Person Centred Care Dr Pat O’Connor Clinical Director of Research and Development NHS Tayside Honorary Professor School of Business Dundee University Research Portfolio Healthcare Improvement and Innovation
Overview • What is person centredness • How can it be measured and delivered
Usual suspects.... • patient focus • quality care and treatment • patient participation • communication • patient feedback • best use of resources • respect and holism • power and empowerment • choice and autonomy • empathy and compassion.
‘Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making’ Person Centredness Quality Ambition
People have told us they want ... • Caring and compassionate staff and services • Effective links between clinicians, patients and others • A clean and safe care environment • Continuity of care and goodaccess to care Clinical excellence • Clear communication and explanation about conditions and treatment
How was the healthcare worker at? • Making you feel at ease • Letting you tell your “story”…... • Really listening…….. • Being interested in you as a “whole-person”….. • Fully understanding your concerns…... • Showing care and compassionate …….. • Being positive……... • Explaining things clearly……… • Helping you to take control…….. • Making a plan of action with you……
Patient Enablement Instrument(Howie et al 1998,1999) • As a results of your visit to the today, do you feel you are; • 1) Able to cope with life • 2) Able to understand your illness • 3) Able to cope with your illness • 4) Able to keep yourself healthy • 5)Confident about your health • 6) Able to help yourself
The Law • “There will be mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.” The Patient Rights (Scotland) Act 2011
Best service you have ever had? In the next 5 mins discuss with your neighbour • What is the best service you have ever had • What made it special • What happened • How can we create that in health?
Hold the thought • How did you feel listening to this story? What did you notice? • What do you think / feel about Agnes and her situation? • Did you reach any conclusions about her experience and her relationships with staff? • About her care?
Hold the thought • How did you feel hearing May’s story? What did you notice? • Has hearing May’s story influenced your thoughts about Agnes or her situation? • Should it? • Does it expose any assumptions made previously?
Discussion prompts • What have you learned from your reactions to hearing Agnes and May’s stories? • What do these stories tell us about some of the challenges of ‘delivering’ person centred care? • What actions would you like to take in response to hearing the stories? • What would be the main challenges of ‘measuring’ improvements resulting from your actions?
Committees & Groups Person Centredness: Text about this section A list of the various groups & committees relating to person centredness e.g. Patient Info Group, Better Together . Here we can publish minutes, agendas, papers etc and link with the “other committees” section under corporate governance
Person centred care Secondary Drivers Outcome Primary Drivers • Use of information to improve outcomes for patients • Improve Health literacy • Evaluate patient resources to support patient involvement in their own care • Increase independent advocacy • Increase identification, and role of carers Provide care in partnership with people using services and other core services Aim: Improve the care experience for all patients receiving healthcare in NHS Tayside • Implement patient /carer feedback and undertake actions in all clinical areas • Use complaints, feedback and incidents to inform local improvement plans • Identify service partners to obtain feedback • Include patient experience in all medical revalidation and staff appraisal plans • Implement patient experience on the dashboard Feedback from patients, carers and families improves care, and local service delivery • Raise awareness and provide support in the tools available to capture patient feedback • Incorporate person centredness and 7Cs in all training opportunities • Implement Releasing Time to care • Implement Leading Better Care • Implement Caring Behaviours Programme • Include person centredness within all staff KSF profiles / revalidation plans • Improve the health and well being of the workforce • Culture and leadership commitment to person centredness High Level Outcome Measures for 1st September 2012 Healthcare staff provide person centred care to every patient every time based upon the 7C’s • 95% of patients describe the service as being person centred • 70% of nurses time spent in direct patient care (after implementing RTC) • 50% reduction in complaints related to patient experience • 95% of patients recall having a daily conversation with the SCN • 100% spread of real time feedback in clinical areas Feedback from patients, families and carers informs NHS Tayside strategies and future direction • Ensure Policies contain evidence of patient/public participation • Ensure patients stories are heard at the Board and are used in development of strategies • Include a description of how patients/public will be informed, engaged and consulted within all Board papers. • Include patient experience within Board Development Events
Good Questions for Your Good Health Every time you talk with a doctor, nurse, or pharmacist, use the Ask Me 3™ questions to better understand your health. • What is my main problem? • What do I need to do? • Why is it important for me to do this?
Emotional touchpoints • Using emotional touchpoints (Bate and Robert 2007) as way of learning about the patient and family experience of being in hospital and using this to help staff recognise and celebrate positive care practices and develop the service. Touchpoints refer to important stages/events in their care.
Emotional Touchpoint • Developed a series of emotional touchpoints e.g. coming into hospital, mealtimes, personal care, going for tests and a bank of positive and negative emotional words e.g. powerless, happy, included, numb. • Invited patients/relatives to take part in sharing their experience including providing written information and obtaining written consent 24 hours before the discussion took place. • Asked the patient/relative to select the touchpoints that were relevant to them and invited them to identify any other touchpoints (one relative though being here at night was a key touchpoint for her so this was added). • Taking each touchpoint in turn, we asked them to select an emotional word(s) that summed up how they felt about the particular experience. • Asked the patient/family why they felt that emotion. A relative said for example that they felt ‘out of their depth’ being on the ward at night as they did not know the routine and what they could and could not do. They also felt ‘privileged’ as they were given the space on the ward and support from the nurses to laugh, cry and talk with their family about what a lovely life their father had had. • When a negative point was raised we asked the patient/relative what they thought we could do to improve things and if appropriate ask if they would like to be involved in this (for example a family member is helping to develop an information sheet to support families who are on the ward at night). • Following the interview we type up the notes from what the patient/family have said and with their permission share this with staff on the ward. • We ask staff to tell us what they have learnt from reading the story and if there are any actions we would like to take forward.
Improvement • Staff more at ease move away from blame • Better relationships when developing improving service • Directly sources how individuals ‘feel’ about care • Actions taking based on meaningful evidence • Staff moved and motivated by transparency and inclusiveness
What can you do ask ? • Today would have been better if .......
References • http://www.napier.ac.uk/fhlss/NMSC/compassionatecare/practicemethods/Pages/EmotionalTouchpoints.aspx • http://www.kingsfund.org.uk/events/person-centred-integrated-care • http://www.bridgingthegap.scot.nhs.uk/values-and-principles,-policy-and-practice/person-centred-caring.aspx • http://www.evidenceintopractice.scot.nhs.uk/leading-better-care.aspx
References • Bridges J et al (2009) Best Practice for Older People in Acute Care Settings: Guidance for Nursing Staff Nursing Times RCN Publishing / City University London • Nolan M et al (2006) The Senses Framework. Improving care for older people through a relationship-centred approach. Getting Research Into Practice (GRIP) Report No. 2, University of Sheffield • Patterson M et al (2011) From Metrics to Meaning: Culture Change and Quality of Acute Hospital Care SDO • Tadd W et al (2011) Dignity in Practice: An exploration of the care of older adults in acute NHS hospital trusts. PANICOA Publication
From where I’m Standing Looking along the beam and looking at the beam are very different experiencesC.S.Lewis • In emergency admissions, In the outpatient department • At the here-we-go-again clinic, In yet another waiting room.. • From where I’m standing • There’s nothing worse that being treated as an illness • From where I’m standing • There’s nothing worse that it all flaring up again • From where I’m standing • There’s nothing worse than not knowing whether to laugh • or to cry • Except dealing with people who Act like they never laugh or cry