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<<Chief Executive or Board Chair/Member>>

From The Top – what makes leading patient based health services tick?<<Local Leader with focus on Patient Based Care>>

“I couldn’t have faulted

the technical care but...”

Patient Based Care Model

Overall Views of Health Care System, 2010

Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US

Only minor changes needed

24 38 42 38 51 37 40 44 46 62 29

Fundamental changes needed

55 51 47 48 41 51 46 45 44 34 41

Rebuild completely 20 10 11 14 7 11 12 8 8 3 27

Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

What affects quality in health care?

The level of quality in hospital environments

is affected by:

(1) the quality of technical care;

(2) the quality of interpersonal relationships;

(3) the quality of hospital amenities and the

environment (Potter et. al, 1994. Int J of Health Care Qual Assur, Vol 7, pp.4–29).

High performing organizations

Hospitals with high levels of ‘patient care

experience’ reported by patients provide

clinical care that is higher in quality across a

range of conditions.

Jha A et al (2008) N Engl J Med 2008; 359:1921-1931.

The evidence

Improved patient experience is positively

associated with:

• Objectively measured health outcomes

• Adherence to medications and treatments

• Health resource usage

• Technical quality of care & adverse events

Doyle C et al BMJ Open Jan 20, 2013

Benefits of Patient Based Care

Refocusing care delivery around the patient• Improves patient care experience....• Improves clinical and operational-level

outcomes:• improved patient adherence

• fewer medication errors

• decreased adverse events

• improved staff satisfaction

• enhanced staff recruitment

• decreased length of stay

• decreased ED return visits

• And the bottom line.

Organizational outcomes

Business-case for Patient Based Care: • Decreased malpractice claims• Higher employee retention rates• Decreased readmission rates• Reduced operating costs

Charmel PA, Frampton SB. Building the business case for

patient-centred Care. Healthcare Financial Management

2008;March 1-6.

“The three dimensions of quality should be

looked at as group and not in isolation.”

“Clinicians should resist sidelining patient

experience as too subjective or mood-

orientated, divorced from the ‘real’ clinical

work of measuring safety & effectiveness.”

Doyle C et al BMJ Open Jan 20, 2013

Leaders in patient based care*Organisational characteristics:

• Strong committed senior leadership

• Communication of strategic vision

• Engagement of patient and families

• Sustained focus on staff satisfaction

• Regular measurement and feedback reporting

• Adequate resourcing of care delivery change

• Staff capacity building

• Accountability and incentives

• Culture strongly supportive of change and learning

*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.

Leadership commitment Start each Board meeting with a story of patient

care from your service Arrange for board and executive members to

visit wards to regularly talk with staff and patients Involve patient advisors in strategic planning

process Demonstrate leadership commitment –

communicate a patient-focussed mission to new staff at orientation

Lessons learnt – Inquiries....Mid Staffordshire, UK

• Need for a common culture of ‘putting

patients first’

• “Every single person serving patients

needs to contribute to a safe, committed

and compassionate and caring service”

• Need for strong, patient centred healthcare

leadership

Listening to patient feedback – use to drive change....

Catheter-related bloodstream infections

occur 56% more frequently in hospitals

with low patient ratings for nurse or

doctor communication

Reed K. (2012) Health Grades Patient Safety and Satisfaction

Patient feedback as a predictor...

Safety: patient feedback about hospital

cleanliness is a positive predictor:

• for staff participation in activities like hand-

washing

• for MRSA infection levels

Raleigh V. et al (2009) – Qual. Saf. Health Care. 18: 347-354

Edgcumbe - (2008) J. Hosp. Infection

What do patients value in care?

Being treated with dignity and respect

Having confidence & trust in providers

Courtesy & availability of staff

Continuity & transitions

Coordination of care

Pain management & physical comfort

Respect for preferences

Emotional support

Joffe et al. (2003) J Med Ethics

Jenkinson et al. (2002) Qual Saf Health Care

2.8 million patient surveys

4,610 hospitals

Red = low performance + high impact

Driver matrix – US data

“Hospital improvement

priorities do not seem to

match up with what

hospitals need to

improve...”

BHI – Insights into Care, 2009

Challenges ahead

• Changing mind set of staff from ‘provider-focus’ to a ‘patient-focus’

• Change takes longer than anticipated – it’s about transforming culture and care delivered

“So for whatever reason, we had the attitude where the physician is king and the patient, ‘well, we’ll get to the patient when we have time.’” (COO)

*Luxford et.al. 2011 Int J Quality in Healthcare Vol 23(5): 510-515.

Clinical unit level – frequency of patient involvement (CEC Quality System Assessment - NSW)

Shift handover

Ward rounds

Medication rounds / medication reconciliation

Discharge planning

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

42

138

96

368

200

297

254

472

199

179

196

146

180

116

156

26

229

131

141

5

319

308

326

152

Always (100%) Often (67%-99%) Sometimes (34% – 66%) Rarely (1% - 33%)Never (0%) Not Applicable

Just streamlining

processes within a

clinical/provider model is

not truly engaging

patients

Patients & their families and/or carers are viewed as integral members of the health care team 2011 – 2013 (strongly agree response)

2011 2012 20130%

10%

20%

30%

40%

50%

60%

28%

33%

48%

Patient engagement:Not just the ‘soft stuff’

Service quality and interpersonal relationships are

critical dimensions to support and promote not

only improved patient care experience but also

patient safety, treatment, recovery and wellbeing

(Australian Commission on Safety and Quality in Healthcare [ACSQHC], 2010).

Mandatory for

service

accreditation

from 2013

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