Our healthcare: what patients want from patient centred standards

1. Our healthcare: what patients want from patient centred standards Patricia Wilkie Chairman Lay Committee Academy Medical Royal Colleges

3. Patient standards. 1 Discussion about treatment and options (7) Explanation about what is happening (A&E) Reason for investigations Explanation of test results Information about medicines and their side effects (3) Accurate information about how one feels post operatively (After Bruster et al 1994)

4. Patient standards.2 Competent diagnostician (3) Competent surgeon (3) Treating patient as a whole Continuity of care (general practice) Knows limits of expertise (3) Knows how to guide patients to information

5. Two definitions of a good physician �The most important difference between a good and indifferent clinician lies in the amount of attention paid to the story of the patient� Sir Farquahar Buzzard (1871-1945) �A great physician understands diagnosis and is not he who has a remedy for all symptoms� Dr Jacob Bigelow (1787-1879)

6. Patient centred care.1 Should provide patient access to protocols and guidelines Should give patient choice in treatments provided Should use patient information in service design Should place premium on patient views Should challenge vested interests by asking �who is the customer�

7. Patient centred care.2  Should share information with patients Should share information with public Should ensure collaborative planning involving patients and professionals Should develop advocacy for those least able to speak out Should publish audit results

8. Problem for organisation: how patients are described Demand, costs, benefits, input and output Voters, clients or consumers of services Bearers of rights or pursuers of litigation The �leg ulcer� in bed 14 Frozen sperm in the deep freeze Points in a graph Numbers crunched in a soft ware programme (after Roy Porter,1997)

9. Organisation: patient standards and patient centred care. 1 Services to focus directly on patient Patient surveys in clinical and non clinical departments Focus on high quality patient outcomes Partnership between patient and clinical team Use of reliable instruments for measuring and monitoring patient care

10. Organisation: patient standards and patient centred care. 2 Publish results of surveys Use results of surveys to improve service Understand how management affects the provision of patient centred care � mixed sex wards Involve and work with patients, voluntary organisations and the public

11. Organisational readiness Must have an attitude that accepts patient standards and patient centred approach Must have commitment to make the changes to produce a patient centred environment Needs sufficient enthusiasm to maintain changes Patient centred approach requires reinforcement and reward

12. Patient standards in education Patients as teachers Patient involvement in research Patient involvement in curriculum development �Town and Gown� partnerships Improving health care

13. Patients as teachers. 1 Patients playing patient role for training and examination Patients involved in creating roles Patients involved in assessment Patients involved in giving both formative and summative feedback about interpersonal, communication and physical examination skills Implications for GMC, Colleges and PMETB

14. Patients as teachers. 2 Patients involved in developing and enhancing the quality of teaching Patient narratives to capture the patient experience Patient involvement in curricula development in undergraduate and post graduate education and training

15. Patients involved in research Not just as a participant Patients involved in defining questions Patients choosing research topics Patients involved in research design Patient testing of information leaflet Disseminating of research information Research results into practice Cochrane Collaboration and Involve

16. Town and Gown: the community DOCC- parents of children with chronic illness as teachers in the community of trainee physicians (USA) Community Involvement Team work with mental health users (University of Central Lancashire) Queen�s Anniversary Prize for higher and further education

17. Improving health services UK Expert Patient Programme Maternity services Care of children in hospital Potential for fewer complaints Potential for more satisfied patients Pilot studies and evaluation needed

18. Changing heart and minds Persuading guardians of curriculum GMC Post graduate deans PMETB Colleges and Faculties

19. Patient and public awareness of GMP standards Patients expect high quality care given by competent doctors Unlikely that most patients know the standards they should expect Public and patients unaware of role of GMC GMP not widely available: distribute and show widely

20. Patient feedback Patient surveys but not instant Use of Blogs Patient opinion websites, government and problem specific Comments books widely available Use of complaints to organisations, NCAS and to GMC Surveys must reflect patient standards

21. Who to consult, listen to and appoint? Individual patients who have direct experience Patient members of voluntary organisations who have group knowledge Patient advocates who have wide general knowledge of the patient perspective (After Charlotte Williamson 2007)

22. Who to appoint or consult? Organisations need to find the �right� people Non-executive directors need to have an understanding and knowledge of the patient standards and patient centred care Applies to GMC Council, proposed GMC lay associates, PMETB Board and DH working groups and committees and commissioners

23. A conversation First doctor. It seems to me that you are locating them wrongly. The heart is on the left and the liver is on the right. Second doctor. Yes in the old days that was so, but we have changed all that and now practice medicine by a completely new method. Moli�re Le M�decin Malgr� Lui 1666

24. Overweight patients wanting treatment Advice from Dr John Abernethy (1764 -1831) � Madam, buy a skipping rope�