essence of care -moving forward maureen morgan, department of health 13 th november 2008
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Essence of Care -Moving Forward Maureen Morgan, Department of Health 13 th November 2008. Two Main Themes. The value of benchmarking the environment EoC and the new quality landscape. Context. In 3 rd stage of 10yr plan to reform health care - PowerPoint PPT PresentationTRANSCRIPT
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Essence of Care
-Moving Forward
Maureen Morgan, Department of Health
13th November 2008
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Two Main Themes
• The value of benchmarking the environment
• EoC and the new quality landscape
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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
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So far – So Good
• Achieved national targets on reducing mortality from cancer and cardio-vascular 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]
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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
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Safe from....
• harm• indignity• hunger and thirst
• being de-
humanised• being de-
personalised
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BBC Poll 30th June ‘08
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Why the Environment?
• Earlier benchmarks arose from patient complaints & untoward incidents
• Patients’ experience of care can be important as clinical outcome
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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
First Impressions Count
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• 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!
What you see tells a story
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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
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More than just an ‘extra’
Research identified • how healing environments
shortened patients’ post-operative 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
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Environment Encompasses how Care
is ExperiencedLittle things matter
• the ambience
• the rapport with staff• how staff behave
towards one another• how they look • cleanliness, tidiness
etc
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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
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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?
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Relevance of EoC to New Relevance of EoC to New Approach to Managing Approach to Managing
PerformancePerformance • From central targets to self-improving systems From central targets to self-improving systems • Clinically focused and evidence basedClinically focused and evidence based• Responsive to patients, public and staff Responsive to patients, public and staff • Stronger accountability Stronger accountability • Emphasis on qualitative dataEmphasis on qualitative data• Externally validated by CQCExternally validated by CQC
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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