Enhancing the Outpatient/Client Experience

Report
Outpatients – the enigma
Enhancing the Outpatient/Client Experience –
through Staff Development, Service Improvement &
User Engagement/ Involvement
Barbara McDowell Anderson
South Eastern HSC Trust
Outpatient Nursing… it is more than:
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Directing ‘lost’ patients and visitors
Forwarding phone calls to relevant departments
Handling patient records
Chasing up missing notes/ results/ doctors
Setting up before clinics
Chaperoning doctors during consultations
Clearing up after clinics
Handing out leaflets
Making review appointments
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Outpatient Nursing… in SET includes:
• Routine clinic ‘work up’ – ECG’s/ spirometry/ bloods
• Ophthalmology – pre and post op assessment/
review clinics
• Urology – flow clinics
• DVT/ VTE - risk assessment/ prophylaxsis treatment
• Anticoagulant (Warfarin ) clinics
• ENT – micro-suction clinics
• Gynae – Pessary assessment clinics
• ED – injection clinics
• Diabetic clinics
• Dermatology clinics
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Dermatology Service in SET
• Integrated team
– Hospital Clinicians – Consultant/ Associate
Specialist Registrar/ Staff Grade Doctors
– Hospital Specialist Nurses
– ICATS – GPwSI
– ICATS – Specialist Nurses
– GP’s
– Outpatient Nurses
• a ‘general specialist’ or a ‘special generalist’
Leading Care, Leading Teams – Shaping the Future
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Dermatology – nursing
Staff
Training
• Commissioned
courses academic base
• Study Days
• Workshops
• ‘In-house’/ ‘on
the job’ training
Service
Improvement
• Establishment of a
variety of nurse led
clinics
•Patch Test Clinics
•Cryotherapy Clinics
•Roaccutane Clinics
•Biologics Clinics
•PUVA/ UVB Clinics
•PDT Clinics
•Botox Clinics
•ICATS Clinics
User
Involvement
• Patient
•Questionnaires
•Patient Stories
•User Involvement
• Staff
•Team Meetings
•Supervision
•Sharing Successes
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led Patch Testing ‘allergy’ Clinics
• Dermatology Consultants refer
patients to Nurse Led Patch
Testing Clinics
• Appointments arranged
• Nurses prepare allergy tests in
advance
• Treatment explained & test
strips applied
• Patient attend 48 hours later
for ‘reading of patch tests’
• Review with Doctor or Nurse
and further treatment plan
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led Cryotherapy Clinics
• Dermatology
Consultants refer
patients to Nurse Led
Cryotherapy Clinics
• Appointments
arranged
• Treatment process
explained
• Patient attend
weekly/ fortnightly
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led Roaccutane Clinics
• Dermatology
Consultants refer
patients to Nurse Led
Roaccutane Clinics
• Systemic drug therapy
for treating acne
• Consultant only
initiated treatment for
4 months
• 4 weekly review for
ladies (pregnancy
testing )
• 4 & 16 week review
for males
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led Biologics Clinics
• Dermatology Consultants refer patients with Psoriasis to
Nurse Led Biologics Clinics
• Appointments arranged/ treatment/ process explained
• Information added to the Badbir Database
• Ongoing IV or SC drug therapy monitoring – 3 monthly
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led PUVA/UVB Light Therapy Clinics
• Dermatology Consultants
refer patients with eczema
/psoriasis to Nurse Led
PUVA clinics
• Appointments arranged
• Treatment/ process
explained
• Patient attend 3 times a
week for 15 treatments
• Initial treatments are only
seconds/ minutes long
Leading Care, Leading Teams – Shaping the Future
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Nurse-led PDT clinics
• Dermatology Consultants refer
patients with oncological/ nononcological conditions, including
non-melanoma skin cancers and
acne to Photodynamic therapy
(PDT) Nurse Led Clinics.
• Particularly lesions in difficult,
cosmetically sensitive and poor
healing sites.
• Straightforward treatment:
• Procedure can be undertaken by
a skilled nurse practitioner
Bowens disease before and after
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Nurse-led Botox clinics
• Dermatology Consultants refer
patients with hyperhidrosis
(excessive sweating) problems
to Nurse Led Clinics.
• The Botox injections can be
undertaken by a skilled nurse
practitioner
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Centred – Safety
• Staff Training
• Policies, Procedures
& Protocols
• Incidents/ Accidents
• Near Misses
• Complaints
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Centred – Quality
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Evidence Based
Audit - practice
Patient Attendance
Staff Absence/
Turnover
• Communication/
Professional Forum
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Centred – Experience
• Patient
Experience
– Questionnaires
– Patient Stories
– User Involvement
• Staff Experience
– Team Meetings
– Sharing Success
– Staff Involvement
in professional
forums
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Experience
• Patient Experience
– Patient Care Survey
• Dermatology Outpatient Questionnaires
– Online Patient Satisfaction Questionnaires
• Staff as Patients
– Patient Stories/ Themes
– User Engagement/ Involvement
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Care Survey Questionnaires
(Dermatology)
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Survey – January 2013
• Response:
– 53:150 = 35.3%
• Male:
– 46%
• Female:
• Ethnicity
– White: 98%
– Other: 2%
• First Language
– English: 95.5%
– 54%
• <59 years:
– 42%
• >60 years:
– 58%
• Questionnaire easy to
complete:
– Very Easy: 64%
– Easy: 36%
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
14 KPI’s
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On arrival
Respect
Attitude
Behaviour
Communication
Information Leaflets
Privacy & Dignity
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Infection Control
Consultation
Waiting times
Medical Records
Treatment & Care
Environmental Factors
Overall Satisfaction
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Positive comments
That I was seen and
treated by people who
cared for my health
and who did their best
for me
Efficient &
professional way at
which the procedure
was carried out
Local access, fairly
prompt appointments /
information given
The doctor and nurse
spoke directly to my
daughter, they didn’t talk
over her
Getting the all clear
The relaxed manner
and friendliness of the
doctor & nurse in
attendance
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Areas of improvement
Shorter waiting time
for the appointment
and in the department
Clearer contact details
should they be
needed
Need better facilities in
the waiting area
Difficulty with directions
once inside the hospital
Had to park in a public
car park and walk
across main road, in the
pouring rain
More punctual
attendance at the clinic
may – may help prevent
long waits at the clinic
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Online Patient Questionnaires
(Staff as Patients – n=34)
November 2012 – February 2013
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
HOSPITAL ATTENDED
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CLINIC ATTENDED
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DID STAFF INTRODUCE THEMSELVES TO YOU WHEN
YOU FIRST MET?
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
RESPECT
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
ATTITUDE
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
BEHAVIOUR
Leading Care, Leading Teams – Shaping the Future
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COMMUNICATION
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
PRIVACY & DIGNITY
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
OVERALL SATISFACTION
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Patient Stories - themes
Leading Care, Leading Teams – Shaping the Future
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Staff
The way staff put me at
ease, they saw I was
worried and were so kind
and reassuring
Staff put me at easy and
explained everything in a
very warm and friendly
manner. I felt that I was
being treated by a friend
who just happened to be a
professional.
It felt as if I was on a
conveyor belt, just
another person to
be seen on a
particular day
Receptionist
very helpful and
courteous
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Person centred processes
I am profoundly deaf. At the beginning
of the appointment, the doctor finger
spelled his name to me. It had never
happened to me before. It was a
lovely and thoughtful gesture, which
made me feel at ease. The doctor
was also willing to write everything
down which was very helpful.
I am very pleased by the
way I was spoken to and
not spoken down to,
everyone came to my
level
I think it would have been
useful if the information
leaflet given to me at the
clinic had been posted to
me prior to my
appointment
If it was possible to be told
who you could contact
should you have a query
as to your treatment or
next appointment
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Involvement in care
Staff were really nice. Very
respectful in promoting my privacy
and dignity. Explaining everything
really well to me and due to the
nature of my appointment I was
anxious. Staff were very
reassuring.
The information
provided allowed
me to make an
informed choice
My daughter being so
upset throughout the
procedure however that
was no-one’s fault. We
did however enjoy the
fact that she left the clinic
being able to hear
properly
Leading Care, Leading Teams – Shaping the Future
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Processes
The time between referral
and appointment was
good
The speed and efficiency
with which my
appointment was
conducted
There was a ½ hour
delay but at least we
were informed of that
Booking in was
confusing for a 90
year old
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Environment
The open environment,
clean and professional
with a friendly atmosphere
Better catering facilities at
the clinic
The impossibility of car
parking
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
ACTION PLAN
• Feedback and results shared with staff with
specific reminders:
– Confidentiality
– Signage
– Person Centred Practice
• Ongoing collection of patient satisfaction surveys
and patient stories
• Transforming Your Care projects
– OP Reform workstream working in tandem with the
Long Term Conditions workstream to promote greater
User Involvement
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
User Engagement/ Involvement
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Questionnaire feedback
I am profoundly deaf. At the
beginning of the appointment,
the doctor finger spelled his
name to me. It had never
happened to me before. It was
a lovely and thoughtful gesture,
which made me feel at ease.
The doctor was also willing to
write everything down which
was very helpful.
•I think it would be an excellent idea to
provide ‘Deaf Awareness Training’ to
medical staff.
•The standard Deaf Awareness training is
1 full day.
•The training enables the participants to
become more informed on how to deal
with a range of deaf people including
those who use Sign Language and also
Hard of hearing people.
•The Deaf Community will benefit hugely
form this innovation, as that will ensure
that the next generation of doctors are
more aware how to deal with deaf patients
with compassion.
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Complaint - learning
A child attending the
Fracture Clinic had a plaster
cast removed. The parent
complained that the
procedure was not
explained to the child, nor
was he shown the plaster
saw or made aware of how
noisy it was.
A patient attending the
Fracture Clinic
complained that they had
not been offered
(adequate) analgesia
prior to fracture
manipulation/ application
of a plaster cast .
Following investigation/ discussions
the following actions were
implemented:
•Patient information leaflet was
reviewed
•Further training/ awareness for staff
dealing with paediatric fractures
•Ear protectors made available
•Provision of Entonox gas as required
for pain relief
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Incident review
A patient should have had a 6
week review following a wider
excision of melanoma.
Regrettably this did not happen
due to human error - in that the
current administrative processes
were found not to have been
followed completely and the
systems and processes were not
robust enough to prevent or
detect a failure
•Clarity of roles and responsibility of
secretarial staff for clinic attendances
•Discussed at induction of new staff &
reviewed at annual appraisal
•Clinical staff urged to provide clearer
information/ instructions to patients
•Information reports utilised to
validate and follow up patients with
outstanding reviews
•Explore technology solutions for
follow-up surveillance
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
What of the future…
Outpatient Nursing is unlikely to be seen as:
• Life saving – ICU / Theatre
• Cute / lovely – Maternity & Paediatrics
• Emotive – Cancer Services
• Headline hitting – ED trolley waits
Yet Outpatient Departments are uniquely placed at the
Primary and Secondary Care interface & currently
have ¼ - ½ million opportunities per year to provide
Transformational Outpatient Care to all patients
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
Outpatient Nursing needs
• To exploit the natural conduit between Primary &
Secondary Care
• To influence Trust/ Board/ Department for further
opportunities and resources to provide more
Outpatient Nurse Led Clinics
• To gain recognition for the work currently undertaken
– Monetary/ Non Monetary
• To ask for a regional professional forum for Outpatient
Department Sisters/ Managers
• To raise the professional profile of Outpatient Nursing
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
• When I think about all the
patients and their loved ones
that I have worked with over
the years, I know most of
them don't remember me
nor I them. But I do know
that I gave a little piece of
myself to each of them and
they to me and those
threads make up the
beautiful tapestry in my
mind that is my career in
nursing.
Donna Wilk Cardillo
A Daybook for Beginning Nurses
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013
“They may forget your name, but they will never
forget how you made them feel”– Maya Angelou
Thank you
& Questions
Leading Care, Leading Teams – Shaping the Future
Ward Sister/Charge Nurse and Team Leader Conference, 17th April 2013

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