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Andrew & Tony's Excellent Adventure

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Andrew Old

on 16 September 2016

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Transcript of Andrew & Tony's Excellent Adventure

Consumer Liaison Office
: "complaints are never just about the patient; they involve the family"
An overview of the complaints received in the last two years highlighted:

•Care and treatment (perceived quality of)

And: early engagement of patients and families will help resolve issues and prevent escalation of dissatisfaction.

Patient Experience Survey
: Asks if whanau, family or friends made to feel welcome and able to give patients the support they needed.

68% were made to feel welcome
12% were not made to feel welcome, or only to some extent
20% said that no family were involved in their care.

Annual Plan:
for 2012-13 includes “Translate the concept of Families are not Visitors into reality by building the case for a change in culture”. The deliverables are “Business case approved by December 2012” and “Programme roll-out has begun by June 2013”.
26 September - 4 October 2012, USA
Andrew & Tony's Excellent Adventure
What is "Patient & Family Centred Care" ?
To begin .....
White Memorial Medical Center
UC Irvine Medical Center
Sharp Memorial Hospital
Where to from here.....
No evidence of effectiveness
Too costly
Takes too much time
It requires new construction with individual rooms
Patients’ access to the medical record breaches privacy
Patients will have unrealistic demands
Families will interfere with care, creating delays, errors, and lapses in infection control
Having patients and families at care team meetings will inhibit staff and providers from being open
It’s not appropriate for the New Zealand context
An approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.

Patient- and family-centered care is working with patients and families, rather than just doing to or for them.
New Zealand
The Health and Disability Commissioner Code of Rights
The right to dignity and independence
The right to effective communication
The right to be fully informed
The right to make an informed choice and give informed consent
The right to support

Whanau Ora
Mason Durie, and others, work on the collective, holistic model of health

(e.g. Te Whare Tapa Wha)

He Korowai Oranga:
The overall aim of He Korowai Oranga is whanau ora - Maori families supported to achieve their maximum health and wellbeing.

Health Quality & Safety Commission

Improving patient safety
Fostering quality improvement
Improving consumer engagement
Sponsored visits and workshops by Beverley Johnson (IPFCC) & Lynne Maher (NHS Institute for Innovation & Improvement)

Bay of Plenty DHB
A strategy and action plan
Confirm Executive Sponsor
Form a Steering Group, involving patient and family representatives
Form a Working Group, involving patient and family representatives
Develop and present draft Strategy with short, medium and longer-term actions to the Exec team for adoption
? mid-December 2012
Present to Board for endorsement
? February 2013
University of Michigan Cardio-Vascular Centre
"There is nothing more powerful than an idea whose time has come."
Victor Hugo

Do something. Right now. Today.
A five year comparison of two comparable hospital units found that the unit who had implemented a model of patient & family centered care consistently demonstrated
a shorter length of stay
lower cost per case
higher average overall patient satisfaction
Stone, S. (2008). A Retrospective Evaluation of the Impact of the Planetree Patient Centered Model of Care Program on Inpatient Quality Outcomes. Health Environments Research and Design Journal, 1(4):55-69
founded by a patient in 1978
Mission to 'Personlise, Humanise and Demystify the experience of care'

Institute for Family Centered Care (est. 1992)
Changed to Institute for Patient & Family Centered Care (2010)

(est 1994)

Crossing the Quality Chasm (IOM, 2001)
Patient-centered care one of six Quality Aims

World Alliance for Patient Safety (WHO, 2004)
Patients for Patient Safety is one of six action areas

(est 2009)
A more specific Provider-arm view
Options (examples only)
Assign KPIs to patient and family experience and involvement
KPIs to be assigned to senior management committee with responsibility for reporting performance to CEO/Board
Establish regular reports to Exec team, CDs, Nurse Leaders, Service Managers identifying trends and latest results overall and by service unit
Exec-team ward rounds
Provide an opportunity for all senior leaders and high-performing staff of all disciplines to learn about patient- and family-centered care
Further develop the use of patient bedboards
Bedside handover (with patient-id'ed family/carers attendance requested)
Enhance role of vounteers
Address signage, car-parking fees and accessibility
'Visitor' policy
Application of Privacy Code
Establish Forum for all Consumer Reps from across the DHB to share experience, learnings, issues and identify solutions and establish work plan
How well is ADHB doing?
Overall assessment: Some services are patient and family-centered, and have been trying to influence others for a long time.

However, on average ...
Setting the stage = 4/26
Communicating effectively with P and F = 7 /10
Personalisation of care = 7/10
Continuity of care = 5/14
Access to information = 6/14
Family involvement = 5 /18
Environment of care = 10/30
Spirituality = 1/6
Integrative medicine = 0/2
Caring for the Community = 2/4
Care for the Caregiver = 6/12
At the Bedside

Bedside boards in a few wards
Family presence in Starship
Service level
Whanau and Fanau Support Services
Patient Experience survey monthly (inpatients, excluding mental health)
Service-specific surveys (eg: radiology)
'Voice of the Customer'
Consumer reps (eg: Women's health, Mental health)
3 action-research case-studies (Cardiology, Dementia, Te Whare Awhina)
Healthy Village Action Zones
Local Health Partnerships
Reo-Ora Health Voice Community Panel (315 members)
Systems level
MOU with Ngati Whatua
Egs. of activity in the ADHB Provider-arm
Interviews (20 - clinical and management)
Some clear themes:
DMs capacity to respond to 'lay' input greatly influenced by formal and informal networks and accountabilities
Unit/ service specific rules and accountabilities
Generic rules and accountabilities
Some rules and accountabilties counter-productive
Some staff just do it because it feels right
'Lay' perspectives and needs are not seen as credible or compelling as institutionalised ones
Formally ascribing them more value will be helpful
Some new supports, rules and accountabilities needed
How well are we doing at translating what we hear into action?
Picker/Planetree Self-Assessment
health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care.
Suby, C. (2008). 2007 Survey of Hours Report. Direct and Total Hours Per Patient Day (HPPD) By Patient Care Units. Perspectives on Staffing and Scheduling. Bloomington, MN
RN staffing ratios and hours per patient day had not changed after the adoption of a patient centered care approach in four hospitals studied.
Over the course of a patient-centered care implementation (a five year period), a patient-centered care unit was able to reduce the higher cost RN hours by using more lower cost clerical and aide/LVN hours, compared to an increase in these higher cost RN hours by the other hospital units studied
Stone, S. (2008). A Retrospective Evaluation of the Impact of the Planetree Patient Centered Model of Care Program on Inpatient Quality Outcomes. Health Environments Research and Design Journal, 1(4):55-69
Dignity and Respect
... patient feedback

I felt very comfortable with the attention and care offered by the nursing staff and the way the "next shift" of nurses always introduced themselves and asked if there was anything they could do to make my stay more comfortable

My Aunt has bladder issues which means that she needs to go to the toilet the second she has the urge - so waiting half an hour for a nurse to come means that she wets the bed which is just awful. The nurses were talking together rather than attending her call. … There needs to be a greater focus on identifying individual needs - and that will mean you provide a better service.
Information sharing
The A&E department was absolutely marvellous when I was in there for 24 hours the other week, everyone explained to me what they were going to do and why and answered all questions.

Poor communication and shielding important information seriousness of the case was kept in the dark. Making me lose my wife prematurely. A definite let down.
As I had an eye operation as well as treatment, all staff encouraged my wife to participate in any discussions. This was important as my wife organised my appointments & medications & understood what & why these were needed

… I have asked continuously to see a psychologist as have got unresolved childhood abuse/bullying issues that have never been addressed due to the psychiatrist perhaps misdiagnosing me. My key-worker could see I was dissociating on a frequent basis and had an obvious eating disorder yet this was never addressed nor was the complex PTSD that I had diagnosed ... when I found out I could ask for a second opinion (after 9 years). I just feel abused and bullied by certain staff in the way they have treated me.
My family have received fast and effective medical care both in the wdhb and adhb but I know this isn't the same for everyone. I'd like to help make it better for everyone who needs it
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