Strategic Application of the Patient Experience Narrative. Heather McKay ACT Health Canberra, Australia

Transcription

1 Strategic Application of the Patient Experience Narrative Heather McKay ACT Health Canberra, Australia

2 DISCLOSURE I have no relevant financial relationship to disclose

3 OBJECTIVES At the conclusion of this activity, participants will be better able to: Identify how patient experience narratives can be used to inform a targeted theme or concept Apply the use patient narratives to inform strategic direction Convey the processes involved in planning and conducting patient experience narratives

4 CONTEXT Canberra Hospital: is the region's major public hospital providing specialist and acute care to more than 500,000 people tertiary level health facility, and a teaching hospital of the Australian National University

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6 THE CHALLENGE The drive for improving patient experience is different for public hospitals in some aspects from private hospitals Its not about keeping loyalty Creates a challenge for how to ensure staff see the need for change

7 LOCAL HEALTH NETWORK COUNCIL ACT Local Health Network consists of a networked system that holds service contracts with the ACT Health Directorate. This incorporates 4 inpatient facilities. The ACT Local Hospital Network Council was established in 2011 as an independent advisory body to support the implementation of national health reforms and to provide high level strategic advice to the Government.

8 The ACT LHN Council is tasked with making recommendations to the Director General of ACT Health in regard to: clinical and corporate governance frameworks; methods to support, encourage, and facilitate community and clinician involvement in the planning of ACT LHN services; the ACT LHN s policies, plans and initiatives for the provision of health services; integration and collaboration of service delivery with the ACT Medicare Local; and the ACT LHN s financial and operational performance The project referred to today was undertaken on behalf of the LHN Council to inform change

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10 History of Patient Narratives within ACT Health Introduced narratives to provide patient insights to their health experiences 2008 commenced using narratives to inform redesign projects Response from patients and "families" very positive ("families" as identified by the patient)

11 Utilising individual stories in teaching Utilising individual stories at Executive meetings: one experience will not change a system but may have an emotive effect Often we focus on just the negative things in life (and health care) using positive stories is important as well

12 Benefits of Patient Narratives previously within ACT Health Stories gave a voice to recent users of the health system Insights gained through stories provided rich data not previously gathered Provided information not just on what we wanted to know Feedback from those who would not instigate it themselves

13 WHAT DO WE MEAN BY THE PATIENT EXPERIENCE? Compare it with your most recent restaurant experience

14 PATIENT EXPERIENCE THE SUM OF ALL INTERACTIONS, SHAPED BY AN ORGANISATIONS CULTURE, THAT INFLUENCE PATIENT PERCEPTIONS ACROSS THE CONTINUUM OF CARE THE BERYL INSTITUTE

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16 PICKER PRINCIPLES OF PATIENT CENTERED CARE Respect for patients values, preferences and expressed needs Coordination and integration of care Information, communication and education Physical comfort Emotional support and alleviation of fear and anxiety Involvement of family and friends Transition and continuity Access to Care Picker Principles of Patient-Centered Care in 1987

17 Your experience exercise Share with those at your table the last time you remember a healthcare experience (for yourself or a family member or friend) What is the first thing you can remember about it? With the first thing that came to mind, was it a positive memory or a negative memory? Did you feel empowered or disempowered?

18 STEPS FOR UNDERTAKING NARRATIVE PROJECT Define your purpose/aim Clarify scope Recruitment strategy Planning interviews Consent Conducting Analysing Reporting

19 DEFINE YOUR PURPOSE/AIM? Undertake and analyse patient experience interviews to evaluate the patients / carers experience of bed side hand over and discharge planning processes in one ward by June 2013 LHN looking for information on bedside handover Insight into patients experience of a particular aspect of care eg handover/discharge Helps define your target group

20 SCOPE? How big a project- numbers of wards/patients? Is there a specific target group? Who needs to know about what your doing? Who has the authority to make change with the results? Who will lead it? How will you get the results out there? What resources do you have?

21 How long will it take? WBS for Patient Experience Project Draft Scope Source names of potential patients Identify random sorting methodology Define number of potential recruits Source patient names and contacts - Calvary Draft letter to patients Collate material to post to patients Approve letter / documentation to patients Send letters/packages Draft scribing guidelines Schedule interviews Complete consent documentation Conduct interviews Document interviews Send to patient for confimation of content Receive content back from patient Amend as required Analyse for themes Draft Report Circulate for comment Finalise Report Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 * * Wk 6 Wk 7 Wk 8 Wk 9 Wk 10 Wk 11 Wk 12 Wk 13 Wk 14 Wk 15 Wk 16 Wk 17 Wk 18 Wk 19 Wk 20 Submit Report to LHN

22 RECRUITMENT STRATEGY What meth ods are likely to work for your identified group? Particular ward Particular demographic eg young women Particular disease process eg cardiac failure Social circumstance homeless Where are they and how will you contact them? Eg Letters, phone calls, social media, direct contact Persist 10% is a good response rate

23 PLANNING Where different venues bring bias Watch for personal safety, privacy and feeling safe to share the story Watch for distractions busy venues, phones, pets Bring a scribe Encourage carers / family members they have a valuable perspective Shouldn t need to pay clients, but they shouldn t be out of pocket Consent as agreed by your organisation

24 TOOLS Templates for Consent Letter of invitation Reports

25 FACTORS TO CONSIDER Objectivity Bias/ Emotional state Hungry, Angry, Late, Tired (HALT) Emotional safety for the patient and family Emotional safety for you Mitigating strategies Group / Peer Review Postpone Self Manage

26 PRACTICAL EXERCISE P s Story

27 PICKER PRINCIPLES OF PATIENT CENTERED CARE Respect for patients values, preferences and expressed needs Coordination and integration of care Information, communication and education Physical comfort Emotional support and alleviation of fear and anxiety Involvement of family and friends Transition and continuity Access to Care Picker Principles of Patient-Centered Care in 1987

28 P S STORY In September last year I had a pain in my lower abdomen. I went from home to the Emergency Department at Canberra Hospital. The Triage nurse was really good and picked up my pain level and obviously had a sense of what was wrong. I had avoided taking pain killers earlier because I didn t want to mask anything, but in ED I was given Panadeine Forte. I then waited for around 6-7 hours (at least) to be seen. During this wait, I was quite concerned for an older gent that had been waiting for longer than me.

29 P S STORY When I went to ED I said that I had a kidney stone and I didn t have to wait. They didn t muck around and I went straight in to ED and to a bed. I had another x-ray and they did some further investigation and decided that they needed to do more this time. So they admitted me.

30 P S STORY I waited for outpatients to call, but they didn t so I called them two weeks after my hospitalisation. They hadn t heard of me; had no record. I don t know whether ED didn t send the information along or whether it got lost, but luckily I m a proactive guy so I made the call and discovered that there were no referrals at all.

31 THE WRITE UP & REPORTS Look for and highlight the positive Commend / Recommend /Commend Keep it all in perspective Professional writing non emotive / 3rd person impersonal Use of extracted quotes make sure that they don t give away the patient or their family. Beware of the small town syndrome everyone knows someone Extracts and quotes, used well are extremely powerful

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33 Themes across the cohort of stories is important Common themes means its not reactive to one incident We tend to focus on the negative but the positive is just as important

34 So has the ACT Report changed anything? Bedside Handover Discharge Planning Emerging themes: Visiting Hours System Navigation Nil by Mouth NBM = NPO

35 Flickr-koala at lonepine These issues were: Not new Too hard to address previously Not presented in a coordinated way (in conjunction with other sources of feedback) Not sexy

36 Bedside Handover Overall, most patient s experienced bedside handover at some point in their stay. Feedback was mostly positive, with comments from patients being focused on enjoying the update, understanding what was happening for them, being reassured that staff knew about co-morbidities and being able to participate in the handover.

37 Clinical Handover Committee Progressing and auditing bedside handover Working on improving medical, nursing and allied health handovers Working on improving handovers back into the community

38 Discharge Planning They gave me a script and organised follow-up. I had a date for the follow-up before I left The first time I was packed and ready to go by 10am, then at 12 o clock I was thinking why am I still here, I got my medications at 4:30pm. That was a whole day wasted When I was going home I was told I d have a phone call from Kambah to organise a shower chair and a walker. I never heard from them and I d agreed for them to leave a message on the answer phone so I know they didn t ring

39 Project Venturi Establishing clear processes for discharge planning and coordination of care Clinical Handover Committee establishing content of the handover to the community setting

40 Visiting Hours We think that close family members should be able to attend in small numbers but people need to be respectful of others especially in shared rooms and nurses should enforce this more I always find visiting hours are not enforced. I understand that you need some leeway and it s good for people s recovery, but both times I was in X ward some families were very loud and were there until 9:30 10pm in the evening

41 Partnering with Consumers Governance Committee Visiting Hours Subgroup established as a subgroup Developing consistent hours, guidance for staff, patients, family and visitors

42 System Navigation I have no problem getting him in immediately for a clinic they know him and know he can t wait I know the system and yes, it did make a difference. I don t know how someone who didn t know it would go We know how to do that now - we know the system some people can wait for a while. Someone tried to show me the easy way through the new hospital and it took me ages to find the Doctor

43 System Navigation: Way finding project- short term and long term Health Literacy work progressing Increased focus on multicultural needs

44 Nil by Mouth NBM = NPO I didn t know until my previous admission that you can suck on ice if you re NBM. This is helpful to know as when you re NBM it makes a difference if you have a dry mouth By the time the lunch trolley arrived I was really hungry and it wasn t helpful having someone give me food again

45 NBM Working group Working group established Data has been collected on current practice Data collected on average length of NBM for surgical patients Data collected on process and length of NBM for medical NBMs (i.e Speech therapist referrals)

46 Summary The LHN project informed strategic thinking and was the catalyst for new working groups for system change Change builds slowly but happens quickly once the right drivers are in place We tend to focus on the negative but the positive is just as important

47 ACT Health s I am the Patient Experience Video

48 Remember for us this is ORDINARY, for this girl and her family it is EXTRORDINARY

49 Special thanks to: A/Professor Zsuzsoka Kecskes Carmel Brennan Bernadette Brady Kangaroo Island-Stewart M