patient empowerment designing a better healthcare...

Promoting patient-centred healthcare around the world

Patient Empowerment

Designing a Better Healthcare Estate

EuHPN Workshop 16 November 2015


Advocacy

Capacity Building

Partnerships

Vision: patients at the centre of healthcare around the world .

Mission: build patient-centred healthcare worldwide.

– Set-up 15 years ago. Size,

diversity and experience our

strength

– We are a unique global alliance of

over 250 national, regional and

international groups representing

patients in over 60 countries

– Our diverse cross-disease

member organisations cover over

50 main WHO ICD 10 disease

classifications

– We are the global voice for

patient-centred healthcare:

representing an estimated 365

million patients


IAPO’s Global Membership


OUTCOMES DESIRED

Patients ask for health infrastructure and facilities that are: Available: sufficient quantity of functioning LOCAL health care facilities-no overcrowding or long travelling Accessible: physically accessible, economically accessible (affordability), information accessibility (signage etc) and non-discriminatory(gender, age, race etc) Acceptable: respectful of medical ethics and comfort. Designed ergonomically in a culturally sensitive way (age and gender).cooling, heating and lighting to improve patient experience. Quality: appropriate medically and by construction codes (fabric, ventilation, heating, sanitation). Safe: From accidents (trips, falls and electrocutions!) and clinically safe nosocomial infections


Whole-of-System & Life-Course approach

• IAPO wants a whole-of-system & integrated Estate. Clinical care (operating theatres etc) should link with ‘hoteling’ ( wards, beds, catering, stores etc.). Primary, acute and social care should be seamless as: • Our patients have chronic conditions. The use both primary and acute care

facilities. They use acute care on an out/in patient basis.

• We want a Life-Course Approach: Facility design to

reflect changing needs:

• Compared to other patients, who use facilities for a single issue on a one-off treatment, our patients have to access these facilities for multiple comorbidities over a LIFE-COURSE.

• Needs of patients with chronic conditions change with time. Health infrastructure needs to change to meet these changing needs

• Digital infrastructure also needs to match pace of change. Free broadband access helps communication and patient experience


Age, gender and culturally sensitive hospitals

People-centred and integrated health care (WHO)


• WHO- transfer decision-making to local level. Encourage local responsiveness and economies of scale in redesigning health infrastructure

• WHO- health infrastructure best managed and maintained by local community and patients. Redistribute resources to respond to this new integrated models of care.

• Patient groups bring about people-centred local health care facilities. They can be better custodians (they use the facilities regularly). Self-help can mean user maintained facilities.

Installation of water tank for a maternity care unit-Serengeti Plains

Engage patients at the outset in feasibility, design and procurement stages*


*Royal Institute of British Architects: Good Design: it adds up Healthcare buildings: a suitable case for treatment

e-buildings* + telehealth**=joinedup care


• Patients lead ‘connected lives’. Health estates now connected buildings. ‘Intelligent Buildings’ linked with telehealth.

• Geospatial revolution and automated responses. (Case Study) • Patients walk into building. Building picks up phone signal.

• Patient recognised and then tracked in building • App logs them into clinic and guides them to the right clinic

• App alerts health care team, waiting-time status SMS sent • App launches health records retrieval. Records ready.

• App keeps patients informed on waiting-time • Patient leaves with an e-prescription voucher that redeemed by

pharmacists. Maybe uploads health plan. • Maybe pays by M-Pesa mobile credit!

• Home monitoring. Telehealth equipment and devices connected to primary and acute care facilities via local intranet. Early discharge no bed blocking!

* Connected Buildings Make Technology A Path To Peak Performance : Johnson controls ** Telecare Services Association


PROBLEM

• Poor illumination leads to accidents

• Inadequate power supply. Sockets overloaded

• Water and electrical systems a nosocomial infection reservoir

• Post-surgery wash-down and sluicing arrangement not adequate

WHO Safe Surgery: Operating Theatres

SOLUTION:

Atul Gwande’s ‘Checklist Manifesto’:

Give the checklist to the patient groups! They will make sure every faulty device and electrical system is mapped and repaired!


PATIENTS & VALUE ENGINEERING*

• Value engineering is used in public procurement of health infrastructure. Used to identify and eliminate unwanted costs, while improving function and quality.

• Used at a very early stage before a line is drawn on plan, and then continues at each design stage and construction stage.

• Do we need this facility? Are the materials and construction methods optimum for this location? Have we addressed transportation issues, site limitations or budgets?

• Benefits delivered include an estate that fits with local patients’ needs and also reduces life cycle costs, improves quality, reduces environmental impact

* 1) The good and the bad of value engineering HEALTH CARE DESIGN June 2005 2) Incorporating Patient Handling Ergonomics into the Design of Healthcare Facilities: Patient and Caregiver Benefits 3) eBook: Empowering the Patient and Hospital Staff: Evidence Based Designs Practices that Promote Healing in a Healthcare Environment

Value engineering (VE) examples

• World Bank Budget: US $7 million for maternal hospital. Site chosen a forested grove. Mothers in VE identified centrally located disused railway warehouses. Budget reduced to $ 2.5 million. Savings ploughed back into health professional training.

• NHS East London wanted to set-up a new women's’ health and well being services for Bangladeshi women. £4 million budgeted to turn old wards into clinics etc. Women identified local East London Mosque and its Friday female services. Mosque refitted its women’s wing into a clinic and other health services. Saving £3 million.


Patients and life-cycle of buildings

• Where Private Finance Initiative (PFI) used as procurement method for facilities, patients to be involved in all stages of finance, construction and operating decisions. *

• Transparent, accountable and participatory procurement and investment decision-making

• Patients involved in all subsequent change-of-use and refurbishment considerations

• Patients involved in regular condition of estate and maintenance inspections

• Recovered MRSA and other nosocomial patients to be part of the environmental inspection and control regimes!


Private finance initiative: A catalyst for better healthcare design? HEALTH CARE DESIGN

IAPO & WHO Patients for Patient Safety collaboration


One in 10 patients may be harmed while in hospital

Hospital infections affect 14 out of every 100 patients admitted

Many patients lack access to properly wired and connected medical devices

Patient and community engagement and empowerment are key

Hospital partnerships can play a critical role

A poor safety record for health care

THANK YOU!


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patient empowerment designing a better healthcare...

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