Hospital pathways programme

Listening to older people – understanding what matters

Annie Laverty & Aileen Beatty

Dignity in Practice: An exploration of the care

of older adults in acute NHS Trusts

• Win Tadd* Alex Hillman* Sian Calnan** Mike Calnan**• Tony Bayer* Simon Read*

Environments designed to disorientate“One ward looked very much the same as another. If they’d moved me when I was asleep, I simply would

not have known I’d been moved. It was like that.”

Organisational processes – main barriers to dignified care

• The perpetual movement of older people within and between hospital wards.

• The view that these patients should not be there anyway.

Core skill or specialism

“We have forgotten the generalised humanity that we have to deal with. We want to partition everybody into their own ‘ism’ or their ‘ology’. What I’m trying to convey is that there are some aspects of patient need that we’re almost in denial about because somebody else specialises in it – but whoever it is, it ain’t me.”

Trust Board member.

Influences on dignified care

‘Being addressed the way I want to be addressed. Being asked, not told. Having people working with me. Respecting my choices, my decisions. And if I’m able to control my situation, being allowed to do that without being judged and being seen as difficult – that is dignity.’

Access to assessment

• Dementia

• Delirium

• Depression

Acute pathway algorithm

This is me

Expectations, hopes and fears

• Measure confidence levels

• Learning needs from staff viewpoint

• Reassurance

Practical solutions

NutritionEnvironment

Intentional rounding

• Structured process where front-line staff regularly round on patients and reliably perform scheduled/required tasks

• Rounding with purpose - linked to an aim

• Measurable improvements

Improving the things that matter most6.

26

8.13

7.22

8.11

7.24

9.04

8.81

6.36

7.65

8.54

10.0

0

9.57 10

.00

9.62 10

.00

10.0

0

8.33

9.51

8.94

10.0

0

9.60 9.

91

9.46 9.

94 10.0

0

8.21

9.51

8.96

10.0

0

8.89

9.86

9.79 10

.00

10.0

0

8.33

9.48

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Consistency &coordination

Respect &dignity

Involvement Doctors Nurses Cleanliness Pain control Medicines Domain Avg

Baseline 2010 August 2011 September 2011 October 2011

“ I just wanted to feel proud of the team and the care we provide here. Now I really am”

Our learning

Future plans

• Leadership for experience

• Systemic solutions

• Our quality strategy

• Trust board support for 3 year improvement plan

Thanks for listening

Any questions ?