Improving the patient environment maintaining the momentum
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Improving the patient environment – maintaining the momentum. 3 rd December 2008 Ann Close National Clinical Advisor. Overview. The context Importance of the environment Measuring and monitoring Involving patients and the public Value of team working The future.

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Improving the patient environment maintaining the momentum

Improving the patient environment – maintaining the momentum

  • 3rd December 2008

  • Ann Close

  • National Clinical Advisor


Overview

Overview

  • The context

  • Importance of the environment

  • Measuring and monitoring

  • Involving patients and the public

  • Value of team working

  • The future


The context so far so good

The context – so far - so good

  • In 3rd stage of 10 year plan to reform healthcare

  • Now attention on quality – safe care, patient experience, choice, individualised care

  • On track to reduce MRSA by 50%

  • 92% of patients rated care as good or excellent

  • C15a (choice of safely prepared food)- one of 6 standards with highest compliance rates

  • Slight improvement in score for C21 – Standards for Better Health over previous year


Improving the patient environment maintaining the momentum

BUT….

  • If 92% patients rated care as good or excellent – 8% did not

  • There is wide variation across the country

  • High profile cases e.g. Maidstone contribute to loss of confidence

  • The 3 Standards for Better Health related to HCAI are among the worst performers with lowest rates of compliance

  • (C4a C4e and C21)

  • Patients feel ‘at risk’ in our care


Compliance with standards

Compliance with standards

  • C4aC4c

  • 2005/06 – 92%2005/06 - 87%

  • 2006/07 - 84%2006/07 – 85%

  • 2007-08 – 88%2007/08 – 77%

  • C21

  • 2005/06 - 90%

  • 2006/07 – 88%

  • 2007/08 – 90%


The environment matters

Patient will use what they can see to make assumptions about what they cannot.

Often the first thing a patient will see is the building and its entrance.

If something is wrong patients will tell at least 10 people…..

If its OK they may tell one or two.

The environment matters


The environment contributes to care

The environment contributes to care

  • Physical and psychological environment are inter-related

  • Healing environments can shorten patients’ post operative recovery

  • Little things matter

    • Ambience

    • Rapport with staff

    • How staff behave towards one another

    • How they look

    • Cleanliness, tidiness


Measuring and monitoring

Measuring and Monitoring

  • Essential

  • Difficult to make improvements if you are unaware of your performance

  • No excuse for not having some information


Assessing performance and identifying best practice

Assessing performance and identifying best practice

  • Healthcare Commission assessments – annual health check/ hygiene code inspections?

  • Self assessments or external audit– annual declarations; PEAT; routine audit?

  • Patient views – remote opinion survey or “hands-on”?

  • Essence of Care –

    • Environment of care 11th benchmark

    • Food and nutrition benchmark


Eoc environment

EOC - Environment

  • Launched 2007 – covers

  • Access

  • Culture

  • Maintenance

  • Cleanliness

  • Infection control precautions

  • Personal environment

  • Linen and furnishings

  • Crosses all disciples and care settings


Example

Example

  • Access – ease of getting to the appointment, car parking, access to building, way finding. All are more difficult when anxious and stressed

  • Culture – what sort of culture will generate feelings of safety, dignity and personal care

  • Linen and furnishings – how well are they maintained, what do they say to patients and their visitors


Eoc food and nutrition

EOC - Food and nutrition

  • Includes:

  • Screening and assessment

  • Planning implementation and evluation of care

  • Conducive environment

  • Assistance with eating

  • Obtaining food

  • Food provided

  • Food availability

  • Food presentation

  • Monitoring

  • Eating to promote health


Involving patients how

Involving patients - how

  • In audits

    • Regular audits

    • Essence of Care benchmarking

    • PEAT audits


Peat hospitals

PEAT - Hospitals


Involving patients how1

Involving patients – how?

  • Feedback

    • Complaints

    • Focus groups

    • Patient experience trackers

    • Surveys

      • Local

      • National


Patient surveys toilets and bathrooms

Patient surveys – toilets and bathrooms


Patient surveys ward cleanliness

Patient surveys – ward cleanliness


Monitoring

Monitoring

  • Trends

    • Month on month

    • Year on year

  • Benchmark

    • Locally

    • Nationally

  • Action Plan and implement


Team working

Team working

  • What teams

  • Team leadership

  • Motivating team members

  • Valuing team members

  • Relationships


The future and cqc

The future and CQC

  • CQCs quality model

  • Safety and safeguarding

  • Outcome including clinical outcomes

  • Peoples experience

  • Functionality, independence and quality of life

  • Access to services

  • Value for money


Registration overall time line

Registration – overall time line

  • HCAI registration from April 2009

  • Full registration from April 2010

  • Preceded by

    • Engagement in early 2009

    • Formal consultation in the summer

    • Transition late 2009/ early 2010

  • ? Extend to include GP practices from 2011


Hcai registration

HCAI registration

  • Applications for registration 12th Jan- 6th Feb 2009

  • Registration with or without conditions

  • Enforcement powers

    • Warning

    • Conditions

    • Prosecution

    • Suspension

    • Cancellation


Key points

Key points

  • Environment is important

    • To service users

    • To clinicians

    • To organisations

  • Measuring and monitoring is essential

  • Patients and the public can play their part

  • How teams operate is vital

  • Importance of the environment is not going away


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