Current State Overarching Issue: “What Matters to You? NH Patient Experience 2018-2019 Executive Sponsor: Jodie Ashworth Supporting Partner : Ariana Carrodus Background Future State From: ‘What’s the matter? To: ‘What matters to you? HRO Reliability Organising is the pursuit of flawless performance under complex, dynamic and oftentimes, potentially catastrophic conditions. A vital component of HRO is the development of safety science that improves safety, quality and patient care. In addition to the science is also the art of caring and the provision of a patient experience that is patient centred. NH strives to be an organisation that is recommended by family and friends and supports the delivery of care that is modelled on building trust , compassion and shared decision making with our community. Patient experience is key in moving from a medical model of cure to a compassionate model which delivers care that matters to the patient. The patients family and support networks must also be engaged to ensure that ideal and valued care is provided in a sensitive and appropriate manner. Results for recommending family and friends: 2017: 54 2018: 57 Strategy Intervention Project lead Guideline for multi disciplinary communication Implementation of AIDET organisation wide Donna Christensen Rounding Establishment of Executive , NUM and bedside rounding . Explore strategies and implement Debra Bourne Pt boards Review current usage, embed in practice as a communication tool Jana Garazek Visiting Hours Review of current service state and focus groups Zoe Devenish Communication Explore strategies to improve communication at all levels and target education and engagement Ana Asanovic Open disclosure framework Design and implement an Open disclosure Framework for NH that is tailored to each clinical level requirements. Paul Howat Improved Shared decision making Critical review and implementation of shared decision making tools for the multi disciplinary team Sophie Rodier Promote empathy Development of role play workshops for education and training Linda Romano Scoping “Be kind to me” Run community focus groups to understand community perception of concept Ros Payne Well being Group of strategies to promote health and wellbeing while hospitalised Cindy Joffe End of life care Review of best practice for EOLC and implementation of EOLC toolkit Maria Tucker Essential Nursing Care Scope, plan and implement an Essential Nursing Care package to reduce care variation Lora Davies Tablet technology to deliver interpreting by video Scoping for the development of tablet technology to support interpreting services Emiliano Zucchi Prepared by Jodie Ashworth Endorsed Siva Sivarajah VHES patient satisfaction survey results 2017 2018 NH NH State Where you involved as much as you wanted to be in decisions about your care and treatment 58 50 63 Did your family or someone close to you have enough opportunity to talk to staff 51 42 55 If you had worries or fears about your condition or treatment did a health professional discuss them with you 54 51 59 Did you feel that you were listened to and understood by the people that were looking after you in hospital 77 74 79 Did you feel friend sand family were welcome to visit you 93 87 93 Overall how would you rate the care 83 83 92 Do what matters Listen to what matters Ask what matters Medical cure model Patient journey boards under- utilized Lack of formalised rounding Poor communication with patients and families Inconsistent open disclosure practices Focus on disease pathways Lack of process and tools to promote shared decision making Service pressures obscure the patient focus Our priority is you You matter to us Our specialty is you
Transcript
Current State
Overarching Issue: “What Matters to You?NH Patient Experience 2018-2019
HRO Reliability Organising is the pursuit of flawless performance under complex, dynamic and oftentimes, potentiallycatastrophic conditions. A vital component of HRO is the development of safety science that improves safety, qualityand patient care. In addition to the science is also the art of caring and the provision of a patient experience that ispatient centred. NH strives to be an organisation that is recommended by family and friends and supports thedelivery of care that is modelled on building trust , compassion and shared decision making with our community.Patient experience is key in moving from a medical model of cure to a compassionate model which delivers care that
matters to the patient. The patients family and support networks must also be engaged to ensure that ideal andvalued care is provided in a sensitive and appropriate manner.
Results for recommending family and friends: 2017: 542018: 57
Strategy Intervention Project lead
Guideline for multi disciplinary communication
Implementation of AIDET organisation wide Donna Christensen
Rounding Establishment of Executive , NUM and bedside rounding . Explore strategies and implement
Debra Bourne
Pt boards Review current usage, embed in practice as a communication tool Jana Garazek
Visiting Hours Review of current service state and focus groups Zoe Devenish
Communication Explore strategies to improve communication at all levels and target education and engagement
Ana Asanovic
Open disclosure framework Design and implement an Open disclosure Framework for NH that is tailored to each clinical level requirements.
Paul Howat
Improved Shared decision making Critical review and implementation of shared decision making tools for the multi disciplinary team
Sophie Rodier
Promote empathy Development of role play workshops for education and training Linda Romano
Scoping “Be kind to me” Run community focus groups to understand community perception of concept
Ros Payne
Well being Group of strategies to promote health and wellbeing while hospitalised
Cindy Joffe
End of life care Review of best practice for EOLC and implementation of EOLC toolkit Maria Tucker
Essential Nursing Care Scope, plan and implement an Essential Nursing Care package to reduce care variation
Lora Davies
Tablet technology to deliver interpreting by video
Scoping for the development of tablet technology to support interpreting services
Emiliano Zucchi
Prepared by Jodie Ashworth
Endorsed Siva Sivarajah
VHES patient satisfaction survey results2017 2018NH NH State
Where you involved as much as you wanted to be in decisions about your care and treatment
58 50 63
Did your family or someone close to you have enough opportunity to talk to staff
51 42 55
If you had worries or fears about your condition or treatment did a health professional discuss them with you
54 51 59
Did you feel that you were listened to and understood by the people that were looking after you in hospital
77 74 79
Did you feel friend sand family were welcome to visit you 93 87 93
Overall how would you rate the care 83 83 92
Do what
matters
Listen to what
matters
Ask what
matters
Medical cure model
Patient journey boards under-
utilized
Lack of formalisedrounding
Poor communication with patients and
families
Inconsistent open disclosure practices
Focus on disease
pathways
Lack of process and tools to promote
shared decision making
Service pressures obscure the patient
focus
Our priority is you
You matter to us
Our specialty is you
Open Disclosure FrameworkExecutive Sponsor: Jodie Ashworth
Project Manager: Paul Howat
Background Next Steps
Northern Heath has invested in patient experience and quality, but has not provided consistent basic training and refresher for open disclosure. If performed poorly, open disclosure does not meet family carers needs and is a risk to the organisation.
Problem statement: Poor open disclosure processes due to lack of a comprehensive two teired open disclosure framework.
Prepared by Paul Howat
Endorsed by Jodie Ashworth Signature:
Current State
Future State
Project Timeline
• Currently training is in abeyance• Previously provided by legal department• Lack of high level specialised training for key staff including
simulated patients• Lack of “nominated contact person” process to ensure timely
communication with patient and family• Inconsistent application across the organisation• Lack of alignment with all relevant governance structures• Non-specific staff support /debriefing following open disclosure
Develop a Northern Health Open Disclosure Policy in line with the Australian Open Disclosure Framework (principles below)
1
2
3
4
5
6
7
8
Open and timely communication
Acknowledgement
Apology or expression of regret
Supporting and meeting the needs and expectations of patients, their family and carers
Supporting, and meeting the needs and expectations of those providing health care
Integrated clinical risk management and systems improvement
Good governance
Confidentiality
Risk Likelihood Consequence
Too many separate training programs being rolled at NH in regards to HRO
Possible Medium
Training program knowledge is held with only a small number of people
Possible Medium
Risks:
Milestone Start Date Finish Date
Define objectives of open disclosure framework 3/09/2018 7/09/2018
Identify people to be involved 10/09/2018 14/09/2018
Define training levels 17/09/2018 28/09/2018
Develop framework 1/10/2018 26/10/2018
Meet with stakeholders to discuss framework and training modules
29/10/2018 2/11/2018
Incorporate feedback received 5/11/2018 16/11/2018
Endorsement of module by HRO steering committee 27/11/2018 27/11/2018
Noting of module TCTEOC 04/12/2018 04/12 /2018
Framework to be included into RISSN training 19/11/2018 30/11/2018
Define evaluation process to be used (including results of VHES survey)
3/12/2018 7/12/2018
Undertake evaluation against agreed measures06/06/2019 28/06/2019
Higher level specialised training to be first wave
Develop online general education package to be second wave
Stakeholder meetings held
Development of two tiered training modules
Phases
My doctor and I talk in detail about what
matters to me. I feel confident we are clear
on making good decisions together.
From: Inconsistent conversations
To: Transparent conversations every time
“What matters to you” Building trust, collaboration & shared accountability through developing a patient centred culture.
Current State
Future State
Next Steps
From: Poor communication
with patient & families
To: Communication centred around /with patients & families
Date: Oct 2018 Version: One Project Lead: Donna Christensen
Problem Statement
HRO Support Project Lead Exec Sponsor
Name: Ariana Carrodus Name: Donna Christensen Name: Jodie Ashworth
Scope
AIDET Domain VHES Indicator Q1 2017/18
Q22017/18
Q3 2017/18
Q4 2017/18
Acknowledge 34. While you were in hospital, did hospital staff talk about you as if you
weren’t there?
82%
(83%)
75%
(81%)
83%
(83%)
72%
(82%)
Introduce 32. Did the staff treating and examining you introduce themselves and their role?
85% (77%) 84% (80%) 80% (85%) 87% (84%)
Explain/Duration
37. Were you involved as much as you wanted to be in decisions about your care and treatment?
55. Did hospital staff explain the purpose of any treatments (e.g. an injection, dressing, physiotherapy) before they were administered?
57% (64%)
83%(84%)
53% (61%)
72% (80%)
50% (63%)
77% (82%)
57% (64%)
73% (81%)
Thank you 77. Do you feel that you were listened to and understood by the people looking after you in hospital?
80% (79%) 77% (78%) 74% (79%) 66% (78%)
Overall, how would you rate the care you received while in hospital
Root Causes Strategies Gaps Opportunities Trusted Care Links
1.Poor communication with patients and families.
2. Staff are task not people orientated.
3.Patients and families are not provided with the opportunity to engage in their care.
4. Staff lacking a focus on patient experience
Orientation/Development- Face to face - Online- Agency &
Locum - Capability
framework- Operational
development program
The programs are not linked . Patient communication is not included in all .There is no consistent messaging through the programs.
Build synergies between programswith consistent messaging that facilitates application in practice.
1. Rounding at all levels of the organisation
2. Patient Communication Boards
3. Shared decision making
4. Promote empathy ‘be kind to me’
Failure to provide consistent messaging and link to introduction (AIDET) work “What matters to you” will cause fragmentation and an inability to successfully embed.
Training - Patient First
- AIDET training
Clinical focus but all staff are required to complete. Refresh dependant on LMS
Has been completed in pockets
Develop a program that promotes a positive Patient/Visitor experience across all staff that work at NH.
Roll out organisationally across all work groups
Recognisable – Patients and visitors will experience courtesy person centred communication evidenced by
- Knowing who they are speaking to- Provided with the opportunity to contribute to care / discuss concerns- What to expect and when
Reliable – AIDET will be used for all patient/visitor interactions
Reproducible – All staff will be able to apply AIDET in practice regardless of context
Current Performance
85% (92%)
Gap
10%
NH Target Performance
95%
NH does not meet the VHES state average against a number of indicators related to communication. Poor communication influences the overall hospital experience. The literature has shown organisations that use AIDET (Acknowledge, Introduce,Duration, Explanation and Thank You) as the foundation of all patient/visitor interactions have been able to increase patientsatisfaction scores (Allen et al 2016, Scott 2012, Zamora et al 2014, Baverman et al 2015 & Barber 2018).
Define the problem
• Review current resources
• Collect baseline data
• Review the literature
Working group
• Form working group
Develop
• AIDET support resources
• Link resources into existing and planned programs
• Evaluation measures
Consult
• Engage with key stakeholders across all sites
• Test proposed resources
Next steps
• Present finalized strategies to NH with proposed implementation, evaluation and sustainability processes
• Cohesion with other organizational initiatives
Complete
Complete
Commenced
Overarching Issue: “Talk to me, not at me “ Patients and carers : shared decision makers in their own care HRO Horizon two: Improved Patient experience
Executive Sponsor: Jodie AshworthProject Lead: Sophie Rodier
Background Future State
Next Steps
The delivery of person-centred care increases a patient’s trust and confidence in their care givers and leads to improved patient experience. Shared decision making is important in establishing a partnership to share the power in making healthcare decisions and the responsibility for health outcomes. Shared decision making involves the integration of a patient’s values, goals and concerns with the best available evidence about benefits, risks and uncertainties of treatment, in order to achieve appropriate health care decisions (NHQHS, 2018).
Current research indicates that:• patients are less informed and involved in making decisions about their health care than they would like • shared decision making can improve satisfaction with care and leads to better quality decisions• patients using evidence-based decision aids have improved knowledge of the options, more accurate expectations
of possible benefits and harms, and feel that they had greater participation in decision making than people receiving usual care
• better-informed patients make different, often more conservative, less costly choices about treatment, because, it is thought, that information provides a realistic appreciation of likely benefits and risks of treatment and enables decisions about the potential outcomes in a more considered way.
Northern Health’s feedback gathered through the Victorian Healthcare Experience Survey and complaints management process supports that our patients, in all areas, would like to be more involved in making care decisions and that a lack of involvement in decision making leads to poor outcomes and experience.
Prepared by Sophie Rodier
Endorsed
I was told that I had to agree to feeds for my baby. They didn’t talk
through the other options and risks to allow me to
make an informed decision.
Current State
Key performance indicators:• NH VHES result for Question 37 at 63% by May 2020• Successfully meet NSQHS Accreditation actions for Standard 2
relating to shared decision making:• 2.06• 2.07
Plan
Define project objectives
Meet with identified key stakeholders to select key areas of focus
Rearch
Develop
Implement
Evaluate
Sustain
Conduct an external scan of best practice examples for patient and carer participation in decision making
Develop approach and tools to support staff, patients and carers in shared decision making
Implement approach and tools for shared decision making in target areas
Undertake evaluation against agreed measures
Ensure practices are reviewed and responsive against evaluation
From: Unilateral, clinician decision making
To:person-centred, shared decision making that involves all stakeholders
The doctors said that it was a simple procedure and I’d be home the next day…… I
don't know why I needed to have surgery and did not
expect these complications
My doctor and I talk in detail about what
matters to me. I feel heard and more respected. I am
confident we are making good decisions
together.
I thought I was being taken down for a scan then the doctors told
me I was having a tap. I had to ask about the risks and decided not to
let it go ahead.
Keeping families together : Flexible visitation
Background
Project Lead : Zoe Devenish DON/ Site & Operations Director
Current state
Future State
The National Standards for quality and Safety in Healthcare view family and close friends of patients as partners in care and contributors to shared decision making. An important aspect in encouraging family and friends to contribute as partners in care is the removal of restrictive hospital visiting hours. Evidence suggests that engagement of family and friends during hospitalisation has a positive impact on inpatient care and health outcomes. Recent literature has demonstrated an association between reduced patient anxiety and flexible visiting hours. Improved patient experience, reduced length of stay, reduced readmission rates, improved nutrition and reduced incidences of delirium have also been correlated with flexible visitation models. Staff beliefs and attitudes regarding visitation are a common barrier to implementation of flexible visitation models. This should be considered and staff provided with rationale and education to assist clinical staff to work with families.
Northern Health presently does not consistently support flexible visitation The existing visitors policy is outdated and is not patient centred Rest periods are inconsistently applied There is no consistent process for visitors to gain out of hours access
To establish flexible visiting hours across Northern Health which are underpinned by an evidence based set of principles
To enable family and close friends to participate in patient care and shared decision making To establish a consistent process for after hours visitation
1. Improved patient satisfaction with visitor access2. Improved VHES response for ‘did you feel friends and family were welcome to visit
you?’3. Increased availability of families, carers and close friends to contribute to shared
decision making4. No negative impact on Northern Health staff
References
1. ACHSQ 2018 Sharing decisions and planning care. Accessed http://nationalstandards.safety&quality.gov.au/2.partnering-consumers/shared-decisions-and-planning-care.
2. Rodriguez, C. & Mathew, S. 2016. Time to change: from families as visitors to partners in care, Canadian Journal of Critical Care Nursing, 27(2): 42.
3. Smith, L et. al. 2009. The impact of hospital visiting policies on paediatric and adult patients and their visitors. JBI library of systematic reviews. Vol. 7, pp. 28-79.
4. Westphal, G. et. al. 2018. Effect of a 24-h visiting policy on delirium in critically ill patients. Intensive care medicine, v. 44, n. 6, 968-970.
Overarching Issue: HRO Horizon Two: Improved Patient Experience- What Matters To You?Pillar Two: Giving Compassionate Care to our Community Every Life, Every Moment, Every DayESSENTIAL NURSING CARE = COMPASSIONATE CONNECTED CARE Reducing suffering
Project Lead: Lora Davies
Background
Current State
Future State
Next Steps: Develop a framework that provides guidance for Compassionate Connected Care
From: Fragmented moments of Compassionate Care
To: Reduced Suffering with Compassionate Connected Care
Consider
• Patient in Latin actually means “one who suffers”• Suffering can be segmented into inherent suffering, related to medical diagnosis or the
treatment of the diagnosis and avoidable suffering, related to differences in howorganizations provide care
• Compassion as per Collins dictionary “ To feel or show pity, sympathy, and understanding for people who are suffering”
• Nurses are more accessible to patients during there hospitalisation than any other clinician and as such will communicate with patients more regularly and frequently than any other staff group.
Compassionate Care by nurses is therefore crucial in supporting our patients, reducing there suffering and improving there individual experience.
But, as the work of nursing becomes increasingly complex and significantly more technical, weare faced with losing this focus and becoming a task-driven and checklist orientated workforce,with a diminished appreciation of our patients experience.
The basic nursing interventions that were once the hallmark of good nursing care are at risk ofbeing lost. We must revitalise these interventions, embrace compassionate care, whilst ourpatients are at their most vulnerable we are there and we must positively impact theirexperience.
The Compassionate Connected Care TM Framework provides the methodology and addressesthe challenge of reducing suffering by integrating clinical, operational, cultural and behaviouraldomains. There are six key themes that focuses effort, guide improvement and provide anunderstanding of what's important to the patient.
Prepared by Lora Davies Director of Nursing, Bundoora
Endorsed Jodie Ashworth Executive Sponsor
Prepared and Endorsed by:
Poor Communication
with Patients
Increased Bed
demandCompassionate
Care Is Not A Primary Focus
Time poor staff
Lacking a focus on Patient experience
Patient is not the centre of their
care
Task Orientated
Patients referred to by their diagnosis
Focus on disease
pathway
Medical Cure Model
Working
group
• Establish working group, focused by patient condition / cohort
Data
• Design structure and format for data collection related to key themes
• Undertake Data Collection
Education
• Develop Compassionate Connected Care Education Program, based on data collected, including agreed measures for success
Consult
• Develop Implementation Strategy with working group
• Execute Implementation Strategy
Evaluate
• Evaluation of defined agreed success measure to occur every six month
Sustain
• Ensure practices are reviewed and responsive against evaluation
Bridging the communication gap Video-Interpreting
Background Objectives
Project Lead : Emiliano Zucchi
Current State
Steps for improvement
Prepared by : Emiliano Zucchi Manager TALS | ASU
Endorsed by :
Research clearly demonstrates that the greater the engagement of interpreters, the greaterthe health outcomes of patients with low English proficiency (LEP), and cost containment(Hlavac, J. , Zucchi, E., Beagley, J., 2018; Zucchi, E. & Hlavac J., 2017). Northern Health servicestwo of the most culturally diverse –and fastest growing- catchments in Melbourne, Whittleseaand Hume, and demand for interpreters is currently growing at a rate of 14% to 17% perannum. Moreover with NH campuses expanding (e.g. the Tower at TNH), it takes considerablylonger for patients and clinicians to access interpreters who are situated in a portable outsidethe hospital. The introduction of tablet-based video-interpreting will allow in-houseinterpreters to save travelling time, attend to more requests, and contain costs. This projectwill require: iPads and the creation of video-interpreting booths.
♦ TALS delivers approximately 70, 000 interpreting occasions of service pa in over 100languages♦ At NH approximately 20% of appointments have an interpreter, and interpreter requests are
currently growing by 14% pa.♦ Traveling between campuses takes over 30 minutes each way. With the expansion of TNH, it
can take up to 15 minutes to walk from one end of the site to the other. As a resultinterpreters spend a lot of time ‘traveling’ when they could be interpreting.
TALS is an industry leader recognised Australia-wide. To continue on this path we need to embrace technology.
To establish a working group to develop the Northern Health process for using video-interpreting within the same campus or across campuses
To scope best software application for video-interpreting, and infrastructure costs.
To trial video-interpreting between the TALS office and 1 or more wards at TNH (and later across campuses).
To establish key performance indicators and an evaluation methodology
Working
group
• Establish a working group to develop a “video-interpreting” process at NH
Research
• Research other “ video-interpreting “ practices at hospitals within Australia or overseas.
Develop
• Develop a communication strategy to implement video-interpreting
Implement • Implement video-interpreting trial
Evaluate
• Cleary defined key performance indicators established and evaluation to occur every six month
Sustain
• Ensure practices are reviewed and responsive against evaluation
From: Task orientated Care
To: Sensitive Patient Care
Going Gently with Dignity : Patient centred end of life care Executive Sponsor: Jodie Ashworth
Project Manager: Maria Tucker
Background Next Steps
NH reports no evidence of a standardised approach to education, clinical service delivery and auditing of EOLC practices and some evidence of a clinical governance framework to address this risk.Problem statement: This gap in standardisation poses a significant patient, family and organisational quality of care risk
Prepared by Maria Tucker
Endorsed by Jodie Ashworth Signature:
Current State
• 850 patients per year die at NH; • NH does not currently have a standardised way to manage EOL patients• an HCCC patient complaint (June 2017) highlighted multiple gaps in our EOLC systems
and reinforced the organisational need to improve clinical practice during EOLC
This project will implement and evaluate a standardised NH EOLC framework / toolkit for the delivery of EOLC by staff, evidence based screening tools or pathways to assist with decision making and recognised audit tools to evaluate compliance against NSQHS accreditation requirements.
To develop a standardised staff skill development toolkit to inform
practice for all staff involved in EOLC
To standardise care pathways for
patients at EOL.
To standardise audit tools to evaluate effectiveness and quality of EOLC.
To develop KPI's to monitor the quality of EOLC against best practice and NSQHS
standards.
Objectives
Future State
A preliminary audit (NSQHS audit tool 2018) of 20 palliative care medical records noted inconsistencies in the care delivery for patients and their families during the EOL phase of their care. A recent literature meta-analysis suggests patients and their families consistently expect (at EOL):
Effective communication and shared decision making
Expert care
Respectful and compassionate care
Trust and confidence in clinicians
Project Timeline
Phase Month
O N D J F M A M J J A S
Define
Measure
Analyse
Improve
Control
Project Timeline
In Scope Out of Scope
This project will incorporate all NH Emergency and Inpatient facilities. The tools developed will be tested within areas of high incidence of deaths i.e. Palliative Care, ICU, Cardiology, Respiratory. A secondary pilot will occur within department experiencing lower incidence of deaths to evaluate user acceptance and reliability.
Community, ambulatory and TCP/residential care programs and General Practitioner’s within the community are excluded from this project.
Dying is recognised and documented in medical records and communicated with family.
Reduced use of life sustaining medical treatments within the final 48 hours of life
Improved patient experience, as per VHES and reduced patient / family complaints regarding end of life support
Improved and documented symptom control during EOLC - as evidenced by audit
Risk screen tool for bereavement completed pre-all NH deaths with patient experience reported positively
Variation from best practice for end of
life care
Innovative patient centred end of life care based on best
practice
From To
29.10.18
Small things matter: Fit for Life A project on promoting Wellbeing
Executive Sponsor: Jodie Ashworth
Project Lead: Cindy Joffe
Background Objectives
The provision of patient centred care (PCC) which respects patient’s preferences and values and is underpinned by the principle of “nothing about me, without me” (Delbanco et al,2001), is central to enhanced quality of health care provided (ACSQHC,2011). Northern Health’s commitment to providing trusted care in the North is underpinned by patient experience. Programmes that focus on optimisation of health have been shown to decrease length of hospital stay and readmission rates, improved patient functional capacities and patient experience (Delaney,2017). Functional Maintenance programs and Maintenance care has been in existence in Victorian Hospitals and community settings for many years and are grounded in a multidisciplinary approach with patient driven goal setting. Patients are encouraged to be as physically active as they can and the hospital environment should be one that encourages independence and enhances interactions with family, carers and other patients. Northern Health, as part of the drive to reduce length of stay due to functional decline has introduced the #PJParalysis campaign where patients are expected to be dressed and remain as active as possible during the day. An outdoor vegetable garden and relaxation space is also in development with the intention to provide a communal space for patients in a less restrictive setting and encourage independence. Improvements in patient’s overall health will have flow on effects at their discharge and will support the hospital’s drive to keeping patients out of hospital through the Staying Well focus area. Other hospital initiatives include the move to a silent hospital; circadian rhythm lighting and provision of eye shields/ear plugs.
Current state: Steps for Improvement
Working group
• Establish a working group to review best Patient Centered Care practice
Research
• Research impact of hospitalisation on patients and carers
Develop
• Recommendations for strategies to promote health and wellbeing whilst hospitalised
• Develop agreed measures for evaluation
Consult• Engage with key stakeholders across all sites
Next steps
• Present finalized strategies to NH with proposed implementation, evaluation and sustainability processes
• Cohesion with other organizational initiatives
Prepared by : Cindy Joffe Operations Director Emergency Services and Cardiology
Endorsed by :
There are currently some wards at NH that have modified wellbeing/maintenance programs:• Unit B: Diversional Therapy and common area• Unit A: Outdoor Area• Unit H: #PJP paralysis• BH: gym areas, outdoor areas, patient kitchen• BECC: gym areas, outdoor areas, diversional therapy
Underutilisation
of/environmental concerns with patient lounges
Variability in documented
patient directed goal setting in acute inpatient
setting
Minimal evaluation
Inconsistency in Patient Centered Care best practice
To establish a working group to review best practice To develop a framework to deliver consistent Northern Health well being care To establish key performance indicators and an evaluation methodology for the
strategies selected to promote health and wellbeing whilst hospitalizedFUTURE STATE:% of patients participating in wellbeing programs% of embedded wellbeing practices by patients, carers and staff
From: 0% of acute inpatients participating in
an evaluated Patient Centered Care program
To: >90% of inpatients participating in an
evaluated Patient CenteredCare program
HRO Horizon Two: Improved Patient Experience EMPATHYEvery Moment HEAR, THINK , SEE and DO
Executive Sponsor: Jodie Ashworth Project Lead: Linda Romano
Background
Current State
Objectives
Steps for implementation
Empathy is not sympathy, nor is it feeling sorry for others. Instead it is understanding whatothers are feeling and thinking.Empathy is about standing in someone else's shoes, feeling with his or her heart, seeing with hisor her eyes. Not only is empathy hard to outsource and automate, but it makes the world abetter place. – Daniel H. Hink
Whilst Empathy comes naturally to some it is a skill that requires development in othersThrough walking in someone else's shoes we can truly put aside our view points, recognise and understand the feelings and needs of others to improve delivery of care.Providing empathetic care reduces stress, fosters resilience, trust, healing, personal growth and improves connections.
From our VHES data our Patients and families have told us that we need to improve our listening skills, provide greater respect and dignity and treat our patients and families fairly
Prepared by Linda Romano Operations Director TNH
Endorsed Jodie Ashworth Executive Sponsor
Prepared and Endorsed by:Poor Communication with Patients,
families and staff
Increased access and
Flow demands
Lack of Understanding of
Empathy
Staff reporting they are time poor
Focus shifted away from
Patient experience and
more on completing a
task
Struggle to relate to patient wishesWants and needs
Lack visual tools to role model
Empathy
To establish a working group and develop a Northern Health process for being empathetic to our patients, families and staff
To implement educational material to help support and develop staff skills
VHES indicator FROM Quarter 4 2017/2018 TO Quarter 4 2018/2019
77 66% >80%
78 85% >90%
79 91% 100%
To: Sensitive Patient Care From: Task orientated Care
See me, Hear me, Help me RoundingBackground Objectives
Project Lead : Debra Bourne
Current State
Steps for improvement
Prepared by : Debra Bourne Divisional Director/ DON TNH
Endorsed by :
In 2002 the concept of rounding in nursing was introduced with Castledine ( 2002) calling for the introduction of patient comfort rounds to be attended every 2 hours. Since then there has been numerous projects both within Australia and internationally focused on the concept of nursing staff have a structured process to see each of their patients every one to two hours. The rational behind these projects included:• falls reduction strategy• improved patient satisfaction • process to check that fundamental elements of care was being delivered• reduction in hospital acquired complications including pressure injures• improved pain management
Hutchins et.al ( 2013), Dewing, O’Mera ( 2013)There had been a few different names such as comfort round, hourly rounding ,intentional rounding , proactive nursing rounding
however essentially they all have the following similar process:• clock visible in patient room• Nursing staff tell patient/family that they will visit every hour and what time the next visit will be• each hour the nurse visits , speaks with the patients and addresses, pain, position , toileting, personal belongings in reach ,
questions and support• Often these are documented as the “ 4 R’s ( Refresh, Relieve, Reposition, Restroom) ort he 5 P’s( Pain, Potty, Position, Protect,
Provide)• Each round is always ended with a question similar to “ Is there anything else you need me to do for you before I leave?”
Al Danaf et.al ( 2018 There are other rounding projects such as leadership or executive rounding in which the nurse manager rounds on each patient once a day and the executive team may do once a week. These rounds are focused on an appreciative inquiry approach
• Unit G: 2/24 focused 5 P’s• T2: 1/24 focused on five P’s(is around 60% compliance) • Unit I :with high risk falls patients only . Hourly rounding : reduced falls form 13 to 3 • BH Unit 1 and 3: hourly rounding day shifts/2/24 rounding night duty : obs, pain, positon,
person, wound, IVC check ,falls and air mattress .
There are currently some wards at NH that have some form of rounding practices
No consistent forms/tools
Variation in intent
Variation in methodology
Minimal evaluation .
5 wards only
introduced
To establish a working group to develop Northern Health process f or reviewing each patient ,every hour by their allocated nurse in every ward
To implement rounding across all wards through communication and collaboration with all staff at Northern Health ensuring partnership with patients in this process
To establish key performance indicators including reduced falls, reduced pressure injures and improved patient satisfaction
Working
group
• Establish a working group to develop a “rounding “process at NH
Research
• Research other “ rounding “ practices at hospitals within Australia
Develop
• A “rounding” implementation plan and include agreed measures for evaluation
Implement
• NH “ rounding” process across all wards in all campuses
Evaluate
• Cleary defined key performance indicators established and evaluation to occur every six month
Sustain
• Ensure practices are reviewed and responsive against evaluation
Calling for care Consistent careFrom To
Overarching Issue: “Ask, Plan, Write it down”Executive Sponsor: Jodie Ashworth
Background
Sign Off
Current State
Boards
inconsistently used
at NH (business
rules not followed)
Patients/family/
carers not
included in
discussion
Ineffective
communication
regarding Estimated
Date of Discharge
(EDD)
Boards not used as
a tool during
bedside rounds &
handover
Patients/family/carers
not consistently
orientated to purpose
of boards
Future State
Next Steps
From: 73% in use
50% aspects complete
To: 100% in use & aspects completed
Version: 2
Prepared by : Jana Gazarek Project Manager
Endorsed by :
Project
Initiation
• Develop a project initiation plan, including baseline data & outcome measures
Working
group
• Establish a working group to review & embed the Patient Communication Boards process at NH
Benchmark
• Benchmark with other health services in terms of successful strategies for use of the boards
Develop
• Develop revised business rules and implementation plan for re-launch of Patient Communication Boards at NH
Implement
• Patient Communication Board process at NH, including patient/family/carer education
Evaluate
• Clearly defined key performance indicators established and compliance audit to occur every six months
Sustain
• Ensure practices are reviewed and responsive against evaluation measures
% of boards in use at NH% of aspects of boards completed
Patient communication boards are a well regarded, standardised tool used for communication between the healthcare team and the patient/family/carer. The boards are used to individualise care, and allow for the healthcare team and the patient/family/carers to plan and understand the care being provided on a daily basis. The objectives of the boards are to involve patients/family/carers in their goals of care. The healthcare team documents on the boards and patients/family/carers are also encouraged to document any questions they may have on the boards. The boards do not replace other communications strategies also in place (eg bedside handover and ward rounds).
At Northern Health (NH) patient communications boards were implemented in 2016, following benchmarking and extensive stakeholder consultation. The boards were designed with consumer input and implementation included development of business rules for the use of the boards, staff and consumer education and continuous evaluation.The boards are now displayed in all units, across all NH campuses except the Neonatal Unit and the Emergency Department at The Northern Hospital (TNH). Audits regarding compliance with the use of the boards should be conducted annually.
Each board contains 8 sections:- Patient name- Staff name- Today’s date- Nurse in charge- Planned Discharge
Date- What am I waiting for?- What matters to me?- Patient/Family
questionsPatient/Family orientation to the board is required.
In 3 units at TNH, the
boards are not completed
Results of 2018 compliance audit
No section consistently completed
24.10.18
IN 2018, NH Nursing executive started on a journey to improve patient care and the patient experience. Thisstrategy has now been adopted organisation wide and is a key feature of NH’s trusted care triangle.A literature review on kindness in health care, initially found 157,383 articles, but in-depth reviews haveidentified less than 50 articles which focus on kindness in health care and able to provide a foundation for thisfuture work.Sinclair et al 2017 ”Compassion enhanced the key facets of empathy while adding distinct features of beingmotivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness”, butalso identified a ‘lack of patient and family voices in compassion research”.Cornelison et al 2001 also identified there may be significant cultural barriers to providing compassionate care, soit is vitally important we engage with our community to identify the true meaning of ‘be kind to me is’.Duarte et al in 2003 published a research article titled Kind Nurse- Satisfied patient, but this has the potential tobe even bigger. Those simple acts of kindness have the potential to build a relationship that will improvecommunication and ultimately keep our patients safe while they are in our care.It is also evident in the literature that nurses and kindness are linked, but it is important to note that nurses makeup only 50% of our employees. Can exploring the role of all staff in improving kindness.NH VHES data is also worrying as this is the avenue for our patients to give feedback and is benchmarked acrossthe state. Below is a snap shot of items that may relate to our kindness.Were the nurses treating you compassionate? Did you receive enough emotional support from staff?
Overall did you feel you were treated with respect Were the ED doctors treating you compassionate?and dignity while you were in hospital?
NH nursing has led significant inroads already under the ‘compassionate care’ banner with projects such as ‘thepause’and this will be a great platform to launch into exploring what our patients understand makes a personseem kind and continuing on to implementation over the next 12 months.After all, Kindness is linked to happiness and therefore significant to the wellbeing of patients and staff.
• Design implementation approach and communication plan
• Implement approved plan
• Evaluate
To reinforce the ‘be kind to me’ aspect of patient care by improving our understanding of what
being kind means to them
Prepared by: Roslyn Payne Sept 2018
Endorsed by: Jodie Ashworth Oct 2018
Every life, Every
Moment, Every Day
Always Caring,Always
Here
The skill to heal,
the spirit to
care
M17 S17 M18 J18
NH 80.0 75.7 77.7 82.9
VIC 86.1 86.8 87.1 85.4
M17 S17 M18 J18
NH 59 66.3 54.3 56.9
VIC 71.1 71.3 58.6 70.9
M17 S17 M18 J18
NH 75.3 82.1 82.9 84.5
VIC 88.5 87.8 88.8 87.9
M17 S17 M18 J18
NH 78.4 75.5 75.1 70.4
VIC 79.2 80.8 78.2 79.3
Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences. (English) By: Sinclair S; Beamer K; Hack TF; McClement S; Raffin Bouchal S;
Compassion: a scoping review of the healthcare literature. (English) By: Sinclair S; Norris JM; McConnell SJ; Chochinov HM; Hack TF; Hagen NA; McClement S; Bouchal SR, BMC Palliative Care [BMC Palliat Care], ISSN: 1472-
684X, 2016 Jan 19; Vol. 15, pp. 6; Publisher: BioMed Central; PMID: 26786417;
Cultural barriers to compassionate care--patients' and health professionals' perspectives. (English) By: Cornelison AH, Bioethics Forum [Bioethics Forum], ISSN: 1065-7274, 2001 Spring; Vol. 17 (1), pp. 7-14; Publisher:
Midwest Bioethics Center; PMID: 12164203;
Current State
Overarching Issue: NH Patient Experience 2018-2019 Communicating “What Matters to You”.HRO Horizon two: Ask, listen and do what matters.
Executive Sponsor: Jodie AshworthProject Manager: Ana Asanovic
Background Future State
Next Steps
NH aims to deliver the highest quality outcomes of care to the community itservices.It has been identified that there is a disconnect between the staff’s perception ofthe hospital and the community perception of the hospital.The disconnect shows the need to clearly define messages going out to thecommunity and general public, as well as the need to identify, strategically utiliseand develop communication channels, with the aim to inform and engage targetaudiences.While Patient Experience will be communicated as part of the external HROcommunication strategy, it will also have a strong internal component, focusing onstaff training, engagement and awareness of the key messages “What matters toyou”.Increased external coverage and shared patient success stories, both externallyand internally are expected to additionally motivate and engage staff, leading toincreased staff morale and engagement, leading to positive work culture and evenmore positive stories. Sharing patient experience stories within community andstakeholders will help maintain and enhance NH reputation.
Prepared by Ana Asanovic
Endorsed by
Inform
Engage
Develop messages
Define audiences
Staff training and new staff
orientation could further embed PE
Difficulties in recruiting younger community members for volunteer engagement
Limited sharing of patient experience
stories, both internally and
externally
Social media only moderately used to promote good patient
experience stories
New intranet launched - hub for NH stories
Low media awareness of the trusted care
transformation
Community and consumers not aware
of the HRO transformation
TEST
Strategy Action
Develop Communication Plan as per the schedule
- Key messages development, testing and planning as per defined PE schedule
Raise awareness within community
- Increase communication on NH external media channels
- Increase positive media coverage- Regularly test key messages and their
understanding with target audiences
Increase stakeholder engagement
- Develop communication channels and timelines with key stakeholders
- Increase proactive communication with local GPs and community health services
Increase engagement with volunteers and staff
- Develop channels, key messages and promo materials which will be directly communicated from staff and volunteers to patients and consumers
Consistent monitoring and measuring
- Develop implementation timelines- Define measurement and evaluation techniques
From: Low awareness of Trusted Care transformation, limited sharing of patient experience stories
To: Public Informed and Consumers Engaged, PE stories proactively shared
