Enabling person-centred practice within HSE West

Report
‘Enabling person-centred practice
within HSE West: an
emancipatory practice
development approach’
Dr Randal Parlour
Assistant Director NMPD (HSE West)
Honorary Fellow (University of Ulster)
•Practice development is a continuous process of
developing person-centred cultures
•It is enabled by facilitators who authentically engage with
individuals and teams to blend personal qualities and
creative imagination with practice skills and practice
wisdom
•The learning that occurs brings about transformations of
individual and team practices. This is sustained by
embedding both processes and outcomes in corporate
strategy.
(McCormack, Manley & Wilson, 2008)
Person-centred care is a fundamental tenet in
key national documents:
• National Standards for Safer Better
Healthcare (HIQA (2012)
• Future Health: A Strategic Framework
for Reform of the Health Service
(HSE 2012)
A Review of Practice Development in Nursing & Midwifery
in the Republic of Ireland & Development of a Strategic
Framework (2010)
• identified how practice development can provide a sustainable
methodology to transform the culture and context of care within
Ireland to deliver real person-centred care cultures within the context
of national health policy.
• identifies the importance of multidisciplinary activity in supporting the
development of person-centred practice cultures
• evidence presented recommends the need to develop facilitation
and work-based learning expertise and infrastructures within the
Irish health system.
• is about delivering person centred, safe and
effective health care by developing people
and their practice.
Collaborative Research & Development
• Introductory Practice Development Schools
• Developing Practice with Older People
• Productive Ward/Releasing Time to Care
• Nursing & Midwifery Metrics
The principles of collaboration, inclusion & participation underpin
approaches to PD research and development and guide ways of
working with participants & stakeholders
Introductory Practice Development Schools
The aims of the school are • to provide an opportunity for
participants to focus on their own
effectiveness in fostering a culture of
learning that is person-centred;
• to explore the evidence base to
practice development in relation to
their own learning;
• and, experience the process of
effective teamwork and group learning
in relation to practice development
concepts and theory.
Outcomes
• Support the initial development of key individuals to lead out on
culture change in Health Service Executive (HSE) organisations,
supported and enabled by senior management within each
organisation.
• Evaluation confirms the effectiveness of these schools especially
when run in conjunction with senior management support for
Practice Development and national/local Practice Development
strategy
• Significant in building capacity within the health system and in
developing a critical mass of ‘champions’ to
support the changes required
• ‘In practice there is time if we as a team agree on how that time is
best used to achieve a person centred service for patients and staff.
• ‘I had thought that PD was about someone or some department, I
now realise that we are all PD people and can become involved in
changes to enhance care’
• ‘I came here with an open mind willing to learn all I could, I found the
whole experience very enlightening, empowering and thought
provoking
• ‘Everyone has a part to play in the development
of practice, it is something I am responsible for’.
Developing Practice with Older People
NMPD facilitators challenge & support internal facilitators and
healthcare teams • to get beneath the surface of daily routine
• to critically reflect on the values and beliefs they hold about patient
care
• to identify what needs to change and the part they need to play in
effecting improvement
• to consider if team behaviours, systems and processes used in
practice, are consistent with person centred values.
This is the essence of caring and is dependent on staff who create the
climate and culture within which patients are cared for.
Parlour & McCormack 2012
Developing a culture of effectiveness
Manley, Parlour & Yalden (2013)
Unreceptive/
under-developed
culture
• No shared vision
• Lack of
coherence/teamwork
• No explicit values
guiding practice
• Unclear roles &
responsibilities
• Inconsistent
standards
• Little use of critical
reflection &
workplace learning
• Team members
feeling isolated
• Little/no evaluation
of practice culture
START
Source of evidence
PRACTICAL STRATEGIES








Build a shared vision for practice direction &
ways of working
Raise awareness of the context & culture of care
& its impact using quantitative & qualitative
inquiry methods to evaluate practice,
collaboratively gather data from observations of
care, other tools, patient experience, literature
reviews.
Identify stakeholder claims, concerns & issues &
act on these
Provide feedback & engage staff in making sense
of data & observations through multi-professional
critical reflection, critical dialogue, to enable the
identification of specific baseline contexts
Facilitate group processes/action/active learning
with an ethic of valuing contributions from all
members; challenge & support, sharing critical
incidents on own practice & practice context &
implementing shared values within a safe
environment
Enable collaborative participation in action
cycles, action plans, implementation & evaluation
Recognise & celebrate achievements
Use Qualitative 360 feedback to enable
practitioners to give & receive feedback, build
effective relationships, & develop role clarity
An effective
workplace culture
• Individual/team
learning & sharing
• Awareness of
facilitator role
• Collaborative
analysis
• Staff less isolated/
increased confidence
• Improved patient
care
• Achievement of
purpose/
objectives
• Ongoing learning
& changes to
practice
• Innovation
• Transformed
cultures & contexts
END
Source of evidence
Productive Ward/Releasing Time to Care
Specific objectives :
• To examine how the PW
initiative facilitates the
development of personcentred workplace cultures
for staff.
• To examine how the PW
initiative improves the
experiences of patients and
their families
McCormack & McCance (2010)
Measurable Outcomes
•
•
•
•
Satisfaction with care
Involvement with care
Felling of well being
Creation of a therapeutic culture
McCormack & McCance (2010)
Instrumentation - Staff
Context Assessment Index (range 1-4) - Assists practitioners in
assessing & understanding the context in which they work
• Person-centred Practice Index (range 1-5) – measures the extent to
which staff rate their work setting to be person-centred
• Instrumentation - Patients
• Person-centred Climate Questionnaire – Patients (range 17-119)
Evaluates to what extent the climate of health care settings are
perceived by patients as being person-centred Evaluates to what
extent the climate of health care settings are perceived by patients
as being person-centred
• Patient Experience Questionnaire (range 0-100) - systematically
gathers the views of patients about the care they have recently
received
Results
Site
Prerequisites The Care
Care
Environment Processes
The Patient
The PersonExperience
centred Climate
Questionnaire Questionnaire.
5
4.5
4.1
4.6
90.3
109.6
1
4.2
3.8
4.0
85.7
106.2
6
4.3
3.8
4.4
73.0
106.0
2
4.3
3.9
4.3
82.4
104.4
4
4.2
3.9
4.2
83.2
103.8
3
4.3
3.8
4.2
84.6
103.0
TOTAL 4.3
3.9
4.3
84.5
105.6
Nursing & Midwifery Metrics
• The RCN (2009) explicate the
role of nursing & midwifery in
improving care outcomes for
patients and clients
• These three elements provided
the scope for this evaluation
and were central to the
subsequent evaluation design.
Objectives
• Investigate the impact of the ‘Medication Management Metrics’ in
regards to safe and effective care.
• Examine the experiences of patients with a specific focus on how
their nursing care needs are met.
• Examine the experiences of staff with regard to the implementation
of this initiative within the workplace.
• To create a deeper understanding of how the ‘Metrics’ initiative
impacts upon the context within which care is delivered.
• Clarify the links between this initiative and other
strategic/organisational priorities.
Study Outcomes
Nursing Staff – Quantitative Findings
• Independent pre-post test design
• No or inconsistent impact on workplace culture as measured
using the Nursing Context Index and Context Assessment Index
• Slight impact on nurse stress levels but inconsistent pattern of
change across locations
Nursing Staff – Qualitative Findings
• Cascade method of knowledge transfer
• Lack of reach to staff nurses resulting in:
 Piecemeal implementation
 A lack of engagement by staff nurses
 Poor understanding of the study aims
 Lack of ownership at staff nurse level
 Poor engagement with other health care staff (eg Medical
Clinicians)
Patient findings
• Overall the Medication Management Metrics intervention had, at
best, a slight improvement, on patients’ perceptions of personcentred care
• Marginal increase in scores but not at a statistically significant
level
Thank You For Listening
[email protected]

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