18 July 2011 - Health Issues...
23
18‐20 July 2011
Transcript of 18 July 2011 - Health Issues...
18‐20 July 2011
Partnership at the ‘Sharp End’
Dr Karen LuxfordDirector Patient Based Care18/07/11
What does it take to succeed in patient based care?*Organisational characteristics:• Strong committed senior leadership
• Communication of strategic vision
• Engagement of patient and families• Sustained focus on staff satisfaction
• Regular measurement and feedback reporting
• Adequate resourcing of care delivery change
• Staff capacity building
• Accountability and incentives
• Culture strongly supportive of change and learning
*Luxford et.al. 2011 Int J Quality in Healthcare DOI: 10.1093/intqhc/mzr024
Quality Improvement 101
Back to basics:
• leadership commitment
• training
• sufficient resources
• supportive culture
• a strategic focus on customer needs
Industrial models
Health care has adopted industrial models of quality and safety improvement*:
• Risk management
• Incident reporting
• Clinical audit
• Accreditation
*Jorm C et al. Aust Health Review (2009); 33(3):390-399
Has this improved care from the patient’s perspective?
• “Hospital accreditation status is not linked to measurable better quality from of care as perceived by the patient.*”
• Patient surveys: improvement needed in responsiveness, team work, involving family
• Communication issues still the 2nd most frequent complaint reported to the HCCC
* Sack et al. (2011) Int J Qual HC 23(3): 278-283
Incidents and errors• Deficiencies in patient monitoring – 2nd most
common root cause analysis (RCA) classification in NSW incident review
• Deaths may have been avoided if ‘family concerns’ were better integrated into the ‘alert’ system.
• Patient & Family Activated Escalation:
• Lead to significant decrease in mortality
• Improved patient & family care experience
• Without an overload of inappropriate calls for a rapid response
Gerdik et al 2010 Resus 81: 1676-1681
Building partnerships
‘Fear of the unknown’ by providers is the greatest barrier to involving patients in safety improvement work
Robert Wood Johnson Foundation
Taking improvement to the next level.....
“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
POINT OF
CARE
PATIENTS, FAMILY AND CARERS
CEC - Patient Based Care
Source: Clinical Excellence Commission
• Medication management• Bedside handover• Alerting staff to deterioration
In own care
• Patient involvement throughout organisation(e.g. governance, patient safety, quality improvement, new staff recruitment, systems and building redesign).
• Models include Patient Advisory Committees through to full integration throughout organisation
In governance
Contemporary Patient-based care “Patients and carers as active partners”
Experiential knowledge
• Of patients – stories and narratives
• Of carers – culture of ‘health talk’ in families*
• Of health care professionals – sharing stories, organizational storytelling, tacit learning models
*(Lindenmeyer A (2011) The family is part of the treatment really. Health. 15: 401-415.)
Partnering with Patients
• Aim: foster the inclusion of patients and family as care team members to promote safety & quality
• Advisory Committee established with broad membership. Chaired by Consumer: Alicia Wood
• Integrated into care – sustainability: integrate into policy & process; Tailored to meet local needs in Local Health Districts; Modular approach; initially creating ‘lead sites’
CEC Consumer Advisor Panel
• Panel established – 7 members to date
• Integrating consumer representatives into existing CEC programs and projects (eg BTF, Falls, CLP, RCAs, Undergrad edn)
• Patients sharing personal stories of care to clinicians, junior doctors and nurses, exec’s
Patient/carer partnerships
Alicia Wood
• CEC – Consumer Advisor
• CEC PWPAC - Chair
• Member – NSW Clinical Incident Review Committee
• Member - PFARR
Program streams
• Patient & family activated escalation• Deteriorating patients (in hospitals)
• Builds on CEC clinical program ‘Between The Flags’
• REACH - Empowering patients and families to engage with staff and call for help if still concerned
• LHD leads: Western NSW, HNE, CHW
Program streams
Junior doctors/trainees & nurses• orientation & communication skills
• Westmead Hospital – lead site
• Orientation program developed
• Using patient stories, senior clinical leaders & Exec in program delivery
Program streams
• Handover• bedside, engaging patient & family in team
• Medication management & review• engaging patients & family to avoid errors
• Patient rounding• ‘Patient friend’ – real time feedback/alert
New Program streams
• Health literacy within services• guidance & service assessment
• Information and wayfinding/signage
• Open disclosure• promoting patient and carer engagement
• Leadership – building PBC values• Building leadership skills
What do airlines have to do with anything?
Q. What should you do if you see or hear something that does not look or sound right or normal?
A. Please advise your flight attendant. Rex encourages open communication and will always treat a passenger’s concerns with the upmost seriousness.
