Safer Systems Saving Lives - Clinical Excellence Commission

Report
Welcome
<<Chief Executive or Board Chair/Member>>
From The Top – what makes
leading patient based health
services tick?
<<Local Leader with focus on
Patient Based Care>>
“I couldn’t have faulted
the technical care but...”
Patient Based Care Model
Overall Views of Health Care System, 2010
Percent
AUS
CAN
FR
GER
NET
H
NZ
NOR
SWE
SWIZ
UK
US
Only minor
changes
needed
24 38 42 38 51 37 40 44 46 62 29
Fundamental
changes
needed
55 51 47 48 41 51 46 45 44 34 41
Rebuild
completely
20 10 11 14
7
11 12
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
8
8
3
27
What affects quality in health care?
The level of quality in hospital environments
is affected by:
(1) the quality of technical care;
(2) the quality of interpersonal relationships;
(3) the quality of hospital amenities and the
environment
(Potter et. al, 1994. Int J of Health Care Qual Assur, Vol 7, pp.4–29).
High performing organizations
Hospitals with high levels of ‘patient care
experience’ reported by patients provide
clinical care that is higher in quality across a
range of conditions.
Jha A et al (2008) N Engl J Med 2008; 359:1921-1931.
The evidence
Improved patient experience is positively
associated with:
• Objectively measured health outcomes
• Adherence to medications and treatments
• Health resource usage
• Technical quality of care & adverse events
Doyle C et al BMJ Open Jan 20, 2013
Benefits of Patient Based Care
Refocusing care delivery around the patient
• Improves patient care experience....
• Improves clinical and operational-level
outcomes:
• improved patient adherence
• fewer medication errors
• decreased adverse events
• improved staff satisfaction
• enhanced staff recruitment
• decreased length of stay
• decreased ED return visits
• And the bottom line.
Organizational outcomes
Business-case for Patient Based Care:
•
•
•
•
Decreased malpractice claims
Higher employee retention rates
Decreased readmission rates
Reduced operating costs
Charmel PA, Frampton SB. Building the business case for
patient-centred Care. Healthcare Financial Management
2008;March 1-6.
“The three dimensions of quality should be
looked at as group and not in isolation.”
“Clinicians should resist sidelining patient
experience as too subjective or moodorientated, divorced from the ‘real’ clinical
work of measuring safety & effectiveness.”
Doyle C et al BMJ Open Jan 20, 2013
Leaders in patient based care*
Organisational characteristics:
• Strong committed senior leadership
• Communication of strategic vision
• Engagement of patient and families
• Sustained focus on staff satisfaction
• Regular measurement and feedback reporting
• Adequate resourcing of care delivery change
• Staff capacity building
• Accountability and incentives
• Culture strongly supportive of change and learning
*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
Leadership commitment
 Start each Board meeting with a story of patient
care from your service
 Arrange for board and executive members to
visit wards to regularly talk with staff and patients
 Involve patient advisors in strategic planning
process
 Demonstrate leadership commitment –
communicate a patient-focussed mission to new
staff at orientation
Lessons learnt – Inquiries....
Mid Staffordshire, UK
• Need for a common culture of ‘putting
patients first’
• “Every single person serving patients
needs to contribute to a safe, committed
and compassionate and caring service”
• Need for strong, patient centred healthcare
leadership
Listening to patient feedback –
use to drive change....
Catheter-related bloodstream infections
occur 56% more frequently in hospitals
with low patient ratings for nurse or
doctor communication
Reed K. (2012) Health Grades Patient Safety and Satisfaction
Patient feedback as a
predictor...
Safety: patient feedback about hospital
cleanliness is a positive predictor:
• for staff participation in activities like handwashing
• for MRSA infection levels
Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354
Edgcumbe - (2008) J. Hosp. Infection
What do patients value in care?
Being treated with dignity and respect
Having confidence & trust in providers
Courtesy & availability of staff
Continuity & transitions
Coordination of care
Pain management & physical comfort
Respect for preferences
Emotional support
Joffe et al. (2003) J Med Ethics
Jenkinson et al. (2002) Qual Saf Health Care
2.8 million patient surveys
4,610 hospitals
Driver matrix – US data
Red = low performance + high impact
“Hospital improvement
priorities do not seem to
match up with what
hospitals need to
improve...”
BHI – Insights into Care, 2009
Challenges ahead
• Changing mind set of staff from ‘provider-focus’
to a ‘patient-focus’
• Change takes longer than anticipated – it’s
about transforming culture and care delivered
“So for whatever reason, we had the attitude
where the physician is king and the patient,
‘well, we’ll get to the patient when we have
time.’” (COO)
*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.
Clinical unit level – frequency of patient involvement
(CEC Quality System Assessment - NSW)
Always (100%)
Rarely (1% - 33%)
Sometimes (34% – 66%)
Not Applicable
Often (67%-99%)
Never (0%)
Discharge planning
Medication rounds / medication
reconciliation
Ward rounds
368
96
472
254
138
297
Shift handover 42 200
0%
196
20%
199
146 26
5 152
156
141
326
179
116 131
308
180
229
319
40%
60%
80%
100%
Just streamlining
processes within a
clinical/provider model is
not truly engaging
patients
Patients & their families and/or carers
are viewed as integral members of the
health care team
2011 – 2013 (strongly agree response)
60%
48%
50%
40%
33%
30%
28%
20%
10%
0%
2011
2012
2013
Patient engagement:
Not just the ‘soft stuff’
Service quality and interpersonal relationships are
critical dimensions to support and promote not
only improved patient care experience but also
patient safety, treatment, recovery and wellbeing
(Australian Commission on Safety and Quality in Healthcare [ACSQHC], 2010).
Mandatory for
service
accreditation
from 2013
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