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  1. Improving the patient and carer experience

  2. Patient Journey Patients take journeys through the health care system. They involve a series of steps in the delivery of health care. These steps should be predictable, with decision points along the way The journey may be short with a few steps. For people with chronic illness, the journey may take a lifetime with continuous stops along the way.

  3. Patient and Carer Experience • patient + carer perspective of journey • shaped by information; the way it is given • what they see, feel, hear all affects their choices • includes “gaps” between clinical care • different from patient satisfaction

  4. 3 reasons why it matters 1. NSW State Health Plan Strategic Direction 2 CREATE BETTER EXPERIENCES FOR PEOPLE USING THE HEALTH SYSTEM

  5. 2. CSRP Objective Deliver better patient journeys by improving • Access • Safety • Patient and carer experience

  6. CSRP Work Orders "How the Proposed Project will understand and improve patient and carer experiences"

  7. 3. Because you care • VEM High Level Stakeholder Study • Consumer Involvement Audit

  8. Patient experience – isn’t that just customer service??

  9. Basis of good customer service • Who are your customers? • What do they value? • What types of value give a competitive edge?

  10. Which partner said this? Governments are at a critical juncture for service success.Leading executives recognize they have “reached the limit” with their current approaches to customer service. They are re-assessing and re-crafting their customer service strategies, not just to satisfy citizens, but also to create lasting value. They are also veering away from a “best practice,” one-size-fits-all template—and putting the “custom” back in governmentcustomer service.

  11. Today’s purpose To learn how to • Really understand patient and carer experience • Monitor change in patient and carer experience

  12. What is the “carer”? • person who supports the patient on their health care journey. • involved in decision making • has information about patient and their journey • may or may not be “carer” when patient is back home

  13. What do patients and carers value? • Access to Care • Respect for Patients values, preferences, and expressed needs • Coordination and integration of care • Information and education • Transition and continuity • Physical comfort • Emotional support and alleviation of fear and anxiety • Involvement of family and friends

  14. When we redesign patient journeys, we can embed systems and processes that contribute to better patient and carer experiences.

  15. In your project • Have you talked to patients and carers to identify opportunities for improving the patient and carer experience? • How will you know if you achieve this?

  16. After morning tea • What method are you using to understand/measure patient and carer experience? • What do you see as the pros and cons of this method?

  17. What we need for clinical redesign • Data – something we can measure and compare results over time • “Juice” – detailed insights into what is not working from patient and carer perspective. Information that informs practical solutions

  18. Measuring Patient Experience Data, results comparable over time Richness of detail for CRU projects (juice)

  19. Patient Experience Measures Data, results comparable over time Richness of detail for CRU projects (juice) Good insight into patient experience but how valid is this story? Patient story

  20. Recognised tool. Annual data can be compared across AHSs and internationally. Great for the dashboard. Not much “juice” for Clinical Redesign and not regular enough for project evaluation. Data, results comparable over time Patient Satisfaction survey Richness of detail for CRU projects (juice)

  21. Data, results comparable over time Use Picker categories to align these tools Patient Satisfaction survey CRU tool delivers data and juice suitable for redesign projects Richness of detail for CRU projects (juice) Patient story

  22. An example

  23. Patient Experience of Waiting Overall, patient and carer satisfaction survey results are encouraging with the majority of respondents reporting a positive experience. However, when there is a breakdown between waiting room and observation area respondents a clear distinction becomes apparent between the two groups in the perception of care, with the waiting room respondents far less than satisfied with the timeliness of care and level of communication causing more negative emotions. • Patient and Carer’s Perception of timeliness of care • Overall the perception of timeliness of care received is good, with the majority of respondents ranking timeliness of care as good or better. • Waiting room patients/ carers are markedly less positive in their perception of the timeliness of their care than that of the observation area patients • Have you been waiting too long? • Again, the majority of patients, overall, do not feel they have been waiting too long for treatment. • Waiting room patients are more likely to feel they have been made to wait too long for treatment.

  24. Patient Experience of Waiting • Feelings generated by waiting. • Although there was a proportion of Observation area respondents who felt they were waiting too long for treatment, waiting room patients/ carers are the only respondents to express anger at waiting for care. • How well have we communicated with you about what is happening in your stay? • Waiting room patients/ carers were far less satisfied with the level of communication received. • Waiting room respondents the only ones to report poor communication. • Actions taken from these survey results include - • An awareness and education program highlighting the need for ongoing and regular communication with patients and carers located in the ED Waiting Room. • Continuing work by the triage Working party to address these issues. • Identification and training of nurses ready for the CIN role. • Further to these actions, it is anticipated that the recent appointed Advanced Practice Nurse should help to address the issue of prolonged waits for low, clinical priority patients.

  25. Fast Access to reliable health care Attention to Physical + Environmental Needs Clare says she is used to waiting hours, sometimes days in the ED for a psychiatric registrar to arrive. All that time under fluorescent lights – she says you never know if it’s night or day…. Clare once spent 6 days in a hospital ED waiting for a bed. (Clare – Mental Health)

  26. How do we understand and improve patient and carer experience? For each journey being redesigned: • At the beginning, ask patients and carers about their experience • Analyse areas for improvement • Respond with solutions that will improve patient and carer experience* • Re-evaluate post-implementation by asking a new group of patients and carers

  27. Morning tea

  28. CRU trial method for measuring patient and carer experience

  29. The CSRP method • Focuses on patient experience, not satisfaction • Qualitative method (discourse analysis, background narrative enquiry) • Requires skilful facilitation • Delivers “juice” and data for Clinical Redesign Projects

  30. Based on….. Learnings from… • Picker Institute • VEM CSRP Evaluation tool • Literature PLUS • Common sense • Commitment to practical, achievable method for CSRP

  31. Step by step • Identify and invite individual patients and carers to a discussion • Set up discussions • Facilitate the discussions • Record and analyse insights • Present the results • Use the knowledge: design solutions • Remeasure to see what’s changed

  32. Method • Not compulsory • Trial by willing CRUs Aug-Dec 2006 • Support, knowledge sharing and resources provided by CSRP

  33. Lunch break

  34. Remember our motivation: to understand and improve patient and carer experience

  35. Step by step • Identify and invite individual patients and carers to a discussion • Set up discussions • Facilitate the discussions • Record and analyse insights • Present the results • Use the knowledge: design solutions • Remeasure to see what’s changed

  36. Step 1Identify and invite individual patients and carers to participate

  37. Step 1: Invite patients and carers • Define target population • Invite them to take part • How many to interview? • Avoiding bias

  38. Step 2Set up the discussions

  39. Step 2: Set up the interviews • Where to interview • Who should interview • How long will it take?

  40. Step 3Facilitate the discussions

  41. Step 3: Facilitate the discussions • Introductions • Skilful listening and questioning • Identifying “best” and “worst” aspects of experience • Ending the discussion • Consent form Note: CSRP has a workshop available to practice these skills

  42. Step 4Record and analyse insights of patients and carers

  43. Step 4: Record and analyse the insights of patients and carers • Enter your notes from discussion record into webform on archi and receive summary • Enter data into MS excel spreadsheet

  44. Step 5Present the results