1. Patient care experience – beyond the rhetoric Dr Karen Luxford Director Patient Based Care 12/11/10

2. Quality Improvement 101 Back to basics: leadership commitment training sufficient resources supportive culture a strategic focus on customer needs

3. QI applied to healthcare Focus: teamwork systems and processes measurement Where is the tenet of ‘client-focused’?? Batalden PB, Stoltz PK. 1993. The Joint Commission Journal, 424:52.

4. 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

5. Nice but not necessary? “The fluffy stuff”

6. Established relationship between improving patient-centred care and patient care experience outcomes

7. The ‘hard stuff’ PCC linked with improved safety: Decreased mortality 1 Decreased rates of hospital-acquired infection 2 Decreased surgical complications 3 Higher quality clinical care/best practice 4 Improved patient functional status 2 1.Meterko M et al (2010) Health Services Research 2.DiGioia A M et al (2008) Agency for Health Care Research and Quality 3.Murff et al (2006) Qual Saf Health Care 4.Jha A et al (2008) New England Journal of Medicine

8. Clinical outcomes Higher positive patient ratings of involvement in care significantly associated with fewer cardiovascular symptoms 6-10 weeks post discharge for AMI Arnetz etal (2010) Health Expectations 13: 298-311

9. Patient feedback as a predictor... Safety: patient feedback about hospital cleanliness is a positive predictor: for staff participation in activities like hand- washing for MRSA infection levels Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354 Edgcumbe - (2008) J. Hosp. Infection

10. Better for all Increasing patient satisfaction through patient-centred approaches increases employee satisfaction, and improves employee retention rates Charmel PA, Frampton SB. Building the business case for patient-centred Care. Healthcare Financial Management 2008;March 1-6.

11. Better for all Positive staff experience is associated with positive patient experience positively associated - witnessing and reporting of errors negatively associated - working extra hours and stress Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354

12. Organizational outcomes Business-case: Decreased malpractice claims Higher employee retention rates Reduced operating costs Increased market share Charmel, P., and Frampton, S. Building the business case for patient-centered care. Healthcare Financial Management. 62(3):80-85, Mar. 2008

13. Overview of the evidence 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.....

14. ....But how do we change? Increasing interest in re-aligning care delivery to focus on needs and preferences of the patient and carers Examples of facilities that have focussed transforming their care around the patient and seen the benefits But hospitals struggling to involve patients and learn from their experience (Groene et al Qual. Saf. Health Care 2009. 18: i44-i50)

15. Beyond patient surveys… Study of US exemplar health care services who had improved their patient care experience Surveys were ‘entry level…’ Many other patient feedback mechanisms –Focus groups, patient journals, advisor rounds, real-time bed side f/b, anonymous shoppers, patient stories at Board meetings, complaints data, environmental intelligence Feedback reported with high specificity Narrative text highly valued (patient stories most powerful tool for using with clinicians)

17. Organizational characteristics* Critical to improving patient care experience: a)strong committed senior leadership b)communication of strategic vision c)engagement of patient and families d)sustained focus on staff satisfaction e)regular measurement and feedback reporting f)adequate resourcing of care delivery redesign g)staff capacity building h)accountability and incentives i)a culture strongly supportive of change and learning * Luxford et.al. 2010 Int J Quality in Healthcare (in review)

18. Responsiveness What did patients want improved? Communication with health care professionals Access/Coordination of care Pain management How did organizations respond? Resourced delivery changes: –new scheduling & tracking systems; hourly rounding –family facilities; 24/7 access; hand-overs –Patient & family advisory committees –multidisciplinary pain management teams –redesign & new facilities Staff capacity building: –training in communication skills, PCC values, customer service –involved patients in resident & medical student training –use patient feedback in individual staff development

19. Engaging patients in improvement “Patients and carers as active partners” In own care: medication review, hand-overs, rapid response call-out In service: high levels of patient involvement throughout organization (board, policy, quality, new staff, systems and building redesign). Patient Advisory Committees seen as ‘bare minimum.’ Highly responsive to patient feedback (QI driver) Patients seen as force to make health care more affordable

20. Health Reform National Performance Authority - early 2011 Hospital Performance Reports - Local Hospital Network hospitals and private hospitals Performance against the new national standards Performance indicators including: public hospital ED & elective Sx waiting times; adverse events in hospitals; patient satisfaction ; and financial management.

21. Health Reform Independent Hospital Pricing Authority nationally consistent funding to providers based on the “national efficient price” of each public hospital calculation = both clinical indicators and outcomes as well as patient experience (COAG 2010) Increased focus by providers on improving PCE

22. Director – Patient Based Care Direct CEC initiatives to promote improving patient care experience within the NSW health system Engage stakeholders in collaborating with CEC Direct the development, delivery and evaluation of programs promoting patient and carer experience to improve safety and quality

23. Director – Patient Based Care Implement the CEC Consumer Engagement Policy Promote CEC as a leader in patient based care in the safety and quality arena Build collaborative relationships with NSW Health to improve patient based care

24. Directorate Activities Stakeholder engagement Supporting the work of the Citizen’s Engagement Advisory Council (CEAC) Promoting role/activities of new Directorate conferences & journal publications Patient Based Care Bulletin

25. Directorate Activities Establishing Consumer Advisor Panel Integrating consumer representatives into existing CEC programs and projects (eg BTF, Falls, CLP, RCAs, Undergrad edn) Working with LHN Governing Councils to promote benefits of patient based care

26. Partnering with Patients New overarching program Aim: inclusion of patients and family as care team members to promote safety & quality Build on existing work Promote the implementation of recommendations from CHED Project Health Literacy Network – grant in review

27. New Program streams Deteriorating patient family activated rapid response teams Handover bedside, engaging patient & family in team Medication review/reconciliation engaging patients & family to avoid errors Patient rounding ‘Patient friend’ – real time feedback/alert

28. New Program streams Junior doctors/trainees & nurses orientation & communication skills (AIDET) Leadership Twin hospitals in patient base care Open disclosure promoting patient and carer engagement Health literacy within services guidance & service assessment Program evaluation

29. Modular approach Program participation tailored to meet local needs in areas/LHNs Areas to date: HNE – Family activated call out; JMO/Trainee edn/Com Skills; Patient Friend; Health literacy assessment Children’s - Family activated call out; Hand-over; Open disclosure; Twin hospital GWAHS - Family activated call out

30. Leadership for Improving patient care experience July 2011 Seminar - Sydney Strategies to support making patient care experience central to organisational governance and management Guest speakers: Jocelyn Cornwell (Point of Care, Kings Fund, UK) Susan Frampton (CEO, Planetree, USA) Co-hosted by CEC & ACSQHC (tbc)

31. Contact: Karen.luxford@cec.health.nsw.gov.au