putting compassion back – improving the experience for staff and patients influencing and...
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Putting compassion back – improving the experience for staff and patients
Influencing and coordinating respiratory care in London
June 2013
NQB/DoH definition of patient experience (after the IoM and Picker)• Respect for values, preferences, and expressed needs• Coordination and integration of care• Information, communication, and education• Physical comfort• Emotional support• Welcoming the involvement of family and friends• Transition and continuity• Access
Patients’ experiences are a mix of the ‘what’ (T) and the ‘how’ (R)
• Respect for values, preferences, and expressed needs (R)
• Coordination and integration of care (T)
• Information, communication, and education (T+R)
• Physical comfort (T)• Emotional support (R)• Welcoming the involvement of
family and friends (T + R)• Transition and continuity (T)• Access (T)
Transactional (T) and relational (R) dimensions of care
relational
tran
sacti
onal
3
High
Low High
The combination of transactional (T) and relational (R) dimensions is often difficult
High
HighLow
T
R
Efficient and impersonal
Efficient and warm
Chaotic and rude, indifferent
Chaotic and warm
Staff experience and patient experience are linked
Management & quality of HR practice linked to mortality and other quality measures (West et al (2009)
National staff & patient experience surveys: the two sets of experience are related (Raleigh et al 2010)
Quality of staff experience precedes quality of patient experience (Maben et al 2012)
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
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
“The health 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 in some cases 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.”
The perennial ‘existential’ problem
6
Dr Kieran Sweeney GP, academic, patient
“Mesothelioma: A patient’s journey”Sweeney, Toy and Cornwell: BMJ 2009
H
PATIENT– FOCUSSED IMPROVEMENT METHODS
Patient and Family Centred Care (PFCC) and Experience Based Co-Design (EBCD)
Key activities1. Shadowing patients / structured
observation/interviewing and filming2. Setting patient based goals3. Using driver diagrams to decide what to do4. Using measures for improvement5. Working with patients on the changes
Mapping process and touch points
Measures tell teams how they are doing- COPD example
Indicator Frequency Numerator Denominator Target
% pts discharged from resp. ward
Monthly No of pts discharged from res ward
Total no discharged from trust with COPD acute exacerbation
70%
% of pts who some offered smoking cessation
Monthly No of smokers offered cessation
No of smokers 100%
% pts with COPD with low BMI offered referral to dietician
Weekly No of pts with MUST scores referred to dietcn.
No of pts. with MUST scores
100%
% offered emergency oxygen correctly
Weekly No of pts with correct oxygen adminstrtn
No of pts with COPD
100%
Pts with confidence in team
Monthly No of pts with confidence
No of pts with COPD admitted
100%
% pts offered GP/practice nurse follow up in 2 weeks
Monthly No of pts offered follow up in 2 weeks
No of COPD admissions
100%
H
In S London, the priorities of patients with breast and lung cancer were different
Lung cancer Breast cancerCommunication of
diagnosisFunctioning of day surgery unit
Information about treatment
Appointments system and conduct of OP clinics
Continuity and coordination of care
Communication
Information about symptoms
H
EBCD improvements at Guys and St Thomas and Kings College Hospital
Over 40 changes in service delivery for both lung cancer and breast cancer patients, including:1. Guidance on the correct procedure on tests and
diagnosis included in junior doctors’ induction2. Referral on diagnosis to lung Clinical Nurse Specialist
(CNS) for information and support3. New space for communicating diagnosis and CNS support4. Patients called to day theatre ‘just in time’5. Customer care training of receptionist and clerks6. A new space in OP for breaking bad news
www.institute.nhs.uk/theguide
Schwartz Center Rounds: space for reflection
Impact of Rounds
› Evaluation shows that Rounds have a positive effect› For individual› For teams› For organisation› Increased impact over time
Sanghavi DM (2006) What makes a compassionate patient-caregiver relationship? Joint Commission Journal on Quality and Patient Safety 32(5): 283-292.
Lown, BA, Manning, CF (2010) The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centred communication, teamwork and provider support. Academic Medicine 85(6).
Format of Schwartz Round
• Lunch is offered before the start• Presenter/presenting team talk for 10-15
minutes • The audience is asked to share their thoughts,
ask questions, offer similar experiences • The discussion is facilitated • Round lasts for 1 hour in total
Selected titles• The patient I’ll never forget• Am I doing the right thing? • When doctors make mistakes• Human too – personal and professional
overlap • I’m the junior, what do I know?• Caring for a doctor colleague
Evaluation: pre and post- pilots
Staff who attend feel• More confident about handling sensitive
issues • More belief in the importance of empathy• More empathy for patients as people• Confident handling non-clinical aspects of care• More open to expressing thoughts, questions
and feelings about patient care
If Schwartz Rounds change the culture, it is not top down but through communities of influence