From The Top – what makes leading patient based health services tick?

1. From The Top – what makes leading patient based health services tick?

2. “I couldn’t have faulted the technical care...”

3. Patient Based Care Model

5. 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).

6. 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.

7. 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

8. 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.

9. 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.

10. “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

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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

17. 2.8 million patient surveys 4,610 hospitals

18. Driver matrix – US data Red = low performance + high impact

19. “Hospital improvement priorities do not seem to match up with what hospitals need to improve...”

20. BHI – Insights into Care, 2009

21. Challenges • 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)

22. Patients & their families and/or carers are viewed as integral members of the health care team 2011 – 2012 (strongly agree response)

23. 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).

24. Mandatory for service accreditation from 2013

27. The Patient Based Care Challenge – How can I really make it happen?

28. Southern NSW Signs Up!

29. Engaging patients & carers“Patients and carers as active partners”

30. Overall Views of Health Care System, 2010 Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

31. Clinical unit level – frequency of patient involvement (CEC Quality System Assessment - NSW)

32. Just streamlining processes within a clinical/provider model is not truly engaging patients

33. Source: Patient Experience Leadership Survey, HealthLeaders Media, October 2010

34. 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 Media Survey, Oct 2010)

35. 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)

36. 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.”

37. Reception Welcome DeskThe Medical City, Private Hospital ManilaWe forge sustainable partnerships with enlightened and empowered clients - our patients, physicians and payers - systematically creating opportunities for active engagement, informed participation, and shared responsibility- CORE VALUE.

38. 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 • AtulGawande

39. 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?

40. 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 40th to 74th percentile in a few years • Neuro ICU renovated (USD$1m). Introduced 24/7 visits. Moved ratings from 10th to 95th 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

41. “Success feeds on success” • staff satisfaction • staff retention rates • market share • mortality • LOS • preventable harm

45. “When [the CEO] first came, he really tagged the phrase, “Patients first.” You’ll hear employees talk about that all the time. That really focused the organization – remember, that’s why we here. It’s not about the nurses, or the physicians. It’s about the patients.” • (Chief Nursing Officer)

46. 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

47. Griffin Hospital’s Quality Outcomes • Recognized for providing superior patient care defined by exceptional clinical outcomes in the top 1% of all hospitals in the United States.

48. Designated Sites Demonstrate Improved Outcomes Medicare Core Clinical MeasuresComparison of U.S. Planetree Designated Hospital Average and CMS National Average January 2009-December 2009 Source: The Commonwealth Fund’s WhyNottheBest.org Data accessed 11.01.10 S Frampton

49. Motivation • Internal organizational ethos • Branding the organization • Personal motivation (‘aha’ moment) • “Why?... Because it’s just better healthcare” (CEO)

50. Sustainability • Embedding strategies within policies & processes • Identifying to staff benefits gained by both staff and patients • Committed leadership continually promotes improvements