Putting compassion back – improving the experience for staff and patients

1. Putting compassion back – improving the experience for staff and patients Influencing and coordinating respiratory care in London June 2013

2. NQB/DoH definition of patient experience (after the IoM and Picker) • Respect for values, preferences, and expressed needs • Coordination and integration of care • Information, communication, and education • Physical comfort • Emotional support • Welcoming the involvement of family and friends • Transition and continuity • Access

3. Patients’ experiences are a mix of the ‘what’ (T) and the ‘how’ (R) • Respect for values, preferences, and expressed needs (R) • Coordination and integration of care (T) • Information, communication, and education (T+R) • Physical comfort (T) • Emotional support (R) • Welcoming the involvement of family and friends (T + R) • Transition and continuity (T) • Access (T) Transactional (T) and relational (R) dimensions of care High transactional Low relational High

4. The combination of transactional (T) and relational (R) dimensions is often difficult High Efficient and impersonal Efficient and warm T Chaotic and rude, indifferent Chaotic and warm Low High R

5. Staff experience and patient experience are linked • Management & quality of HR practice linked to mortality and other quality measures (West et al (2009) • National staff & patient experience surveys: the two sets of experience are related (Raleigh et al 2010) • Quality of staff experience precedes quality of patient experience (Maben et al 2012)

6. The perennial ‘existential’ problem “The health professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And in some cases rather dull. For the individual patient it’s anything but that. Every individual that comes through a hospital is apprehensive. It’s a strange place, you lie in a strange bed, you have strange sheets, you have odd tea in a plastic cup. The whole thing is vibrantly different.” The health care professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And some days rather dull The health care professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And some days rather dull Dr Kieran Sweeney GP, academic, patient “Mesothelioma: A patient’s journey” Sweeney, Toy and Cornwell: BMJ 2009

7. Patient– FOCUSsed improvement methods H

8. Patient and Family Centred Care (PFCC) and Experience Based Co-Design (EBCD) Key activities • Shadowing patients / structured observation/interviewing and filming • Setting patient based goals • Using driver diagrams to decide what to do • Using measures for improvement • Working with patients on the changes

10. Mapping process and touch points

11. Measures tell teams how they are doing- COPD example

12. In S London, the priorities of patients with breast and lung cancer were different H

13. EBCD improvements at Guys and St Thomas and Kings College Hospital Over 40 changes in service delivery for both lung cancer and breast cancer patients, including: • Guidance on the correct procedure on tests and diagnosis included in junior doctors’ induction • Referral on diagnosis to lung Clinical Nurse Specialist (CNS) for information and support • New space for communicating diagnosis and CNS support • Patients called to day theatre ‘just in time’ • Customer care training of receptionist and clerks • A new space in OP for breaking bad news H

14. www.institute.nhs.uk/theguide

15. Schwartz Center Rounds: space for reflection

16. Impact of Rounds • Evaluation shows that Rounds have a positive effect • For individual • For teams • For organisation • Increased impact over time Sanghavi DM (2006) What makes a compassionate patient-caregiver relationship? Joint Commission Journal on Quality and Patient Safety 32(5): 283-292. Lown, BA, Manning, CF (2010) The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centred communication, teamwork and provider support. Academic Medicine 85(6).

17. Format of Schwartz Round • Lunch is offered before the start • Presenter/presenting team talk for 10-15 minutes • The audience is asked to share their thoughts, ask questions, offer similar experiences • The discussion is facilitated • Round lasts for 1 hour in total

18. Selected titles • The patient I’ll never forget • Am I doing the right thing? • When doctors make mistakes • Human too – personal and professional overlap • I’m the junior, what do I know? • Caring for a doctor colleague

19. Evaluation: pre and post- pilots Staff who attend feel • More confident about handling sensitive issues • More belief in the importance of empathy • More empathy for patients as people • Confident handling non-clinical aspects of care • More open to expressing thoughts, questions and feelings about patient care

20. If Schwartz Rounds change the culture, it is not top down but through communities of influence