems, then the
Professor Tom Delbanco,
Inaugural Chair, Picker Institute,
BIDMC Physician, Boston
Harvard Medical School
next level of improvement
you can only do by
engaging the patient”
Patient Based Care Model
Benefits of Patient Based Care
Refocusing care delivery around the patient
• Improves patient care experience....
• Improves clinical and operational-level
outcomes:
• improved patient adherence
• fewer medication errors
• decreased adverse events
• improved staff satisfaction
• enhanced staff recruitment
• decreased length of stay
• decreased ED return visits
• And the bottom line.
High performing organizations
Hospitals with high levels of ‘patient care
experience’ reported by patients provide
clinical care that is higher in quality across a
range of conditions.
Jha A et al (2008) N Engl J Med 2008; 359:1921-1931.
Impact on the ‘hard stuff’...
Patient Based Care links to improved safety:
• Decreased mortality1
• Decreased rates of hospital-acquired infection2
• Decreased surgical complications3
• Higher quality clinical care/best practice4
• Improved patient functional status2
1.
Meterko M et al (2010) Health Services Research
2.
DiGioia A M et al (2008) Agency for Health Care Research and Quality
3.
Murff et al (2006) Qual Saf Health Care
4.
Jha A et al (2008) New England Journal of Medicine
Mandatory for
service
accreditation
from 2013
What do patients from
our service want to see
improved?
<<Local senior staff member>>
BHI – Insights into Care, 2009
What do <<XX Hospital>>
patients say?
• X% inpatients rated overall care ‘excellent’ (NSW
av. 34%); Y% ‘poor-to-fair’
• X% inpatients rated staff team work ‘excellent’
(NSW av. Y%)
• X% inpatients reported that they were always
‘treated with dignity and respect’* (NSW av. 81%) –
NB: a main influencing factor for ‘poor’ care
• X% inpatients rated room cleanliness as ‘excellent’
(NSW av. 25%)
(Bureau Health Information – Insights into Care, 2009)
What do we know about who
our patients are?
• XX% born overseas (from….??)
• YY% speak English as their first language
• X% non-English speaking background (which
languages…..??)
• Y% indigenous population
What do we know about Australians?
• 60% have low health literacy
Patient feedback as a predictor...
Safety: patient feedback about hospital
cleanliness is a positive predictor:
• for staff participation in activities like handwashing
• for MRSA infection levels
Catheter-related bloodstream infections occur
56% more frequently in hospitals with low
ratings for nurse or doctor communication
Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354
Edgcumbe - (2008) J. Hosp. Infection
Reed K. (2012) Health Grades Patient Safety and Satisfaction
Clinical unit level – frequency of patient involvement
(CEC Quality System Assessment - NSW)
Always (100%)
Rarely (1% - 33%)
Sometimes (34% – 66%)
Not Applicable
Often (67%-99%)
Never (0%)
Discharge planning
Medication rounds / medication
reconciliation
Ward rounds
368
96
472
254
138
297
Shift handover 42 200
0%
196
20%
199
146 26
5 152
156
141
326
179
116 131
308
180
229
319
40%
60%
80%
100%
Walk in My Shoes:
Patient Story
Introduced by <<Senior staff member>>
<<Patient/family member who has had a recent
experience of care within the service>>
The importance of
learning from
patient experience
Communication Skills
Interactive Scenarios
Communication skills
• Before we talk about patient-focused
techniques..........
Who would like to volunteer to talk to...?
• Role play: Mrs Schulz (32) presented to ED with
pain on the right side of hip following a fall. X-ray
attended, confirming a right hip fracture. Otherwise
healthy, former gymnast.
Plan: Analgesia for pain. Surgery to repair hip.
ISBAR – communicating
about a patient with peers
• Introduction
• Situation
• Background
• Assessment
• Recommendation
Communicating with a patient
• Acknowledge the patient – ask them how they
would like to be referred to? (Mr/Mrs/First
name etc)
• Introduce yourself and explain your role
• Discuss plans: procedure/process/wait
• Explain what will happen/any risks/ questions?
• Tell me what is important to you today as the
patient?
Teach back
• What is this technique? Discuss next steps
with patient and then invite them to convey
back to you in their own words ‘what they
will do’. Inform you about what has been
understood and ‘taken on board’
• E.g. Medication safety/discharge
Armed with new patientfocused skills?
Part 2 – Would anyone like to volunteer?
• Role play: Mrs Schulz (32) presented to ED with
pain on the right side of hip following a fall. X-ray
attended, confirming a right hip fracture. Otherwise
healthy, former gymnast.
Plan: Analgesia for pain. Surgery to repair hip.
Relationship-based
care: the quality of
interpersonal relationships
Caring for the Care Givers
• “Satisfied Staff, Satisfied Patients”
• Work place culture
• Visibly celebrate successes
• Develop skills to build your own capacity as
a health care professional
What about when
things go wrong??
What do patients & family
expect when things go wrong?
• Shared dialogue about what went wrong
(two way communication; value own
account of events)
• More follow-up support
• Input into when time is right for closure
• More information about subsequent
improvements
More than technical skill
Close – <<Senior clinician sharing/demonstrating
their beliefs/values about patient focussed care>>
Thank you!
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