ESTABLISHING A PATIENT AND FAMILY CENTRED CARE APPROACH TO
IMPROVEMENT
Joanne MinfordConsultant Paediatric SurgeonAlder Hey Children’s Hospital
Liverpool
@joanneminford
PATIENT AND FAMILY CENTRED CARE
...compassionate... ...provided with respect...
...that includes patients and families as partners...
... treats patients and families with dignity...
...revolves around the needs and desires of patients and families...
...rather than around the organizations and systems...
but we’re a children’s hospital we do all that… don’t we?
abdominal pain
1/3
1/10
>6 hrs
1/6
1/31/3
1/20
211 children
WHAT IS IT REALLY LIKE?
Patient shadowing
Care flow mapping
Patient stories
Surveys
GP
Advised to attend
DGH
Arrived in DGH ED
Triaged
Seen by doctor
Referred to AHCH
Left DGH
Arrived at AHCH ED
Surgical team
informed
Seen by surgical registrar
Left ED
anal
gesi
a
Morning surgery 1113 1145 1158 1315 1335 1428 1700 1750
inve
stig
atio
ns
revi
ewed
Nex
t day
U
SS
total journey - 7hrs 20 minutes
total time AHCH - 3 hours 20 minutes
face to face time - 1 hour 2 minutes
Returned for USS
Went to ED for results
Surgical team
contacted
Seen by SHO
Went to ward
Booked emergency
list
Overnight stay
Went to theatre
Overnight stay
Went home
1209 1235 1240 1300
total journey ≈ 3.5 days
total time to theatre ≈ 2 days
face to face time ≈ 1 ½ hours
PATIENT AND FAMILY SHADOWING
BEFORE PFCC - PATIENT EXPERIENCE
•long waits
•inconsistent care
•unnecessary admissions
•delayed diagnosis
•complaints
Poor Experience
BEFORE PFCC - STAFF EXPERIENCE
• distressed children • angry parents• no consistency of care pathway• unnecessary admissions• formal complaints and incidents
Poor Experience
You got it right!
-Well informed-Pain Control -Timely , effective assessment, diagnosis & treatment -Positive experience for child /family/staff
Please sort my pain
Tell me what's going on?
Please help me get better
Please be nice to me!
Please don't make me wait too long
Who are you?What information do I need to know, how long will I wait?How will you find out at first what’s wrong with me? What happens next?Will you keep checking on me?
Will you see me and triage me within 15 minutes?Will a doctor review me on the basis of my triage category?Will a doctor see if I need an operation within 60 minutes?Will you be quick to organise my tests?Will you tell me about this plan as soon as you can?
Will you check if I’m in pain when I arrive?Will you give me something to help the pain?Will you keep checking on me?Will you tell me what to do when I leave here about my care?
Will you look at me fairly quickly?Will you give me all the right tests?Will you look at me and decide what’s wrongWill someone more senior to you look at me and help decide what’s wrong too?Will you make a plan between you and then come and tell me about it?
Will you be kind?Will you be honest?Will you give me things to do?Will you explain things to me? Will you listen to me?
AIMS AND MEASURES
95% of children/families felt that pain was well managed90% of children have action plan
within 2 hours90% of children/families felt that wait
was acceptable< 5% of patients came back unexpectedly
Date: ___ / ___ / ____ Time : _____ : _____ Accompanied by: Mum Dad Other ______________
Parental Responsibility Yes No
Unit number:
Name: Address:
Date of Birth: Male Female School: ___________________________ This proforma record replaces ED notes for this attendance.
Please record history and examination below.
Analgesia given: (see triage sheet)
Patient information given
Yes No
Yes No
Dipstick Urinalysis (including glucose and beta HCG):
Time of last food: ___________________
Time of last clear fluid : ______________
HISTORY History of presenting complaint
Past medical & surgical history:
EXAMINATION Name: Unit Number:
ACUTE LOWER ABDOMINAL PAIN (Presenting to Emergency Department aged ≥4yrs)
SHADOWING - ImERSE
“It can be very dangerous to see things from somebody else's point of view without the proper training.”
― Douglas Adams, The Ultimate Hitchhiker's Guide
ImERSE
3rd Year
Daycase OutpatientsAccident
and Emergency
4th
Year5th
Year
Ward Based(Junior Dr)
How does it work?
•Structured patient shadowing collecting direct observations of hundreds of patient and family experiences per year…
•….using this in a system of continuous service evaluation and improvement…
•….shaping compassionate healthcare providers now and for the future.
Quality Improvement
Positive Findings Negative Findings
Positive InconsistencyIndividual / Team Excellence Awards and Recognition
NO RISK
Positive ConsistencyStaff Morale Positive affirmation and PerceptionPublicity
NO RISKNegative InconsistencyRapid Response Immediate Reaction
Organisational LevelClinical Level
Preventative Strategies Model
HIGH RISK
Negative ConsistencyContinuous Improvement Model
LOW RISK
+VE
-VE
CONSISTENCYLOW HIGH
EXPE
RIEN
CE
Quality Improvement findings
Findings Interpretation and significanceLevel of Issue
Organisational feedback and suggested action plan
Positive Consistencies
Regular updates about progress by Nursing Staff
Good explanations and time taken from nursing staff, doctors and anaesthetists
Daycase
Daycase
Feedback at DaycaseUpdate as positive staff reinforcement
Positive Inconsistencies
“Individual tailoring of treatment to”
Ability to adapt a system to user needs despite high volume of other workloads
Evidence of best practice
Quality Improvement findings
Findings Interpretation and significanceLevel of Issue
Organisational feedback and suggested action plan
Negative Consistencies
Consent – issues surrounding privacy, consent on day
Waiting times
Limited resources in waiting room for patient and families
Surgical CBU’s
Organisational
Daycase
Discuss with Consent LeadEIDO leaflets. Consent in Clinic – confirmation signature in daycaseFurther trial of staggered admission times
Application to Charity for provision of resources in parents waiting room e.g. Television, Newspapers, Magazines.
Negative Inconsistencies
Recent illness (chickenpox) – called hospital advised of no concernLack of clarity - Consultant
“random drug”
Who did they call?
Surgical CBU’s
Poor communication
Liaise with scheduling and booking to review advice sent with daycase letter. Trust Policy
Potential for drug error (never events
Digital Alder Hey – a cognitive hospital