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Patient Based Care and Communication

Patient Based Care and Communication. Walking in the patients shoes <<X>> Hospital. <<XX Hospital/ Service >>– The Vision for Quality Care. General Manager/Chief Executive. Quality and safety programs. What do you expect good care to look like? . <<Local senior staff member>>.

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Patient Based Care and Communication

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  1. Patient Based Care and Communication Walking in the patients shoes <<X>> Hospital

  2. <<XX Hospital/ Service >>– The Vision for Quality Care General Manager/Chief Executive

  3. Quality and safety programs

  4. What do you expect good care to look like? <<Local senior staff member>>

  5. What are your own expectations of ‘good’ care?

  6. 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

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

  8. 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).

  9. Leading with words & actions “We need to think of the patient and their family as integral members of the healthcare team. Once you’ve 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

  10. Patient Based Care Model

  11. 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.

  12. 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.

  13. Impact on the ‘hard stuff’... • Patient Based Care links to improved safety: • Decreased mortality1 • Decreased rates of hospital-acquired infection2 • Decreased surgical complications3 • Higher quality clinical care/best practice4 • Improved patient functional status2 • Meterko M et al (2010) Health Services Research • DiGioia A M et al (2008) Agency for Health Care Research and Quality • Murff et al (2006) Qual Saf Health Care • Jha A et al (2008) New England Journal of Medicine

  14. Mandatory for service accreditation from 2013

  15. What do patients from our service want to see improved? <<Local senior staff member>>

  16. BHI – Insights into Care, 2009

  17. What do <<XX Hospital>> patients say? • X% inpatients rated overall care ‘excellent’ (NSW av. 34%); Y% ‘poor-to-fair’ • X% inpatients rated staff team work ‘excellent’ (NSW av. Y%) • X% inpatients reported that they were always ‘treated with dignity and respect’* (NSW av. 81%) – NB: a main influencing factor for ‘poor’ care • X% inpatients rated room cleanliness as ‘excellent’ (NSW av. 25%) • (Bureau Health Information – Insights into Care, 2009)

  18. What do we know about who our patients are? • XX% born overseas (from….??) • YY% speak English as their first language • X% non-English speaking background (which languages…..??) • Y% indigenous population • What do we know about Australians? • 60% have low health literacy

  19. 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 • Catheter-related bloodstream infections occur 56% more frequently in hospitals with low ratings for nurse or doctor communication Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354 Edgcumbe - (2008) J. Hosp. Infection • Reed K. (2012) Health Grades Patient Safety and Satisfaction

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

  21. Walk in My Shoes: Patient Story Introduced by <<Senior staff member>> <<Patient/family member who has had a recent experience of care within the service>>

  22. The importance of learning from • patient experience

  23. Communication Skills Interactive Scenarios

  24. Communication skills • Before we talk about patient-focused techniques.......... • Who would like to volunteer to talk to...? • Role play: Mrs Schulz (32) presented to ED with pain on the right side of hip following a fall. X-ray attended, confirming a right hip fracture. Otherwise healthy, former gymnast. • Plan: Analgesia for pain. Surgery to repair hip.

  25. ISBAR – communicating about a patient with peers • Introduction • Situation • Background • Assessment • Recommendation

  26. Communicating with a patient • Acknowledge the patient – ask them how they would like to be referred to? (Mr/Mrs/First name etc) • Introduce yourself and explain your role • Discuss plans: procedure/process/wait • Explain what will happen/any risks/ questions? • Tell me what is important to you today as the patient?

  27. Teach back • What is this technique? Discuss next steps with patient and then invite them to convey back to you in their own words ‘what they will do’. Inform you about what has been understood and ‘taken on board’ • E.g. Medication safety/discharge

  28. Armed with new patient-focused skills? • Part 2 – Would anyone like to volunteer? • Role play: Mrs Schulz (32) presented to ED with pain on the right side of hip following a fall. X-ray attended, confirming a right hip fracture. Otherwise healthy, former gymnast. • Plan: Analgesia for pain. Surgery to repair hip.

  29. Relationship-based care: the quality of interpersonal relationships

  30. Caring for the Care Givers • “Satisfied Staff, Satisfied Patients” • Work place culture • Visibly celebrate successes • Develop skills to build your own capacity as a health care professional

  31. What about when • things go wrong??

  32. What do patients & family expect when things go wrong? • Shared dialogue about what went wrong (two way communication; value own account of events) • More follow-up support • Input into when time is right for closure • More information about subsequent improvements

  33. More than technical skill Close – <<Senior clinician sharing/demonstrating their beliefs/values about patient focussed care>>

  34. Thank you! Please fill out the brief evaluation form

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