welcome >. from the top – what makes leading patient based health services tick? >
TRANSCRIPT
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Welcome
<<Chief Executive or Board Chair/Member>>
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From The Top – what makes leading patient based health services tick?<<Local Leader with focus on Patient Based Care>>
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“I couldn’t have faulted
the technical care but...”
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Patient Based Care Model
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Overall Views of Health Care System, 2010
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Only minor changes needed
24 38 42 38 51 37 40 44 46 62 29
Fundamental changes needed
55 51 47 48 41 51 46 45 44 34 41
Rebuild completely 20 10 11 14 7 11 12 8 8 3 27
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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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).
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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.
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The evidence
Improved patient experience is positively
associated with:
• Objectively measured health outcomes
• Adherence to medications and treatments
• Health resource usage
• Technical quality of care & adverse events
Doyle C et al BMJ Open Jan 20, 2013
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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.
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Organizational outcomes
Business-case for Patient Based Care: • Decreased malpractice claims• Higher employee retention rates• Decreased readmission rates• Reduced operating costs
Charmel PA, Frampton SB. Building the business case for
patient-centred Care. Healthcare Financial Management
2008;March 1-6.
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“The three dimensions of quality should be
looked at as group and not in isolation.”
“Clinicians should resist sidelining patient
experience as too subjective or mood-
orientated, divorced from the ‘real’ clinical
work of measuring safety & effectiveness.”
Doyle C et al BMJ Open Jan 20, 2013
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Leaders in patient based care*Organisational characteristics:
• Strong committed senior leadership
• Communication of strategic vision
• Engagement of patient and families
• Sustained focus on staff satisfaction
• Regular measurement and feedback reporting
• Adequate resourcing of care delivery change
• Staff capacity building
• Accountability and incentives
• Culture strongly supportive of change and learning
*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
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Leadership commitment Start each Board meeting with a story of patient
care from your service Arrange for board and executive members to
visit wards to regularly talk with staff and patients Involve patient advisors in strategic planning
process Demonstrate leadership commitment –
communicate a patient-focussed mission to new staff at orientation
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Lessons learnt – Inquiries....Mid Staffordshire, UK
• Need for a common culture of ‘putting
patients first’
• “Every single person serving patients
needs to contribute to a safe, committed
and compassionate and caring service”
• Need for strong, patient centred healthcare
leadership
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Listening to patient feedback – use to drive change....
Catheter-related bloodstream infections
occur 56% more frequently in hospitals
with low patient ratings for nurse or
doctor communication
Reed K. (2012) Health Grades Patient Safety and Satisfaction
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Patient feedback as a predictor...
Safety: patient feedback about hospital
cleanliness is a positive predictor:
• for staff participation in activities like hand-
washing
• for MRSA infection levels
Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354
Edgcumbe - (2008) J. Hosp. Infection
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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
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2.8 million patient surveys
4,610 hospitals
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Red = low performance + high impact
Driver matrix – US data
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“Hospital improvement
priorities do not seem to
match up with what
hospitals need to
improve...”
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BHI – Insights into Care, 2009
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Challenges ahead
• Changing mind set of staff from ‘provider-focus’ to a ‘patient-focus’
• Change takes longer than anticipated – it’s about transforming culture and care delivered
“So for whatever reason, we had the attitude where the physician is king and the patient, ‘well, we’ll get to the patient when we have time.’” (COO)
*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
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Clinical unit level – frequency of patient involvement (CEC Quality System Assessment - NSW)
Shift handover
Ward rounds
Medication rounds / medication reconciliation
Discharge planning
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
42
138
96
368
200
297
254
472
199
179
196
146
180
116
156
26
229
131
141
5
319
308
326
152
Always (100%) Often (67%-99%) Sometimes (34% – 66%) Rarely (1% - 33%)Never (0%) Not Applicable
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Just streamlining
processes within a
clinical/provider model is
not truly engaging
patients
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Patients & their families and/or carers are viewed as integral members of the health care team 2011 – 2013 (strongly agree response)
2011 2012 20130%
10%
20%
30%
40%
50%
60%
28%
33%
48%
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Patient engagement:Not just the ‘soft stuff’
Service quality and interpersonal relationships are
critical dimensions to support and promote not
only improved patient care experience but also
patient safety, treatment, recovery and wellbeing
(Australian Commission on Safety and Quality in Healthcare [ACSQHC], 2010).
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Mandatory for
service
accreditation
from 2013
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Video session