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