Patient Based Care and CommunicationWalking in the patients shoes

<<X>> Hospital

<<XX Hospital/ Service >>– The Vision for Quality Care

General Manager/Chief Executive

Quality and safety programs

3

What do you expect good care to look like?

<<Local senior staff member>>

What are your own

expectations of

‘good’ care?

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

“I couldn’t have faulted

the technical care but...”

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).

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

Patient Based Care Model

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.

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.

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

1. Meterko M et al (2010) Health Services Research

2. DiGioia A M et al (2008) Agency for Health Care Research and Quality

3. Murff et al (2006) Qual Saf Health Care

4. Jha A et al (2008) New England Journal of Medicine

Mandatory for

service

accreditation

from 2013

What do patients from our service want to see improved?

<<Local senior staff member>>

BHI – Insights into Care, 2009

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)

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

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 communicationRaleigh 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

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

Shift handover

Ward rounds

Medication rounds / medication reconciliation

Discharge planning

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

42

138

96

368

200

297

254

472

199

179

196

146

180

116

156

26

229

131

141

5

319

308

326

152

Always (100%) Often (67%-99%) Sometimes (34% – 66%) Rarely (1% - 33%)Never (0%) Not Applicable

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>>

The importance of

learning from

patient experience

Communication SkillsInteractive Scenarios

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.

ISBAR – communicating about a patient with peers• Introduction

• Situation

• Background

• Assessment

• Recommendation

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?

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

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.

Relationship-based care:

the quality of interpersonal

relationships

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

What about when

things go wrong??

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

More than technical skillClose – <<Senior clinician sharing/demonstrating their beliefs/values about patient focussed care>>

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