Enhancing Healthcare Quality: Partnering with Consumers Standard

1. Standard 2:Partnering with consumers Nicola Dunbar, Accrediting Agencies Surveyor Workshop, 10 July 2012

2. Why have a Standard about partnering with consumers? • Declaration of Alma Ata (1978)“The people have the right and duty to participate individually and collectively in the planning and implementation of their health care” • Benefits of partnerships associated with: • experience of care • business and operations of delivery health services • work environment • clinical quality and outcomes: • decreased mortality • lower readmission rates • fewer healthcare associated infections • reduced length of stay • improved adherence to treatment • improved functional status

3. The Standard • Leaders of a health service organisation implement systems to support partnering with patients, carers and others consumers to improve the safety and quality of care. • Patients, carers, consumers, clinicians and other members of the workforce use the systems for partnering with consumers.

4. Three criteria • Consumer partnership in service planning • Governance structures are in place to form partnerships with consumers and/or carers • Consumer partnership in designing care • Consumers and/or carers are supported by the health service organisation to actively participate in the improvement of the patient experience and patients health outcomes • Consumer partnership in service measurement and evaluation • Consumers and/or carers receive information on the health service organisation’s performance and contribute to the ongoing monitoring, measurement and evaluation of performance for continuous quality

5. 1. Consumer partnership in service planning 2.1: Establishing governance structures to facilitate partnership with consumers and/or carers • Why? • Consumers have a unique perspective that can help identify opportunities for improvement that might not otherwise be apparent • What? • Develop / adapt a framework that includes requirements for involving consumers in clinical and organisational governance (2.1.1) • Develop and implement a policy for identifying and involving diverse groups who access your services (2.1.2)

6. 1. Consumer partnership in service planning 2.2: Implementing policies, procedures and/or protocols for partnering with patients, carers and consumers in: • strategic and operational/services planning • decision making about safety and quality initiatives • quality improvement activities • Why? • Need to take a systematic approach to partnering with consumers • What? • Develop / adapt and implement systematic processes for involving consumers in: • strategic and/or operational planning (2.2.1) • decision-making about safety and quality (2.2.2)

7. 1. Consumer partnership in service planning 2.3: Facilitating access to relevant orientation and training for consumers and/or carers partnering with the organisation • Why? • Ensuring that individuals have the necessary skills and capacity to engage with healthcare providers is essential for effective partnerships • What? • Develop / adapt / provide access to orientation training and resources for consumers who participate in governance processes (2.3.1)

8. 1. Consumer partnership in service planning 2.4: Consulting consumers on patient information distributed by the organisation • Why? • 60% of the population have a low level of health literacy • Need to present information in a way that can be understood by target audience • What? • Develop and implement a systematic process for sourcing consumer feedback on publications (2.4.1) • Use consumer feedback to inform development and refinement of patient information publications (2.4.2)

9. 2. Consumer partnership in designing care 2.5: Partnering with consumers and/or carers to design the way care is delivered to better meet patient needs and preferences • Why? • Benefits of involving consumers in design and redesign projects: • improved communication and teamwork • better consumer experiences • better patient flow • What? • Develop / adapt and implement a systematic process for involving consumers in design and redesign projects (2.5)

10. 2. Consumer partnership in designing care 2.6: Implementing training for clinical leaders, senior management and the workforce on the value of and ways to facilitate consumer engagement and how to create and sustain partnerships • Why? • One of the most effective change mechanisms for improving the experience of patients is education and training for healthcare providers • What? • Develop / adapt / provide access to training and resources on partnering with consumers (2.6.1) • Involve consumers in providing training (2.6.2)

11. 3. Consumer partnership in service measurement and evaluation 2.7: Informing consumers and/or carers about the organisation’s safety and quality performance in a format that can be understood and interpreted independently • Why? • Increases transparency about performance and potential for engagement with the community • What? • Develop / adapt and implement a policy on providing safety and quality performance information to the community, consumers and carers (2.7.1)

12. 3. Consumer partnership in service measurement and evaluation 2.8: Consumers and/or carers participating in the analysis of safety and quality performance information and data, and the development and implementation of action plans • Why? • Ensures that consumer perspective is considered in interpretation of, and response to safety and quality performance information • What? • Develop / adapt and implement a process for involving consumers in: • analysis of organisational safety and quality performance data (2.8.1) • planning and implementation of quality improvements (2.8.2)

13. 3. Consumer partnership in service measurement and evaluation 2.9: Consumers and/or carers participating in the evaluation of patient feedback data and development of action plans • Why? • Ensures that consumer perspective is considered in interpretation of, and response to patient feedback information • What? • Develop / adapt and implement a process for involving consumers in: • the evaluation of patient feedback information (2.9.1) • planning and implementation of quality improvements identified through patient feedback information (2.9.2)

14. General issues – 1 • What is a consumer? • Patients, family members, carers etc who are currently or have recently used the service • Patients, family members, carers etc who have used the service in the past • Representatives from consumer groups, disease-based groups etc, members of local community All items and all standards

15. General issues – 2 • Different terms – same concepts: • Consumer partnerships • Consumer / patient / community / citizen engagement • Consumer participation • Consumer-centred care / patient-centred care / patient and family-centred care • Key principle: • Improving the health service by… • … using the knowledge, skills and experience of … • … people who are using, have used or may use the health service All items and all standards

16. General issues – 3 • Some jurisdictions have programs / requirements / legislation in this area – will determine nature of processes for partnering with consumers • eg legislated consumer advisory committees in Victoria • eg consumer engagement framework in Queensland All items

17. General issues – 3 • Methods for partnering with consumers can vary depending on the nature of the organisation and context: • Size of the health service • Nature of services provided • Staff and resources available to support partnerships • Availability of local consumer groups / individuals • Nature of community served – demographics, geographic spread etc • Development of partnership processes to date – recognising that these are new concepts and some items are core, but most are developmental All items

18. General issues – 4 • Methods for involving consumers could include: • Representative on board • Representatives on relevant committees • Consumer advisory committee or similar • “Critical friends” or other less formal groups – more ad hoc groups that may be suitable for smaller organisations, or specialist areas • Holding planning days, forums or workshops with consumer participants – also joint consumer/staff workshops • Consultation process to seek feedback – could be a large formal processes, or small targeted consultations on discrete issues Methods for involving consumers particularly relevant for 2.1, 2.2, 2.4, 2.5, 2.8, 2.9

19. General issues – 5 • Methods for involving consumers could include (cont): • Focus groups / waiting room discussions / informal meetings • Meetings with community and consumer organisations • Can also gain information about the views of consumers from: • Patient experience and other consumer surveys • Real time feedback forms • Review of complaints • Providing information publicly and inviting comment Methods for involving consumers particularly relevant for 2.1, 2.2, 2.4, 2.5, 2.8, 2.9

20. General issues – 6 • Policy frameworks: • Can have one overall policy framework that sets out requirement for involvement of consumers and has a set of associated policies / protocols / plans that cover specific ways in which consumers will be involved • Can have policy framework reflected in terms of reference and documents for relevant governance structures (eg consumer advisory committee or board) • Can have separate consumer partnership / engagement etc policies for the whole organisation • Can have consumer partnership policies for specific clinical areas (eg maternity, paediatrics) • Can have consumer partnerships include in policies for other organisational activities and functions (eg safety and quality, review of patient experience information) All items

21. General issues – 7 • Need documentation of systems and processes to partner with consumers: • Documentation from formal structures such as committees, policies, consultation processes, training etc • Documentation needed even for less formal methods such as critical friends groups, waiting room discussions: • could be in the form of project plans, reports of feedback obtained, file notes of discussions etc • Where the involvement is based only on processes to seek feedback from consumers: • need indication of how this information feeds into organisational governance processes All items

22. Specific issues – 1 • Consideration of hard to reach groups (2.1.2): • Formal assessment of community profile (or similar process) not necessary • Should be some recognition / understanding of nature of population served documented as part of the policy framework for involving consumers • Strategies for involving consumers in hard to reach groups relevant to local population should be included in policy framework • Processes for involving consumers from hard to reach groups may not be across the whole health service – may initially be focussed in areas where there are particular issues (eg drug and alcohol services, mental health)

23. Specific issues – 2 • Training and support for consumers and/or carers (2.3.1): • Could include: • written information • training and education • ongoing support • Does not need to be developed or delivered internally – there are external organisations that can provide such training, or have material that can be adapted • Demonstration of training could include: • policies regarding need / support for training • training calendar • attendance records • training materials

24. Specific issues – 3 • Consulting consumers on patient information (2.4.1 and 2.4.2): • Not all health services will develop their own patient information publications: • they may be obliged to use certain documents and have no control over the content (eg from state health departments) • they may choose patient information publications from consumer / disease groups / professional associations – if possible they should try and choose resources that have been developed in consultation with consumers • if using external publications – need to consider whether they need to be tested locally (eg if there are differences in local population) • Need to demonstrate not only that feedback has been obtained from consumers, but that it has been considered when publications are finalised Core items

25. Specific issues - 4 • Partnering with consumers to design care (2.5.1): • There are a range of methodologies for designing care (eg service redesign, user-centred design, experience-based design etc) • The focus of this item is not on the specific methodology used • The focus is about the need to involve consumers: • both as part of the design / re-design process (eg collecting feedback about experiences, including consumers in processes to generate solutions) • and also as part of the governance process (eg on steering committees)

26. Specific issues – 5 • Training for workforce (2.6.1): • Training can be part of orientation, continuing professional development, online education etc • Focus of training is on partnering with consumers when care is provided – rather than partnerships at an organisational or governance level • Does not need to be developed or delivered internally – there are external organisations that can provide such training, or have material that can be adapted • Demonstration of training could include: • policies regarding need / support for training • training calendar • attendance records • training materials Core item

27. Specific issues – 6 • Involving consumers in training (2.6.2): • Can involve consumers both in design and delivery of training • Different methods for involving consumers in delivery can be used, such as: • inviting consumers to speak about their experiences • using video or audio recordings of consumers’ experiences • undertaking exercises where workforce “live in the patient’s shoes” • Documentation can include: • records of meetings, focus groups etc where consumers provide feedback on training • training materials involving consumers • feedback from consumers involved in training • records of training provided by consumers

28. Specific issues – 7 • Provide consumers with information about safety and quality (2.7.1): • Focus is on providing information about safety and quality performance in a way that can be can be easily understood by consumers • Can include making information available to the general public (eg through the media, web site), as well as providing information to consumers who use the health service (eg posters / displays) • Documentation can be based on information made available to consumers Core item

29. Resources • Safety and Quality Improvement Guide for Standard 2 • Additional material about Standard 2 to follow from the Commission • Jurisdictional programs • National and state-based consumer groups • Other Australian organisations and resources • International organisations: • Picker Institute / Picker Europe • Institute for Family and Patient Centered Care

30. Summary • Purpose of the Standard is to support effective partnerships between consumers, patients, carers, healthcare providers and health service organisations at all levels of healthcare provision, planning and evaluation • There is no one way of achieving this purpose – strategies that are needed to establish and maintain partnerships will depend on context • Health services need to demonstrate that they engage consumers, and use the information they provide to improve services • www.safetyandquality.gov.au • nicola.dunbar@safetyandquality.gov.au