1. Insert name of presentation on Master Slide Sustained Improvement through the future workforce - Engaging with Patients and Carers 29 th October 2011 Joy Whitlock, RN, MSc, IA

2. Topic 8 Engaging with patients and carers WHO Patient Safety Guide for Medics – content and delivery overview Topic 8 detail Applying QI methods Discussion

3. Underpinning principles Capacity-building is integral to curriculum change A flexible curriculum to meet individual needs Easily understood language for a targeted yet global audience A curriculum guide for all countries, cultures and contexts A curriculum guide that is based on learning in a safe and supportive environment

4. The Curriculum Guide topics 1. What is patient safety? 2. What is human factors and why is it important to patient safety? 3. Understanding systems and the impact of complexity on patient care 4. Being an effective team player. 5. Understanding and learning from errors. 6. Understanding and managing clinical risk. 7. Introduction to quality improvement methods. 8. Engaging with patients and carers. 9. Minimizing infection through improved infection control. 10. Patient safety and invasive procedures. 11. Improving medication safety.

5. Topic 8 Learning objective Understand the ways in which patients and carers can be involved as partners in health care both in preventing harm and learning and healing from an adverse event

6. Topic 8: Engaging with patients and carers Students are introduced to the concept that the health- care team includes the patient and/or their carer, and that patients and carers play a key role in ensuring safe health care by: (i) helping with the diagnosis; (ii) deciding about appropriate treatments; (iii) choosing an experienced and safe provider; (iv) ensuring that treatments are appropriately administered; and (v) identifying adverse events and taking appropriate action

7. What students need to do Actively encourage patients and carers to share information Show empathy, honesty and respect for patients and carers Communicate effectively Obtain informed consent Show respect for each patient’s differences, religious and cultural beliefs, and individual needs Describe and understand the basic steps in an open disclosure process Apply patient engagement thinking in all clinical activities Demonstrate ability to recognise the place of patient and carer engagement in good clinical management

8. What the students need to know basic communication techniques informed consent procedures the basics of open disclosure

9. Patient role in minimizing adverse events Patients want to be involved in their health care – but it depends on the tasks Patients were comfortable (85%) asking about a medication’s purpose Nearly half (46%) were very uncomfortable about asking health-care workers whether they had washed their hands

10. Some issues that are raised in an EPP course What problems do you have with the Health Professionals? Don't listen to what I'm saying. Use words I don't understand Decides treatment without explaining or discussing Think they know how I’m feeling Reach for the prescription pad before I’ve finished speaking Condescending/ patronising /talks down to me Being treated as if you know nothing about your condition and how it affects you / not acknowledging your experience and knowledge

11. Informed consent Underpinned by communication Content to be delivered = options, benefits, risks etc.

12. MAGIC MAking Good decisions In Collaboration Multi-centre, implementation study over 18 months Funded by the Health Foundation Looking at how Shared Decision Making can be embedded into mainstream health services Cardiff and Newcastle NHS and Universities

13. What is Shared Decision Making? Clinicians and patients communicating together using the best available evidence when faced with the task of making decisions… Supporting patients to consider the possible attributes and consequences of options… To arrive at informed preferences in making a choice of the best action for the patient Where this is desired, ethical and legal.

14. SDM – Evidence Base Cochrane Review of decision support (O’Connor, 2009): Improves knowledge and more accurate risk perception Increases participation and comfort with decision Fewer undecided Reduces uptake of elective surgery Improves adherence to medication (Joosten, 2008)

15. Where more than one treatment is possible Where it is possible to delay treatment Where treatments depend on adherence Where there is a balance of benefit and harm Where patient preference is important Application of SDM

16. Preference- sensitive decisions Patient access to Decision Support Shared Decision Making Clinician explains the need for deliberation Consultations where patients are informed and involved in decision making Workflow in SDM

17. Implementation Barriers 1.Patients: New and unfamiliar role 2.System: Not designed to allow decision support 3.System: Competing priorities 4.System: Availability of decision support aids

18. Paediatric Tonsillectomy Head and Neck Cancers Breast Cancer General Practice Cardiff Teams

20. Story about a patient Jeremy is a 15-year-old boy who arrives at the local medical clinic with noisy breathing and itch. His father says he was fine 30 minutes ago and that he just became unwell quite suddenly. On examination, Jeremy looks distressed and nervous. He has a puffy face, his lips are huge and he can hardly open his eyes as they are so swollen. He has red blotches on his skin and he is scratching his body. Every time he breathes in he makes a noise.

21. Story cont. Jeremy’s father says his son was like this once before after having some medicine called penicillin and he was told never to have penicillin again because it could kill him. Jeremy saw a doctor this morning because of a runny nose, sore throat and fever. The doctor prescribed amoxicillin, which Jeremy started earlier today. Jeremy’s father wonders if his son might also be allergic to this new medicine amoxicillin.

22. Patient Story DVD

23. Open disclosure Informing patients and their families of bad outcomes of medical treatment, as distinguished from bad outcomes that are expected from the disease or injury being treated

24. MENUS -TIRED- EVALUATING POORLY 850 Questionnaires formed basis for the new menus Volunteers will assist in evaluation

25. Listening to Patient/Carers Stories – Changing Places

26. Summary WHO curriculum overview Topic 8 content Examples of applying improvement principles, human factors and system design

27. Discussion What actions do we need to take? How do we work together? My contact details joy.whitlock@wales.nhs.uk 02920 74 5099

28. Introducing … 1000 Lives Plus 1000 Lives Plus aims to improve patient safety and reduce avoidable harm, waste and variation across NHS Wales. 1000 Lives Plus - Making patient safety a priority

29. If we can improve care for one person, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000 And if we can do it for a 1000, we can do it for everyone in Wales.