Patient Participation Culture Questionnaire (PPCQ) in general Flemish hospitals

Transcription

1 Patient Participation Culture Questionnaire (PPCQ) in general Flemish hospitals Prof. dr. Ann Van Hecke Prof. dr. Kristof Eeckloo Simon Malfait 20 th May 2015

2 Refer to this presentation as follow: Van Hecke A., Malfait, S., Van Belleghem S., Schouppe L. Van Daele J., Eeckloo K. (2014). Patiëntenparticipatiecultuur Peiling 2014 Meerjarig programma Patiëntveiligheid ( ). Universiteit Gent.

3 Patient Participation is very diverse

4 Patient participation: The use of the patient s unique expertise in the healthcare process with the goal of improving the quality of care (CBO)

5 + Arnstein s Ladder of participation I n f l u e n c e Self-care Partnership Advising Patient determines goals and priorities. The patient manages the illness. The healthcare professional has a supporting and advisory role. The patient decides or co-decides on matters that concern his or her health situation and the healthcare process. The patient s expectations or advice are questioned and can be taken into account by the healthcare professional. The healthcare professional can decide to deviate from these expectations or advices based on argued reasons. p a t i e n t - Consulting Informing The healthcare professional decides about the care-process but actively asks the patient s opinion. The patient is well informed about his or her health situation. The patient does not necessarily has decisional rights in the healthcare process. + Influence professional -

6 Informing Hip and knee classes The hip and knee class is an oral information group session. Good practice AZ Sint Blasius Dendermonde

7 Boe-group/ Peer-group/ PIT-group Boe peer pit groepen. Good practice Psychiatric hospital, Pittem Source: Debyser B.

8 Levels of patient participation Micro-level = interaction between patient and healthcare professional concerning examination and treatment The importance of information-sharing and involvement, support trough information brochures, Bron: King s Fund

9 Levels of patient participation Online on the spot (OOS): Van Duppen D, Aertgeerts B, Hannes K, NeirinckxJ, Seuntjens L, Goossens F, Van Linden A. Online on-the-spot searching increases use of evidence during consultations in family practice. Patient Educ Couns 2007;68:61-5. Bron: King s Fund

10 Levels of patient participation Meso-level = focus on a ward or healthcare Bron: King s Fund organization

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12 Levels of patient participation Macro-level = focus on federal or regional health policy Less frequent in the Belgian Healthcare system (cfr. study of the KCE 2012) Bron: King s Fund An exception is the Observatorium for Chronic illnesses (RIZIV)

13 Micro- and meso-level

14 Goals To obtain insight in the degree of patient participation on wards in general, with a specific attention for patient participation related to patient safety issues; To map good practice concerning patient participation; To compare the results of the PPCQ with the results of the Flemish Patient Questionnaire (VPP).

15 Respondents Healthcare professionals with direct patient contact; > 6 months employed on a ward; Included units: C-wards (surgery); D-wards (internal medicine); G-wards (geriatric wards); M-wards (maternity units); Sp-wards(revalidation wards).

16 Structure 1. Patient participation culture A. The ward s culture B. Competence C. Support D. Sources/perceived lack of time E. Communication F. Methods 2. Patient participation and patient safety A. Beliefs and convictions related to patient participation and patient safety B. Patient participation in specific topics of patient safety 3. Mapping of good practices Construct of the questionnaire

17 Preliminary results Healthcare/Healthcarefacilities/Patientsafety/ Supportplan/supportplan2014/empowerment ugent/index.htm#.vgyt-jsg9xy

18 Preliminary results 15 participating hospitals Overall analysis 13 non-respondent wards (n=0) were deleted 162 wards Duplicates removed (n=17) 1329 questionnaires Analysis on hospital level questionnaires (n=83) removed from wards (n=33) which didn t meet the inclusion criteria 1266 questionnaires

19 Respondents 65,4 % Healthcare profession(%) 11,4 % 10,8 % 9,2 % 3,2 % Nurses Paramedici Physicians Midwives Nurse assistants

20 Respondents Specialisation (%) C-ward Age group (%) < 25 years 10,7 10,0 31,9 14,7 32,8 D-ward G-ward M-ward 10,8 8,1 25,9 24,9 30, years years years SP-ward > 55 years

21 Respondents 57,6 Job time (%) Part-time ( 50%) 8,7 33,8 Part-time (51% - 99%) Full-time (100%) Supervisor (%) 17,8 Yes 82,2 No 2,8 Degree (%) 19,1 54,4 23,7 High School Graduate Bachelor Master or higher

22 Number of wards (n) nurse/midwife nurse/midwifeparamedic nurse/midwifenurse assistant physiciannurse/midwife nurse/midwifeparamedicnurse assistant nurse/midwifephysicianparamedic nurse/midwifephysiciannurse assistant nurse/midwifephysicianparamedicnurse assistant 1 profession 2 professions 3 professions 4 professions

23 Patient participation culture: Ward Excellent Good Acceptable Significant difference between the perception of patient participation, based on the wards specialization: C-, M- en Sp-wards score highest. G-wards score lowest. mean M-wards C-wards SP-wards D-wards G-wards Poor * * *2 hospitals have significant lower scores

24 Patient participation culture : Ward The degree in which patient participation is a topic discussed on the ward 26% 19% 55% On our ward patient participation is never or seldomly a topic On our ward patient participation is sometimes a topic On our ward patient participation is a common topic

25 Patient participation culture : Ward 100% 90% 80% 70% 60% 50% 40% 30% On our ward patient participation is a common topic On our ward patient participation is sometimes a topic On our ward patient participation is never or seldomly a topic 20% 10% 0% Excellent Good Acceptable Poor Very poor

26 Does my age matters? Should I work more to achieve better results? Does the hospitals wherei work matters? What about my profession? Andmyeducation? The degree of patient participation in Flanders is more than acceptable!!!

27 Patient participation culture: Competence 100% 90% 80% 70% 46,2% 43,8% 30,3% 60% 50% 40% 30% 20% 50,3% 53,0% 59,8% fully agree rather agree rather disagree fully disagree 10% 0% 3,0% 2,8% I feel competent to inform patients I feel competent to ask the patient's advice and to take this advice into account 9,1% I feel competent to let the patient co-decide

28 Patient participation culture: Competence Healthcare workers with a higher education feel more competent to let the patient participate; Nurses and nurse assistants feel least competent, physicians and paramedici feel most competent; Full-time employees feel more competent than part-time employees; Supervisors feel more competent.

29 Patient participation culture : Support 1.9 My supervisor has organized collaboration with patient organizations. 1.1 The management of the hospital facilitates a working environment that supports patient participation. 3,50 3, The actions of the hospital management illustrate that patient participation is an important issue. 1.8 My supervisor is personally involved by forming a mission/vision concerning patient participation. 2,50 2, My supervisor has a positive attitude towards patient participation on the ward. 1.7 Colleagues support each other in letting patients participate in the healthcare process. 1.4 My supervisor shows appreciation when I let a patient participate. 1.6 My supervisor shares the results we achieve related to patient participation. 1.5 My supervisor takes into account suggestions of employees to improve patient participation on the ward. Mean Physician < 35 years Master Supervisor

30 Patient participation culture: Support Physicians experience less support from their supervisor and colleagues; No difference between ward s specialization; Healthcare professionals < 35 experience more support than their older colleagues (overall, supervisor, colleagues); Healthcare professionals with a master degree experience less support (even within the groups of nurses and midwives); Supervisors experience less support from their supervisor, colleagues and overall).

31 Patient participation culture: Communication always mostly sometimes never this is not my responsibility

32 Patient participation culture : Communication Healthcare professionals of M- en C-wards > D- and G-wards; Supervisors > non-supervisors; Physicians > midwives > nurses >paramedici> nurse assistants; Masters > bachelors > graduates > high school degrees; The age group of < 35 will inform the patient less than their older peers.

33 Patientparticipationculture : Communication To which degree a healthcare professional positive towards patient s questions about: How long they have to stay in the hospital 4,00 3,00 How a certain procedure is executed 2,00 How long their pain will last 1,00 When they can start normal activities Which signals indicate their recovery process is not going as planned

34 Patient participation culture : Communication In which degree are healthcare workers positive towards patient asking questions about: -35 years < years < + 45 years, even within groups (physicians, nurses and nurse assistants); Bachelors en masters have higher scores; M-wards have a lower score than G- en D-wards; Supervisors have a higher score.

35 Patient participation culture : Methods 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% * * * * * * Is being practiced Has or could have value *Supervisors find this method significant more meaningful than non-supervisors

36 Structure 1. Patient participation culture A. The ward s culture B. Competencies C. Support D. Sources/perceived lack of time E. Communication F. Methods 2. Patient participation and patient safety A. Beliefs and convictions related to patient participation and patient safety B. Patient participation in specific topics of patient safety 3. Mapping of good practices Construct of the questionnaire

37 Patient participation and patient safety

38 Patient participation and patient safety: Convictions and beliefs I think it is positive if patient ask questions or make suggestions concerning patient safety. Rather agree or fully agree 96% I stimulate patients to ask questions concerning patient safety. I think it is important if patients are informed about the general results of our hospital concerning patient participation issues (e.g. number of medication errors). I think it is important if patients are informed about a patient safety-incident, if they are involved in this incident. 70% 50% 83%

39 Patient participation and patient safety: Convictions and beliefs Rather agree or fully agree I think it is inappropriate to concern patient with aspects relating to patient safety. A more important role for patients in patient safety will have a negative influence on the relationship between healthcare professional and patient. I have the impression that patients do not dare to ask questions relating to patient safety. I feel competent to involve patients in several aspects of patient participation. 25% 34% 36% 81%

40 Patient participation and patient safety: Convictions and beliefs The age group of < 35 years have lower scores than their older colleagues, both in competence as overall attitude; G-wards have a less positive attitude but feel equally competent towards the involvement of patients in patient safety issues; Masters en bachelors are more positive towards involvement of the patient in patient safety issues; Supervisors are more positive, but don t feel more competent than non-supervisor.

41 Patient participation and patient safety : Patient safety topics Do you think it s positive when patients are asking questions or reporting problems about: If their identification bracelet is missing. If they have received the right medication. 3,80 3,60 3,40 Majority (+80%) rather or fully agrees What the health care professional's name is and why he is in their room If they think their wound is infected 3,20 3,00 Why a health care professional removes a certain device gemiddeld < 35 years If they have not got their results If the health care professionnal has washed or disinfected their hands If they think there has been a mistake in the care they receive.

42 Conclusion and future challenges Patient participation is equally about attitude as it is about technological possibilities (e.g. e-health) and innovation; Patient participation in relation to illiteracy, elderly and deprived social groups needs additional attention; The importance to learn from good practices as scientific prove about efficacy and efficiency is lacking.

43 Future goals Implementation of actions to improve patient participation: Bed site reporting Tell-us cards

44 Future goals Translation Flemish Patient questionnaire (VVP) PPCQ - Flemish general hospitals PPCQ - Walloon general hospitals PPCQ -Flemish psychiatric hospitals PPCQ -Walloon psychiatric hospitals