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This presentation explores the fundamental difference between citizen-centred care and patient-centred care, and how citizen-centred care influences the care experienced across the continuum of health services. Examples of citizen-centred health services in New Brunswick will be provided.
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What Citizen Centred Health Services Look Like – Perspective Matters Presented by Michelina Mancuso
Learning objectives • Review the fundamental difference between citizen centred care and patient centred care. • Learn about the relationship of how citizen centred care influences the care experienced across the continuum of health services. • Examples of citizen centred health services in New Brunswick will be provided.
Patient-centered care Person-centred care or citizen centred Time focus • Visit focus
Patient-centredness varies, depending on one’s perspective • For patients, it can mean that the care they receive reflects their values and preferences and they feel they are treated as a whole person.
Patient-centredness varies, depending on one’s perspective • Clinicians may see patient-centredness as advocating for their patients to ensure their needs are met.
Patient-centredness varies, depending on one’s perspective • Organizations within health care, such as family health teams and hospitals, may consider themselves patient-centred when they involve patients on committees and use the results of patient satisfaction surveys to inform their decisions.
Patient-centredness varies, depending on one’s perspective • Policy makers sometimes describe patient centredness as a measure of health system performance or as a principle to strive for when designing health services within the budgets they have been allocated.
Patient-centredness varies, depending on one’s perspective • Public health practitioners may feel that patient-centredness should be less concerned with meeting the desires of individual patients and more concerned with addressing the social determinants of health, which they argue would prevent many citizens from becoming patients in the first place.
Person-centred care or citizen centred • To be person or citizen-focused, it must be accessible, comprehensive (dealing with all problems except those too uncommon to maintain competence), continuous over time, and coordinating when patients have to receive care elsewhere. • The essence of person focus implies a time focus rather than a visit focus. It extends beyond communication because much of it relies on knowledge of the patient (and of the patient population) that accrues over time and is not specific to disease-oriented episodes
What citizens from across the province told the New Brunswick Health Council in 2010 during our citizen engagement sessions and continue to tell us…
What do citizen centred health services and programs look like? Health zone names and numbers
Focus on aspects of care that research has shown matters to people This applies to each and every program and service citizens experience as part of their journey through the health system
Citizens care experience ratings across different health services in the care continuum All scales reporting % 8, 9 or 10 out of 10
The “what” is being done in an organization is important but the “how” it is being done carries a big weight........................citizen “how our experience, service, quality and safety are handled is what makes the impression on us” .....citizen
Timely Access • Primary Care services within 5 days • Wait time hip surgery Range in communities from 21.8% to 88.8%
Supported Self-management • Ambulatory Clinics- Diabetes Clinics (enhanced care for diabetes)
The actions common to those diabetes services that efficiently use human resources and achieve good health outcomes include: 1. Using a holistic approach in developing a good relationship with patients, 2. Sharing power and responsibility with the patient for disease management, 3. Ensuring flexibility in the offering of services to encourage patients to use them, 4. Establishing and maintaining strong links with other health services and community resources. • Organizational and cultural environment that enables staff to be person centred in the way they work.
“We have drop-ins all the time. For blood sugar and blood pressure checks, patients requiring insulin or just to get weighed… we never refuse anyone.” Staff “At times, the staff at the clinic must refer them to psychologists or mental health specialists. The waiting list is especially long for those who cannot afford private care. There have been occurrences where a staff member has brought a patient directly to the psychiatric unit or to the ER.” Staff “Any time I need something I can call. Even if they aren’t there, leave a message in voicemail and she calls back” Patient
Patients who believed that the hospital takes their safety seriously
Patient Care Experience Survey – Patient Safety Strength of relationship of single-item responses to the patient safety culture item (Q28) and contribution of composites/items to the prediction of patient safety culture (based on linear regression analysis)
Important Enablers Person-centred care also has a focus on staff. ‘To succeed, a person-centred approach should also address the staff experience, because the staff’s ability and inclination to care effectively for patients is compromised if they do not feel cared for themselves.’
Involving Family or Caregivers- (Home Care – Clinical Services- 2015 survey) **Home Support Services 2015 results range between 23 and 33% strongly agree
including families where appropriate • making sure that staff are supportive, well trained in communication and striving to put people at the centre of their care • making sure that the physical, cultural and psychosocial environment of health services supports person-centred care getting to know the patient as a person and recognising their individuality taking a holistic approach to assessing people’s needs and providing care looking at people’s whole experience of care to promote coordination and continuity seeing the patient as an expert about their own health and care sharing power and responsibility making sure that services are accessible, flexible and easy to navigate
Is it possible that if you are being citizen-centred and meeting needs of people that you can improve health outcomes? *Age-standardized demonstrated by Tiering Categories
Conclusion • Person-centredness varies depending on the lens used but the core elements required to be person-centred remain the same no matter which program and service is being provided across the continuum of care. • There are pockets everywhere of where person-centred care is being delivered but critical mass is needed if we want the benefits to scale up at a population level. • Studies show that when healthcare administrators, providers, patients and families work in partnership, the quality and safety of health care rises, costs decrease, and provider and patient satisfaction increase. • Person-centred care is a fundamental practice or value not an add-on.
Questions? Michelina Mancuso Directriceexécutive de l’évaluation du rendement Executive Director of Performance Measurement Michelina.Mancuso@csnb.ca 1.877.225.2521 www.csnb.ca www.nbhc.ca
