chcs patient journey project report

8/9/2019 CHCS Patient Journey Project Report

1/19

Calvary Health Care SydneyCalvary Health Care Sydney

South East Sydney and IllawarraSouth East Sydney and IllawarraArea Health ServiceArea Health Service

Patient and Carer Experience ReportPatient and Carer Experience Report

Rehabilitation and Palliative Care JourneysRehabilitation and Palliative Care Journeys

July, August, September 2008July, August, September 2008


2/19

CONTENTSCONTENTS

PATIENT AND CARER EXPERIENCE REPORT ................................ ............. ... 1

JULY, AUGUST, SEPTEMBER 2008 .................................................................. ..... 1

CONTENTS .................................................................................................................. 2

1. INTRODUCTION .................................................................................... 32. METHODOLOGY ................................................................................... 4EXECUTIVE SUMMARY ........................................................................... 63 (a). Top 3 Positive Aspects of patient and carer experience: ........... 63 (b). Top 3 Negative Aspects of patient and carer experience: ......... 63 (d). Trend Analysis: ............................................................................. 10DISCUSSION ........................................................................................... 10COMPARATIVE ANALYSIS .................................................................... 19APPENDIX 1 THE STORIES ................................................................... 19APPENDIX 2 ANALYSIS SPREADSHEET ............................................. 19


3/19

1.1. INTRODUCTIONINTRODUCTION

Calvary Health Care Sydney Ltd. (CHCS) is a "Non-declared", AffiliatedHealth Organisation listed in Schedule Three of the Health Services Act 1997.It is owned and operated by Little Company of Mary Health Care Ltd,(LCMHC) a national organisation established to manage the health, aged andcommunity services of The Sisters of the Little Company of Mary (LCM) inAustralia. The Sisters of the Little Company of Mary is an internationalreligious order of Catholic sisters who first arrived in Australia in 1885 andcommenced providing services as a public hospital in 1966. Today, LCMHCprovides services in every capital city and many regional centres in thefollowing states and territories - ACT, NSW, SA, Tasmania, Victoria andrecently the Northern Territory.

Calvary Health Care Sydney is situated in Kogarah and serves the St. Georgedistrict for Rehabilitative and Aged Care services. The CHCS PalliativeService serves the St. George and Sutherland Shire for both inpatient andcommunity services.

Beds in operation at CHCS are:

Capacity of 43 Palliative Care beds budgeted to operate at 88%occupancy

45 Aged Care Rehabilitation inpatient beds budgeted to operate at84% occupancy with capacity of 53 beds

10 Day Rehabilitation Unit beds operating on a Monday to Friday basis.

The average length of stay (LOS) for the inpatient Rehabilitation wards is19.36 days and the average LOS for inpatient Palliative wards is 18.49. Thecombined average LOS for CHCS is 18.91 days. Both service streamsprovide extensive community services.

The CHCS Palliative Care Service is the largest specialised comprehensivepalliative care provider in NSW. It incorporates community, inpatient, andfollow up bereavement services and Pastoral Care as its core business. Theservice's primary patient catchment area is contained within the Sutherlandand St. George areas. On occasion, out of area patients are accommodatedin the inpatient unit. The integrated approach to care delivery is based on aholistic framework. Referrals are sourced from both the public and privatehospitals in the area. Primary health carers such as the General Practitioner or Generalist nursing services are also able to refer. The actual patient or their carer may also self refer. All referrals are assessed for specialistpalliative care need based on the Palliative Care Australia Standards.

CHCS operates a large multidisciplinary Community Rehabilitation andGeriatric Service (CRAGS) which incorporates a 45 bed inpatient

rehabilitation unit, day rehabilitation program and an extensive range of community based services. The role and function of CRAGS is that of


4/19

assessment and intervention, case management, care planning, and referraland placement support where appropriate. Calvary has substantialexperience in facilitating the integration and expansion of rehabilitationservices within the St. George Area. Its community and aged care servicesinclude:

St George Aged Care Assessment Team (ACAT) Placement Service (Nursing Home, Hostel, Respite and CCP Liaison) Podiatry Service (Centre based and domiciliary) Driver Assessment & Rehabilitation Service Continence Advisory Service Neuropsychological assessment and treatment Dementia Specific Day Care Centre Occupational Therapy services including home assessment, equipment

prescription and home modifications Physiotherapy including hydrotherapy, home assessment, Mobility

Group, prescription of exercise programs and equipment Speech Pathology assessment and intervention Dietetics services Medical oversight from Rehabilitation Specialists and Geriatricians Social Work services including advocacy, assessment, care planning

and liaison Veterans Home Care service for South East Sydney Program of Appliances for Disabled Persons (PADP) and the

Equipment Loan Pool (ELP)

Transitional Aged Care Services (TACS)

The major source of funding for operations is through South Eastern SydneyIllawarra Area Health Service (SESIAHS). This is provided by an annualrecurrent subsidy which is historically based rather than activity driven (52publicly funded beds).

2.2. METHODOLOGYMETHODOLOGY

In order to engage directly and meaningfully with patients and carers whohave recently experienced health care at Calvary Health Care Sydney, teninterviews with service users, using a methodology supported by NSW Health,were conducted.

The NSW Health supported methodology, which uses the Picker PatientCentred Dimensions of Care, was applied. This approach focuses on criticalaspects of the patients experience of health care as identified throughextensive research undertaken by the NRC+Picker Institute (USA). The NSWHealth approach has adapted the findings to define the key dimensions of care as valued by patients and carers.

The eight Patient-Centred Dimensions of Care provided by NRC+Picker areas follows:


5/19

1) Access to care2) Respect for patients values, preferences and expressed needs3) Coordination and integration of care4) Information and education5) Transition and continuity

6) Physical comfort7) Emotional support and alleviation of fear and anxiety8) Involvement of family and friends

Patients identified both positive aspects and negative aspects of care inrelation to each of the eight dimensions.

The journey being captured at Calvary Health Care Sydney was the inpatientexperience for both the Rehabilitation and Palliative Care service streams.This would also, in some instances, capture those patients who hadexperienced services delivered by Calvarys Community Rehabilitation andGeriatric Services Team and Calvarys Community Palliative Care Team.

The following criteria were used to determine participant eligibility for theproject:

admitted from an acute facility stayed more than 7 days and reside within the community and may/may not have a carer.

Ten interviews were conducted between July and September 2008. Mostinterviews took approximately an hour. All interviews were undertaken by two

staff - one acting as scribe and the other as lead interviewer.

The staff who conducted the interviews had received training on how tointerview patients and capture patient stories using this methodology.

Potential interview subjects were identified through iPM. A report listingdischarges for the previous fortnight was used to identify candidates for interviewing. Patients were randomly contacted using this list.

Discharged rehabilitation patients were contacted by phone to determine their interest to be interviewed. Appointments were made with those who

responded positively, and a letter inviting them to participate, a PatientInformation Sheet, and the Consent Forms, were mailed to them. Areminder/confirmation call was made the morning of the interview.

Due to the fragile nature of the palliative care patient group, it eventuated thatdischarged palliative care patients had already passed away when they wererandomly selected for contact from the iPM list. It became necessary to targetthose patients who were presently experiencing an inpatient stay. Patientsfrom the ward were randomly selected to be interviewed.

All interviews conducted were face to face interviews. Patients dischargedfrom the rehabilitation service were interviewed in their homes. Patients


6/19

experiencing a Palliative Care Patient Journey were interviewed in their roomson-site in the hospital.

On completion of the interviews, the story was written by the scribe. The storyalong with a thank you letter was sent to the patient/carer for review and an

opportunity to make amendments.

EXECUTIVE SUMMARYEXECUTIVE SUMMARY

Positive and negative aspec t of patient expefindings from 1 0 interviews in SESIAHS

4 3 2 1 0 1 2 3

Access to Care

Res pect for patients

Coo rdination and integration of care

Information and education

Transition and co ntinuity

Physical comfort

Emotional support

Involveme nt of fam ily and friends

N eg ative/ D is agree Po sitive / Ag ree

3 (a). Top 3 Positive Aspects of patient and carer experience:3 (a). Top 3 Positive Aspects of patient and carer experience:

1. Coordination and integration of care2. Emotional support and alleviation of fear and anxiety3. Access to care

3 (b). Top 3 Negative Aspects of patient and carer experience:3 (b). Top 3 Negative Aspects of patient and carer experience:

1. Physical comfort2. Emotional support and alleviation of fear and anxiety3. Information and education


7/19

3(c).3(c). Exemplars:Exemplars:

Positive:

Patient and carer experience Exemplars

1 Coordination and integration of care

I had asked to have mums toenails clippedand it was done the next day.

When mum went home for the first time,they had equipment put in place.

I had a problem with my bowel, so I rangthe community nurse who was looking after me. He said what he thought I should do,but that didnt work, so I tried somethingelse, but that didnt work either so hesuggested coming to hospital. He got me inthat same day.

Ive been to Calvary three times in the lastfour years An Occupational Therapistcame to my house, each time I was in.

On the last day the physiotherapist said,would you like to come to outpatients? Ididnt think I needed it, but seeing hesuggested it, I thought I should takeadvantage of it.

2 Emotional support andalleviation of fear and anxiety

I got very downhearted one day, and mydoctor sent one of the girls to take me outfor a drive to Cronulla. They had asked meif you werent here, where would you like tobe? I had said Id love to be by the water,the rougher the better. If I stayed in hospitaltoo much, Id become institutionalised.

I know Ive got someone if I need help. I

can ring them at night if needs be, if Imworried about anything I can always get tothem. It builds up confidence and I can gethelp if I need it. Theyre interested to knowhow Im going, whats happening to me.They speak to my doctors on my behalf. Itsgood to know theyre there for me. Onenurse, shes very, very good. I could ringher any time I needed her. She used tophone me to see how everything was going.

Social work has been excellent. I have anintellectually handicapped son. I amworried about him when Im not aroundanymore. Shes been helping him. Hes

accepted that Im not going to be around allthe time. The staff have been absolutely terrific.

They are so good. If Im in their hands Iknow Im going to be safe. The doctors aregreat. I havent found a doctor yet, thatdoesnt talk to you like a doctor and thatswhat I like. I dont understand about everypiece of medication, but I understand whattheyre trying to do. I understand theyretrying to relieve things. I understand thatIm not going to get any better, Im not goingto walk again. Now its a matter of howwere going to go into this. The doctors aredirect, straightforward and considerate.

Weve known all along that Ken had cancer.Were comfortable with it. Weve had


8/19

support offered all the time. Pastoral careand social work have always let us know allthe time that support is available.

3 Access to Care Initially, I was told that I would have to waitanother fortnight to get into to CalvaryHospital, but the same afternoon the sister came to me and said you are going toCalvary within the next hour. The transfer went very smoothly.

The most positive aspect of my care atCalvary was the access to care. Both timesI needed to come to Calvary I only had towait two days for a bed.

Negative:

Patient and carer experience Exemplars1 Physical comfort I missed my double bed from home,

because they had a little tiny bed. Maybeone night I could fall, because I had somany falls. I felt like crying. I ask two or three times for side rails. It was scaring me.I missed my bed and electric blanket. I wascold. They gave me blankets but I wasalways cold.

They had put me in the Independent LivingUnit before I was discharged. The bed wasdifficult to make there as it was pushed intothe corner, so I had problems making thebed. The nurse moved it for me. AtCalvary you dont strip the bed, to make it,you pull it down and pull it up. Im used tostripping the bed, letting it air, rubbing my

hand over it, laying sheets, blankets, quilts.Just pulling it down, and pulling it up is notsanitary.

What theyre doing now in building a pool isexcellent, except at the time I was scaredstiff! I would get up at 6.45am, have myshower and wait for breakfast, and then itwas like an earthquake, they wereexcavating right under my bathroom and mybed.

Knowing my own body, 8 Panadol per dayis too much for me. Id be sound asleep,and the lights would go on, and the Nursewould be there with 2 Panadol, and Id have

to take them. I said no a couple of times,and she left them there and I chucked themdown the toilet the next morning.

Jacqueline: I was taking him off all histablets at home but when Rudi came herethey started them all again. I was a little bitannoyed because when Rudi wasdischarged they gave him five days worth of Chemotherapy tablets but they ran out on aSunday. Rudi: When we did try to get moretablets the supply had run low so I had to gowithout the tablets for a week until newstock came.

Most of the time the ward seemed verynoisy. Mostly I slept well but the there wasa lot of talking. I didnt get bothered about itthough. Generally when I asked for


9/19

something the nurses did it straight away soI didnt worry about the talking. I was alsoclose to the lift so I heard the lift bell quite alot but that didnt bother me. It was morethe laughing and talking. The noise fromthe room next door seemed very closetoo. Being near the front desk was verynoisy. I didnt hear anything negative, itwas just the noise.

2 Emotional support andalleviation of fear and anxiety

At first, I was frightened about being movedaround. It is traumatic being moved aroundand not knowing where you are. Especially,I was a bit confused at the beginning.

She told me she went to the toilet in themiddle of the night by herself as she is usedto doing that at home, but the nurse spoketo her in a manner which upset her for days.This experience really stayed with my mumfor a while and she was scared that if shecomplained, that the nurse might retaliate.She asked that I did not complain when thishad just occurred.

I was in a four-bedded room, but I couldnthandle it. There was a woman in the bedopposite me screaming, Please God takeme. I wanted to go. I was there for twodays and that lady was screaming the entiretime. This made me most upset, as I wasall right compared to the others in thatroom. The only problem was that mybowels didnt work. Thats what got medown. It was like a morgue I shouldvenever have been put in a room with otherswho were that sick After a week they

asked me to move into a four-bed wardagain. I was scared again but they kept mein a single room. I could see them all in mymind. I just lost a friend to cancer. I reallycouldnt cope.

The room is a bit noisy when theyre allhaving their break out there but that doesntreally worry me, theyve got to eatsomewhere. Sometimes its depressingconversation which I can do without. If theyre talking generally I dont mind, but if theyre talking about how long Harrys got tolive

I thought, Im in trouble, and I dont know

where to turn. My daughter came by train from the CentralCoast. The first time she came she gotthere about 10.00am, but another time therewas a hold up on the train so she got there11.45am. She asked the nurse if she couldstay a little longer but struck a nurse whosaid no. If shed only come from another suburb, but she came from quite a distance.

3 Information and education Being taught how to move around may havebeen helpful. The physiotherapistsuggested some alternative methods, butsome of them werent too good. For example, I was worried about Ken slippingon the tiles. As much as they were trying tolook at alternatives, they werent


10/19

appropriate for home. If only someone hadshown me the easy way to do things.

I found some procedures were not clearlyexplained like the visiting hours. Also thereseemed to be inconsistencies between thenurses. Some allowed me to do things for myself but others wouldnt let me andinsisted I wait for their help. There does notseem to be a lot of communication betweenthe nurses. On occasions this made mevery frustrated and hence I had a few spatswith the nurses. I found this poor communication affected my family as well.My wife started to tell me I was not to dothings for myself. It has createddisagreement amongst us. If the nursesspoke with her and told her what I amcapable of I think it would make everythingmuch easier.

3 (d). Trend Analysis:3 (d). Trend Analysis:

This is the first collection of Patient Journey Stories at Calvary Health CareSydney. It is anticipated that this process will be repeated in the future with asimilar cohort of patients. Trend analysis and comparative analysis will bepossible with a series of patient stories conducted in the future.

DISCUSSIONDISCUSSION

This series of patient/carer journeys has offered great insight into the

experience of users of services provided at Calvary Health Care Sydney.Overall, comments were overwhelmingly positive, but some constructivefeedback was obtained.

Access to Care

Several patients commented on how quickly they were accepted into Calvary:

Initially, I was told that I would have to wait another fortnight to get into toCalvary Hospital, but the same afternoon the sister came to me and said you are going to Calvary within the next hour. The transfer went very smoothly.

The most positive aspect of my care at Calvary was the access to care. Bothtimes I needed to come to Calvary I only had to wait two days for a bed.

However, a palliative care patient and his wife highlighted the time delaybetween clinic appointments:

Ken: I was attending the clinic weekly. It was hard to scheduleappointments in the clinics.

Mrs. Ken: They booked appointments 3 weeks ahead. A lot can happen in3 weeks its a long time for a person to be waiting.


11/19

Respect for patients values, preferences and expressed needs

All patients praised the treatment they received by the staff they came acrossduring their patient journey. Several patients commented on how theyappreciated the appropriate level of encouragement from the staff in the gym:

The gym is good. The girls are great. They know exactly how far to pushyou. They really listen to you. I like feeling like I am allowed to make my owndecisions. The gym staff are good listeners; I feel like I am in control.

They just work miracles in the gym. The physiotherapists are such caring people. They understand each patient. Were all different. I haveemphysema. Ill do so much at the gym and then my breathing will be a

problem. Theyre so understanding. They told me to stop when I was having trouble breathing and have a rest. The gym was hard work but I needed it.No point in going if you were going to sit down and watch. I can only praisethem.

One patients carer commented on the contrary:

Mum just wasnt happy going to physio. They need to understand that it canbe difficult for the elderly. My mum has a heart condition and it was difficultfor her the second time around.

The interviewees acknowledged, on several occasions, that they were treatedwith respect, and that their requests were always considered:

They respect people at Calvary. The doctors, nurses, everybody says hello.

What I liked about Calvary is getting dressed in my own clothes and walking around. No woman likes to be walking around in her nightdress and sleeping in it at night.

I was awake early and usually showered first, provided they let me keep my nightgown on as I could go back to sleep again before breakfast arrived.

One patient provided an example where she and her fellow inpatients asked

to have their lunch in the patient lounge room so they could watch theOlympics during lunchtime and their request was granted:

It was just a matter of speaking with them, you cant break the rules, I understand that. You just had to ask, and it was either yes or no, no hassles.

On one occasion a patient felt that she was not regarded in relation to her medication management needs:

Knowing my own body, 8 Panadol per day is too much for me. Id be sound asleep, and the lights would go on, and the Nurse would be there with 2

Panadol, and Id have to take them. I said no a couple of times, and she left them there and I chucked them down the toilet the next morning.


12/19

Coordination and integration of care

Most patients were impressed by the coordination of care provided. Itappears that Calvarys internal service referral systems operate efficiently:

I had asked to have my mums toenails clipped and it was done the next day.When I phoned the doctor, they got back to me immediately.

One nurse, shes very, very good. I could ring her any time I needed her.She used to phone me to see how everything was going. If I had a problemwith pain, I would speak with her and she would speak to the doctor in thehospital and it would be sorted within a couple of days.

I had a problem with my bowel, so I rang the community nurse who waslooking after me. He said what he thought I should do, but that didnt work, soI tried something else, but that didnt work either so he suggested coming tohospital. He got me in that same day.

The staff in the gym are so caring. On the last day the physiotherapist said would you like to come to outpatients? I didnt think I needed it, but seeing he suggested it, I thought I should take advantage of it.

An Occupational Therapist came to my house, each time I was in.

One patient was confused about the coordination of his care:

Jacqueline: Rudis hands were still a problem. The Doctors and nurses said he needed to go to Prince of Wales for a check up. We couldnt understand this. Why couldnt he go up to St. George which is almost next door! Rudi:They still sent me to Prince of Wales by ambulance even though it was muchfurther.

Another patient described a scenario where one of her medications was leftoff her chart and she struggled to manage her condition. She acknowledgedthat the issue was addressed the following day.

Another patient was disappointed that his medication needs had not beenanticipated in advance:

Jacqueline: I was taking him off all his tablets at home but when Rudi camehere they started them all again. I was a little bit annoyed because whenRudi was discharged they gave him five days worth of Chemotherapy tabletsbut they ran out on a Sunday. Rudi: When we did try to get more tablets thesupply had run low so I had to go without the tablets for a week until new stock came.

Two patients experienced difficulties with front-line patient care:


13/19

When I did get to the shower she left me there on my own. When she cameback I told her she had left me for 15 minutes. She became defensive and said she didnt.

I had someone in the shower to watch over me but they never dried me,

except for one nurse. I never said to them Im not completely dry. That was just minor.

Information and education

Some patients related that their information needs were not satisfied:

Being taught how to move around may have been helpful. We were offered help with showering but Ken didnt want that as he is private and modest.The physiotherapists were excellent at showing me what to do to help Kenget into bed. The physiotherapist suggested some alternative methods, but some of them werent too good. For example, I was worried about Kenslipping on the tiles. As much as they were trying to look at alternatives, they werent appropriate for home. If only someone had shown me the easy way to do things.

I had a bad experience with two doctors. They were not regular doctors and they were young. They bustled in whilst I was showering. They are, Imafraid, overseas staff. They did not really talk to me. They came in, talked amongst themselves, and just left. They did not explain what they were therefor.

One patient described his struggle with accessing information to facilitate hisautonomy:

Sometimes I find the nurses a bit over the top. I am fighting for independence but they want to do too much for me. I yelled at one which I felt bad about but I really wanted to try and do things for myself. She didnt really seem to be listening to me when I told her I wanted to have a go myself.I found some procedures were not clearly explained like the visiting hours.

Also there seemed to be inconsistencies between the nurses. Some allowed me to do things for myself but others wouldnt let me and insisted I wait for

their help. There does not seem to be a lot of communication between thenurses. On occasions this made me very frustrated and hence I had a few spats with the nurses. I found this poor communication affected my family aswell. My wife started to tell me I was not to do things for myself. It hascreated disagreement amongst us. If the nurses spoke with her and told her what I am capable of I think it would make everything much easier.

Positive feedback regarding knowledge of the availability of support was oftenhighlighted:

They gave us instructions, so we knew who to call. We knew it was 24hrs,

we knew the office hours, after hours. We got a pamphlet, and knew thetimes to phone. We knew that we could leave a message on the answering


14/19

machine as they had a meeting on Monday mornings and then they were out on the road.

Transition and continuity

Most patients were satisfied with the transition to home and continuity of service. In particular, they appreciated the discharge instructions related totheir medications:

My medications were well explained to me before I left Calvary.

The Webster Pack has been helpful after I went home. You just burst thebubble. Its better than picking up bottles when you cant read what they are.

One patient commented on the timing of being offered further services:

Now that I have been home for a few days and feeling better, I miss physio,but for me this is not very easy because I dont have transport. One day, my

physiotherapist tried asking me if I would like to come back for rehab but I was so mixed up. I had lots of blood tests, and afterwards I was very weak.He asked me something but I asked to be left alone as I was dizzy.

In another instance:

After my mother got stronger and I could see that she could come home,nothing seem to be happening. The doctors were a bit slow discharging her.I had to ask to make it happen. They could have moved her home quicker.The follow up assistance after discharge has been slow. Im still struggling with the services. There is lots of paperwork. My mother gets a bit lonely during the day.

Physical Comfort

Mixed responses surfaced regarding the physical comfort of the environment.

Overall, patients acknowledged that the patient rooms in the wards at Calvarywere satisfactory:

Its a nice, calm ward. Its fantastic. You just relax, its really good. Noise isnot an issue.

The room is lovely. I have a beautiful view. Its good fun seeing the planesgo off during the day. I let my imagination run away with me and often wonder where theyre going.

It was like saying goodbye to friends. They [new patients] come in, some areworried, scared, you introduce them, youre nice to them, theyre visitors say hello to you, and before you know it youre friends. It was a lovely

atmosphere. One of the nurses used to say this is the happiest ward in thehospital.


15/19

Patients also expressed appreciation for Calvarys same gender rooms policy:

I was in a four bed ward four ladies, no men thank goodness.

At Calvary I only shared with women which was much better.

The beds were regularly commented upon:

I also noticed that the beds were also good because I could lower them right down so I had no difficulty getting out of bed.

The room is quite comfortable and the bed is fine.

The bed is quite comfortable.

The bed is as comfortable as any bed.

However, one patient related that she was worried about falling out of the beddue to the absence of rails.

The temperature was highlighted by many:

When you left your room, it was quite cold. I would get really cold going tothe dining room and at certain parts of the hospital you freeze. I would always put on a coat or jacket.

The only problem I find is that the temperature seems to vary quite a bit. At times I feel quite cold which is very unusual for me.

I missed my electric blanket. I was cold. They gave me blankets but I was always cold.

Its not at all cold in the room. Sometimes it gets a bit warm in the afternoon.The hallways are sometimes cold but the ward itself is warm.

On two occasions patients were disturbed by the surrounding noise:

Most of the time the ward seemed very noisy. Mostly I slept well but thethere was a lot of talking. I didnt get bothered about it though. Generally when I asked for something the nurses did it straight away so I didnt worry about the talking. I was also close to the lift so I heard the lift bell quite a lot but that didnt bother me. It was more the laughing and talking. The noisefrom the room next door seemed very close too.

What theyre doing now in building a pool is excellent, except at the time I was scared stiff! I would get up at 6.45am, have my shower and wait for breakfast, and then it was like an earthquake, they were excavating right

under my bathroom and my bed.


16/19

Overall, patients were most pleased with the food on offer, the choiceavailable and the size of the portions:

The food is fantastic. Whoever the chef is, they should be congratulated.The quality of food is spot on. The portions are good enough, you have a

choice of small, medium or large. They cater for all appetites. You should charge more, because the food is first class.

The food here is very good. I have no complaints about the food. Theyre plenty big enough portions, theres enough selection and enough food when it comes. You can have fresh fruit if you want it and your family can bring it.The temperature of the food is quite right. I like soup and theres always soupon the menu and its always hot.

I would give the food about seven and a half out of ten. There is plenty of choice.

However, some patients offered feedback about some aspects of their diningexperience:

The menus were very good, exceptionally good, except when you ordered a piece of fruit and were given metal cutlery to cut it. Metal cutlery wont peel an orange or cut an apple. One of the helpers in the dining room used a

plastic knife and did it for me.

I enjoyed getting my hot tea in the morning and would have preferred getting hot tea throughout the day rather than getting iced cold cordial especially at night.

The cereal packets are very difficult for aged people to open, for example,Kellogs Corn Flakes, you cant cut open with a knife, so I put my fork throughthe top, and used my thumb nail to slowly pry it open. Skippy Crispies, thoseyou can open straight away!

My mother also likes fruit more than sweets as she says, but, they tended togive hard fruit like apples. Bananas would be better and easier to eat for older people.

You could order fruit from the menu but they did not specify what sort of fruit.It would be helpful if they did.

The standard of cleaning was also praised:

Calvary was very clean and pleasant. The cleaners were fantastic. They worked very hard and one in particular was very friendly.

However, one patient identified a perceived gap:

Sometimes people would go to the toilet and they wouldnt press the flushbutton. How would the nurses know? But sometimes visitors would use our


17/19

toilets. I dont want to criticise the cleaning ladies in any way, they never cleaned the showers on weekends. Theres four people, I thought well maybe they could do it once over the weekend. It didnt worry me greatly but I noticed it. The ladies doing the cleaning, the were of European background,not that it mattered, perhaps we shouldnt talk to them, but they didnt like to

say good morning. They couldve been more friendly. Oh well, thats their job, and you cant expect everybody to be cheerful.

It was acknowledged that pain medication was organised promptly andappropriately:

I get enough pain relief and it happens quickly. I only have to wait 10-15 minutes, which is fair enough when they have to go and get the drug.

Emotional support and alleviation of fear and anxiety

Patients expressed mixed feedback with regards to receiving emotionalsupport and the alleviation of fear and anxiety.

I got very downhearted one day, and my doctor sent one of the girls to takeme out for a drive to Cronulla. They had asked me if you werent here,where would you like to be? I had said Id love to be by the water, therougher the better. If I stayed in hospital too much, Id becomeinstitutionalised.

I know Ive got someone if I need help. I can ring them at night if needs be, if Im worried about anything I can always get to them. It builds up confidenceand I can get help if I need it. Theyre interested to know how Im going,whats happening to me. They speak to my doctors on my behalf. Its good to know theyre there for me. One nurse, shes very, very good. I could ring her any time I needed her. She used to phone me to see how everything wasgoing.

The staff have been absolutely terrific. They are so good. If Im in their hands I know Im going to be safe. The doctors are great. I havent found adoctor yet, that doesnt talk to you like a doctor and thats what I like. I dont understand about every piece of medication, but I understand what theyre

trying to do. I understand theyre trying to relieve things. I understand that Im not going to get any better, Im not going to walk again. Now its a matter of how were going to go into this. The doctors are direct, straightforward and considerate.

Weve had support offered all the time. Pastoral care and social work havealways let us know all the time that support is available.

Some distressful examples were relayed:

I was in a four-bedded room, but I couldnt handle it. There was a woman in

the bed opposite me screaming, Please God take me. I wanted to go. I was there for two days and that lady was screaming the entire time. This


18/19

made me most upset, as I was all right compared to the others in that room.The only problem was that my bowels didnt work. Thats what got me down.It was like a morgue. I was moved the same day as I complained, withinaround 20 minutes. If things go wrong they seem to fix it up. I shouldvenever have been put in a room with others who were that sick. I feel that this

[private room] is the best place for me to be. After a week they asked me tomove into a four-bed ward again. I was scared again but they kept me in asingle room. I could see them all in my mind. I just lost a friend to cancer. I really couldnt cope.

The room is a bit noisy when theyre all having their break out there but that doesnt really worry me, theyve got to eat somewhere. Sometimes itsdepressing conversation which I can do without. If theyre talking generally I dont mind, but if theyre talking about how long Harrys got to live

She told me she went to the toilet in the middle of the night by herself as sheis used to doing that at home, but the nurse spoke to her in a manner whichupset her for days. This experience really stayed with my mum for a whileand she was scared that if she complained, that the nurse might retaliate.She asked that I did not complain when this had just occurred.

Volunteers were highly valued and praised:

each patient has got a carer of their own. I have a dear friend who hasbeen appointed to see me once a week. The idea is companionship and itsbeautiful. She comes once a week.

The volunteers are wonderful. I love to see them come. Theyre all very helpful. Two of them come very Monday and we have tea, toast and eggs.

The volunteers are absolute angels. One day I was lying on my bed with not much to do when suddenly a face appeared at the door and offered me abeer. That was ten out of ten! I also had a foot massage the first in my life.

The volunteers spent a lot of time with me which was nice because I didnt have visitors during the day. It filled in the afternoon.

Involvement of family and friends

On a couple of occasions, patients felt that the needs of their family were nottaken into consideration.

One carer was disappointed that her needs were not regarded on an occasionwhere she was visiting during her lunch break and was pressed for time:

I was visiting around lunchtime and wanted to get a sandwich at theVolunteers Caf. I thought it would be nice to have my mother join me in the

caf so I asked their permission. They said it was ok, but, when I asked the


19/19

staff if I could bring my mother and her lunch into the caf even though I already told them I had their permission, they wouldnt let me do it.

Another patient provided feedback related to visiting hours:

My daughter came by train from the Central Coast. The first time she cameshe got there about 10.00am, but another time there was a hold up on thetrain so she got there 11.45am. She asked the nurse if she could stay a littlelonger but struck a nurse who said no. If shed only come from another suburb, but she came from quite a distance. The other times they were morerelaxed.

Another patient was most grateful about how staff had assisted her son andhis needs:

Social work has been excellent. I have an intellectually handicapped son. I am worried about him when Im not around anymore. Shes been helping him. Hes accepted that Im not going to be around all the time.

This series of patient and carer journeys has highlighted both the positive andnegative aspects of the patient journey at Calvary as recently experienced bythe interviewed patients and their carers. The information gathered from thisproject will assist the organisation in identifying areas requiring improvementas well as acknowledging services and behaviours to be applauded andmaintained. This feedback will be fed back to relevant staff with a view tocreating an action plan to address the issues raised.

COMPARATIVE ANALYSISCOMPARATIVE ANALYSIS

This is the first collection of Patient Journey Stories at Calvary Health CareSydney. It is anticipated that this process will be repeated in the future with asimilar cohort of patients. Trend analysis and comparative analysis will bepossible with a series of patient stories conducted in the future.

APPENDIX 1APPENDIX 1 THE STORIESTHE STORIES

Attached

APPENDIX 2APPENDIX 2 ANALYSIS SPREADSHEETANALYSIS SPREADSHEET

Attached

chcs patient journey project report

Documents