Dr Joanne WatsonClinical Director of the King’s Fund Point of Care Hospital Programme

Clinical Director of Patient Experience & Consultant Physician, Musgrove Park Hospital, Taunton

Quality Improvement Fellow (The Health Foundation & IHI)

Re:thinking the Experience.

The Path Forward.

Thank you so much!

Dr Joanne WatsonClinical Director of the King’s Fund Point of Care Hospital Programme

Clinical Director of Patient Experience & Consultant Physician, Musgrove Park Hospital, Taunton

Quality Improvement Fellow (The Health Foundation & IHI)

Re:thinking the Experience.

The Path Forward.

From a World Class Person- Don Berwick July 1st, 2008

Put the patient at the absolute centre of your

system of care

- In its most authentic form, this rule feels very risky… It means the active presence of patients,

families and communities in the design, management and assessment and improvement

of care. It means total transparency. It means that

patients have their own medical records and that

restricted visiting hours are eliminated. It means ‘nothing

about me without me’.

“Nice but not necessary”

“Nice but too expensive”

There is nothing more powerful than an idea whose time has

come.

Victor Hugo

Safety

Effec

tiven

ess

Patient Centred

Timely

Efficie

ncy

Equity

What is at the Centre?

Value in Health Care

Safety

Effec

tiven

ess

Patient Centred

Timely

Efficie

ncy

Equity

What is at the Centre?

Patient Experience

Value in Health Care

Safety

Effec

tiven

ess

Patient Centred

Timely

Efficie

ncy

Equity

What is at the Centre?

Value in Health Care

Outline of this Talk’s Direction of Travel

• What are we trying to accomplish?

• How will we know that a change is an improvement?

• What changes can we make that will result in improvement?

What are we trying to accomplish?

One day Alice came to a fork in the road and saw a

Cheshire Cat in a tree. “Which road do I take?” she

asked. “Where do you want to go?” was his response.

“I don’t know” she answered. “Then” said the Cat “it doesn’t matter.” Lewis Carroll ‘Alice in Wonderland’ 1865

What are we trying to accomplish?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. 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.

Dr Kieran Sweeney, 2009

What are we trying to accomplish?

Every patient counts

What are we trying to accomplish?

Every patient counts&

Compassionate care embedded

Value in Health Care- Porter M and Lee T: 2010,NEJM Dec 23

• How is value defined in health care?

• What is important to our customers, the patients?

• OUTCOMES, results, consequences, effects, conclusions etc of Health Care

Value =Health Outcomes

£ Spent

What are we trying to accomplish?

• Delivering health care which adds VALUE through considering what patients need and want

• Be accountable for the total care of the medical condition

• Develop pride in what we do in health care- working with a sense of achievement and accomplishment

Warning

The next question is the really

crucial one!

How will we know that a change is an improvement?

• Focus on outcomes, as well as process

• Meaningful data – a department is too narrow, a whole hospital too broad

• Real team work as we cross the silos of medicine’s organisational structure

• “If you don’t measure it, you can’t manage it”

Measurement Strategy 1- Outcome HierarchyPrimary Acute Knee Osteoarthritis Requiring Replacement

Dimensions: Survival Mortality rate (inpatient)

Degree of health or recovery

Functional level achieved Pain level achieved Extent of return to physical activities Ability to return to work

Time to recovery and time to return to normal activities

Time to treatment Time to return to physical activities Time to return to work

Disutility of care or treatment process (e.g. diagnostic errors, ineffectual care,

treatment-related discomfort, complications, adverse effects)

Pain Length of hospital stay Infection Pulmonary embolism/ DVT Myocardial infarction Immediate revision Delirium

Sustainability of health or recovery And nature of recurrences

Maintained functional level Ability to live independently Need for revision or reoperation

Long-term consequences of therapy (e.g. care-induced illnesses)

Loss of mobility due to inadequate rehabilitation Risk of complex fracture Susceptible to infection Stiff knee due to unrecognized complication Regional pain syndrome

Measurement Strategy 2- Key Drivers

Primary drivers in building reliability into patient experience.(P= process measure, O= outcome measure)

LeadershipExecutive involvement:Walkround by Executive Sponsor (3 per pthwy per m: P)Reporting of patient experience at Board Level (qualitative: P)Steering group:Time spent per week on this work (P)Attendence at meeting (P)

Staff Engagem’tRelational Coordination 3 m survey of different staff groups (O)Sickness monitoring (P)

Patient Involvement in CareWays & number of patients involved (P)Pt surveys on involvement in care (O)Literacy scores on reading material for patients (P)

Processes of CareCancellations (P)Length of Stay (O)Readmission Rate (balancing)Noise at night (P/O)

Clinical Outcomes (Safety & Quality)

Disciplines to track an

important clinical

process or outcome e.g. time to first

physio consultation

post op.

Airline Performance Index

Relational Coordination

62%

28%

-1.35 1.32

Impact of Relational Coordination on Airline Performance

Hoffer Gittell J 2003, The SW Airlines Way, NY McGraw-Hill

Impact of Relational Coordination on Surgical Performance

Surgical Performance Index

Relational Coordination

4.22

3.84

-.43 .48

Hosp 2

Hosp 7

Hosp 1

Hosp 8

Hosp 5

Hosp 3

Hosp 4

Hosp 9

Hosp 6

Hoffer Gittell J 2009, High Performance Healthcare

How will we know that a change is an improvement?

Dr Foster

The Intelligent Board Series

The King’s Fund

Point of Care

NHS Confederation

Feeling better? Improving

patient experience in

hospital

What changes can we make that will result in improvement?

Vital Sign Care CardsSELF CONFIDENCEI want to feel confidentin managing my own health

RESPECTI want to feel treatedwith respect

REASSURANCEI want to feel reassured

EFFECTIVENESSI want my treatment to make me feel better

SAFETYI want to feel safe

COMFORTI want to feel physically comfortable

UNDERSTANDINGI want to understand myTreatment and condition

HONESTYI want to feel staff are open and honest with me

OPPORTUNITY CARDFor patient to express any other care needs

Airedale New Venture CharityAiredale General Hospital

Helping families with Supportive

Care

The Year of Care Consultation Skills and Philosophy Toolkit ‘Mind your language’

And so to summarise….

• Patient experience is a complex outcome to focus improvement in

• Measurement- strategy to cover the breadth & depth of experience relevant to the pathway

• Co-ordinated programme to shift overall experience, not random acts of goodness

Say to them, say to the down-keepers,

the sun-slappers,the self-soilers,

the harmony hushers,

“Even if you are not ready for dayit cannot always be night.”

You will be rightFor that is the hard home-run.

And remember:Live not for Battles won.

Live not for The-End-of-the-Song.Live in the along.

Speech to the Young. Speech to the Progress-Toward.

Gwendolyn Brooks