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The Patient Based Care Challenge How can I really make it happen? > Slide 2 LHDs Sign Up Slide 3 Engaging patients & carers Patients and carers as active partners Slide 4 Source: Patient Experience Leadership Survey, HealthLeaders Media, October 2010 Slide 5 Leaders making patient based care a top priority Survey of over 300 US healthcare leaders 80% strongly agree that patient experience is a business imperative as important as clinical quality 71% rated patient experience as more of a priority this year than last year 82% provide employee training with an increased focus on patient experience Top ranking motivation? producing better quality outcomes (Health Leaders M edia Survey, Oct 2010) Slide 6 Leaders making patient based care a top priority 21% of health leaders in USA (n=332) responded that patient experience is the responsibility of the CEO (up from 14% in 2011). 84% of leaders placed patient experience in their top 3 priorities. Health Leaders Media Patient Experience and H-CAHPS (Aug 2012) Slide 7 Committed senior leadership The mission to improve patient care experience in most leading organizations arose from the Board or CEO, with senior clinicians also in strong support. Slide 8 Engaging staff - Organisational story telling Skill of effective leaders Useful to drive change How to re-engage with original values? History of narrative in medicine & nursing Atul Gawande Slide 9 Sharing a patient-based vision Illustrate your values in your personal story Gain staff commitment (beyond a control culture) Access discretionary effort by staff Reconnecting staff with original values Why did you start to work in health care? Slide 10 CASE STUDIES Slide 11 Medical College of Georgia Case Study 632 bed tertiary medical centre 22,000 admissions per year; 455,000 outpatients Breast cancer unit redesigned by patients. Moved ratings from 40 th to 74 th percentile in a few years Neuro ICU renovated (USD$1m). Introduced 24/7 visits. Moved ratings from 10 th to 95 th percentile in 5yrs. Cut LOS by 50%. CEO saw business case MCG Health overall staff vacancy rate fell from 8% to 0%. Now have long waiting list 2011+ planning for new cancer centre with patient input into design Slide 12 Success feeds on success staff satisfaction staff retention rates market share mortality LOS preventable harm Slide 13 Slide 14 Slide 15 Slide 16 When [the CEO] first came, he really tagged the phrase, Patients first. Youll hear employees talk about that all the time. That really focused the organization remember, thats why we here. Its not about the nurses, or the physicians. Its about the patients. (Chief Nursing Officer) *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515. Slide 17 What makes a difference? Leading the change strategic priority Being transparent -public reporting Gaining a better understanding of the patient experience Improved communication (with patients and between staff) Everyone is a caregiver! The cleaner and the neurosurgeon Slide 18 How do you demonstrate that families and carers are welcome members of the care team? Slide 19 Open visitation? Open Visitation is positively associated with: Decreased septic complications Decreased cardiovascular complications Reducing emotional distress and anxiety Decreased stress hormonal profile Lower mortality rates Fumagalli et al. 2005. Circulation American Heart Association Lee et al. 2007. Crit Care Med Vol. 35, No. 2 Kleinpell. 2008. Crit Care Med Vol. 36, No. 1 Slide 20 Why open visitation? Family and friends visiting decreases patient stress (whilst staff visits often do the opposite) Provides support without getting in the way does not negatively affect performance of clinicians (Bauchner et al, 1996). Range of models: Unrestricted visiting hours Care Partner US Exemplars Slide 21 US Presidential Memorandum on Hospital Visitation (2010) ..addresses the right of a patient to choose who may and may not visit him or her. The President pointed out the plight of individuals who are denied the comfort of a loved one, whether a family member or a close friend, at their side during a time of pain or anxiety after they are admitted to a hospital. Slide 22 Where to start.. Evidence Gap analysis Facilities Existing policies Engage consumer advisors LHD / local executive sponsor Local clinical champions Patient / Family views Slide 23 S Frampton Griffin Hospitals Quality Outcomes Recognized for providing superior patient care defined by exceptional clinical outcomes in the top 1% of all hospitals in the United States. Slide 24 Source: The Commonwealth Funds WhyNottheBest.org Data accessed 11.01.10 S Frampton Designated Sites Demonstrate Improved Outcomes Medicare Core Clinical Measures Comparison of U.S. Planetree Designated Hospital Average and CMS National Average January 2009-December 2009 Slide 25 Internal organizational ethos Branding the organization Personal motivation (aha moment) Why?... Because its just better healthcare (CEO) Motivation *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515. Slide 26 Sustainability Embedding strategies within policies & processes Identifying to staff benefits gained by both staff and patients Committed leadership continually promotes improvements *Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515. Slide 27 Experience Economy: Disney does not provide a service. They provide an "experience. Hospitals would do well to emulate the most vital things that earn Disney the love of their guest and employees. Slide 28 Taking it to the next level We need to think of the patient and their family as integral members of the healthcare team. Once youve gotten mileage out of your systems, then the next level of improvement you can only do by engaging the patient Professor Tom Delbanco, Inaugural Chair, Picker Institute, BIDMC Physician, Boston Harvard Medical School Slide 29 Staff training capacity building (S2.6) Planetree retreat Frampton S Slide 30 Informing consumers about the organizations S&Q performance (S2.7) Slide 31 Slide 32 Uptake by Local Health Districts Slide 33 Consumers and/or carers participate in the evaluation of patient feedback data (S2.9) Slide 34 Slide 35 Tea Break Slide 36 Consumer partnerships that work > Slide 37 The Challenge for health services Recent survey of over 3500 hospital/health senior executives across Australia. From the survey, 39.2% of the respondents said that Partnering with Consumers is by far the most challenging aspect of the NSQHS standards. Partnering with Consumers Survey respondents: public 75.3%, private 24.7%. Source: Criterion Slide 38 Models for Consumer Partnerships Patients as Advisors (PFAC, etc) Patients as Teachers (service design & professional education) Patients Accelerating Practice Change Service improvement initiatives with priorities identified through patient feedback Patients informing Policy development Slide 39 Consumer partnerships Determine attributes: fit for the job Aim to improve patient care through positive contribution Objective and constructive manner Willing to speak up -in the right place in their journey Adequately prepared orientation;expectations Cultural fit organisation/committee believes consumer involvement is integral to QI Responsive: suggestions acted upon Slide 40 Power of the n=1 Using individual patient stories to drive change Political tactic Powerful tool for engendering emotion Use to complement clinical focus Slide 41 Slide 42 > Slide 43 Challenges? Squeaky wheel syndrome Advocacy Vs sharing experience Supporting seat at the table Which consumers have the time? Slide 44 Which core action item in Standard 2 had the highest Not Met rate?.... 2.2.2 Consumers actively involved in decision making about safety & quality 49% - Highest not met rate in ACHS pilot audit of standards with 46 hospitals Slide 45 Building partnerships Fear of the unknown by providers is the greatest barrier to involving patients in safety improvement work Robert Wood Johnson Foundation Slide 46 Consumer engagement in Safety & Quality (at CEC) (S2.2) The consumer tends to see the problem and solution so much more simply and they ask reasonable questions whereas the healthcare professional tends to drown in the complexity / what cannot be done Helps to focus a clinical group on the purpose of initiatives Slide 47 Perceived Role of CEC Consumer Advisors in Safety & Quality Slide 48 Access to orientation and training for consumers (S2.3) Consumer Safety & Quality Training open to LHD Consumers on S&Q Committees since 2012 Slide 49 Caregivers and patients co-creating a shared agenda for improvement Strategies for scaling up consumer engagement: o Focus Groups with patients, families, staff, etc. o Patient and Family Advisory Councils o Patient engagement on safety, quality and other organizational committees o Patient participation in hiring and evaluation o Patients as faculty o Patients to develop/act in simulations for staff training Slide 50 Culture Assessment: Listening to the voices of patients, families and caregivers PersonalizeHumanizeDemystify Slide 51 The generic patient? About 60% of Australians (15-74yrs) have limited health literacy* 1 in 3 NSW residents were born overseas 1 in 4 speak a language other than English at home *2006 Adult Literacy and Life Skills Survey, ABS Slide 52 Consumer feedback on patient information publications (S2.4) What is your health services policy on health literacy? How are you assessing and breaking down barriers for patients? Slide 53 How are you addressing health literacy barriers? Slide 54 Slide 55 Slide 56 Slide 57 Sharing patient experiences of care > Slide 58 Engaging clinicians and patients/family in improving care > Slide 59 Summation >