1. Listening to Older People: Experiences with Health Services Greg Price, Assistant National Director Quality Improvement Division people caring with people what matters to you your service, your say You said... we did

2. Listening to the patient perspective “You never really understand a person until you consider things from his point of view… until you climb inside of his skin and walk around in it.” Atticus Finch, in Harper Lee’s To Kill a Mockingbird

3. Listening to the patient perspective Retailers do it, travel websites do it, banks do it but why does the health service find it so hard to listen to the opinions of service users? Nobody has a stronger incentive for high quality healthcare than the patient. Nobody else knows some important things that patients know.

4. Importance of listening to patients Listening is a therapeutic intervention in its own right Are health professionals good at it? International studies: the average doctor interrupts the patient after 18-23 seconds and then categorises them into sets of symptoms and diseases It takes on average 2 minutes for the patient to tell their story

5. What can we learn from listening to patients? Patients and carers know a surprising amount about healthcare: –They know how it feels; –Whether interventions and systems work; – Whether care is joined up; –What impact treatments of interventions have on their life; –What is the burden of living with a disease or condition.

6. Listening meetings with older people 5 meetings took place in November and December 2014 Galway, Kilkenny, Meath, Kildare and Dublin More than 100 people attended “Tell us about your experience of health care” “Eavesdropping on the conversation”

7. Listening to Older People report Feedback categorised into: –Acute hospitals: Inpatient, outpatient, emergency departments –Ambulance services –Primary care: GPs, medical cards, public health nursing, allied health professionals –Social care: older persons service, nursing homes

8. Main themes and issues Waiting lists and delays Appointment scheduling Care not joined up Poor communication, lack of information Nutrition and assistance at meal times Quality of nursing and personal care

9. What did the participants say? Waiting lists and delays “Waited for 2 years to have bilateral cataracts removed as his sight was deteriorating badly and eventually paid for private treatment at a cost of €7,000 which he had to borrow.” “Waited for 7 hours before being seen by someone in ED in a hospital and then subsequently a further wait of 4 hours before being seen by a doctor”.

10. What did the participants say? Appointment scheduling “Was waiting from 9.30am to 4.30pm for a normal scheduled eye appointment. When he was seen, he had waited so long that the effect of the drops needed for the examination had worn off, and he had to have them re ‐ administered.” “Was invited for appointment at 7.30am but the clinic did not start until 9am.”

11. What did the participants say? Care not joined up “A lady spoke about her experience of attending her GP with weight loss. Her GP referred her to a hospital which in turn referred her to another hospital where she arrived at 1pm and waited until 9pm to be seen. She had blood tests repeated in all three settings and X rays in two but never a scan and no results. She is still feeling awful and has no diagnosis”.

12. What did the participants say? Poor communication, lack of information “It is hard for patients to know who staff are, due to an absence of name badges denoting their role.” “Many of the staff in ED wear scrubs which makes it difficult to distinguish them.” “A lady spoke about the lack of health services in the community and was surprised to hear that there was a Primary Care Centre in her area. She felt that communication from the HSE to raise awareness about available services was generally poor.”

13. What did the participants say? Nutrition and assistance at meal times “A gentleman whose wife was in hospital spoke about how he was not allowed in to visit during meal times. When he came in after meal time he would find his wife’s tray untouched. In many cases the bed trolley was not even pushed up close to the patients where they could access the meal. He said his wife suffered from significant weight loss and he had to insist on being present for meals.”

14. What did the participants say? Quality of nursing and personal care “Nursing is now an office job and is not hands ‐ on like it used to be and that nurses never get to know their patients.” “One lady talked of being in hospital for a long period where her bed was not regularly changed but only straightened out. She had to get out and make her own bed.” “A gentleman described how his wife had breast cancer and was on chemotherapy. He could not get a Public Health Nurse to dress her wound after surgery.”

15. What did the participants say? Some Positive Comments “A lady said she had a good experience in a hospital where she received excellent care at night. The Nurses introduced themselves and made her very comfortable.” “A gentleman spoke about a very positive experience he had in a hospital, where even though he did wait from 9am until 6pm in the Acute Medical Unit he nevertheless had a very good experience.” Another gentleman spoke about his one month stay in hospital and said that all the nurses worked very hard and that the food was very good.

16. Quality Improvement Division supporting services Champion Consistent leadership for improving quality Giving greater visibility to QI initiatives Encourage and spur others to QI Educate Build capacity for leadership and quality improvement through training programmes and education events Partner Work with people across the system - patients, clinicians, managers, national bodies to advise and support improvement Demonstrate Share new ideas, test and develop ideas in practice and support the spread of sustainable solutions

17. Leading a National Person Centred Programme Facilitating roundtable discussions with services on what constitutes ‘person centredness’ and personalised care Supporting patient, service user and staff participation in planning, service design and delivery Supporting the establishment of patient councils and forums Promoting and facilitating listening to patients and service users, e.g. listening to older persons sessions Supporting and promoting the introduction of person centred initiatives, e.g. ‘family presence policy’, ‘all about me – story boards’, ‘Hello my name is” Promoting the importance of the patient voice in everything that we do

18. Thank you 18

19. Contact details Greg Price Assistant National Director Quality Improvement Division Health Service Executive Oak House Millennium Park Naas Co Kildare Tel: 045 882518 Mob: 087 8515381 Email: greg.price@hse.ie greg.price@hse.ie people caring with people what matters to you? your service, your say You said... we did