Empowering Our Patients with Information for Patient Safety

Mrs Sandra MillerDirector Safety, Quality & Performance UnitSir Charles Gairdner Hospital, Western AustraliaSAFETY AND QUALITYINWESTERN AUSTRALIA

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AcknowledgementsThe Health Consumers Council of Western AustraliaWA Council for Safety and Quality in Health Care (WACSQHC) Office of Safety & Quality in Health Care, WA Department of HealthSir Charles Gairdner Hospital

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Why Information for Patients?Increased health literacy of patients & communityPatient focused care: care focused on patient needs and engaging patients in health decision makingDemand on health care system and need for self-managementModern expectations in developed worldImprove understanding of the health system

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Rare events?Why Information for Patients?Knowledge about systems, error and human factors Poor health care safety data: 10% adverse events (half deemed preventable?)Early evidence (from human factors and systems literature) that patients can improve outcomes of their own carePotential to minimise adverse events

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Rare events?What is Patient First?Patient First is a unique patient safety management program sponsored by the WACSQHCDeveloped in partnership with the Office of S&Q, the WA Council for Safety and Quality in Health Care & the Health Consumers Council It has been implemented in WA working closely with the CACs and HCCAcknowledges the early developmental work of JCAHO and the US Speak Up program

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Rare events?What is Patient First?Unique patient centred program aiming for patients to be active, involved and informed participants in their health care.Patient centred information tool that helps consumers organise key information to enhance decision making and facilitate dialogue between patients and clinicians.

Both patients and providers indicate that formulating an agenda of questions is important for patients.Chunlan M et al. International Journal of Medical Informatics. 2006

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Rare events?Patient First TopicsInformed consent;Making decisions about your health care;Your rights and responsibilities;Medication Safety;Preventing Infection;Avoiding Falls;Preventing Pressure Ulcers;Correct Patient, Correct Site, Correct Procedure; Improving your emotional wellbeing;Your health information and privacy; and Health service information.

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Rare events?Development processThe development process included the following steps:Identified local, national and international information currently in useConsolidated and summarised into a shortened formRevised by consumers, patients and clinicians for the West Australian contextIdentified information gapsDrafted material to fill the gapsConsulted again with expert consumers

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Rare events?Patient First ResourcesBookletDVDLeaflets (11)PosterPamphletsWebsites: www.safetyandquality.health.wa.gov.auwww.hcc-wa.asn.au

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Patient First Program: Phase 1Patient First resources were disseminated throughout public hospitals within WAArea Health Services continue to implement the Patient First Program in all WA public hospitalsKPI within DOH Operational Plan DoH Patient Satisfaction Survey 20% patients (remember) receiving Patient First information Evaluation of Phase 1 of the Patient First Program identified areas of further need

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Identified needs from Phase 1Development of resources for groups with diverse and special needsindigenous people, mental health patients, children and adolescents, seniors, CALD and vision impairedSpreading the word from consumer to consumer!

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Phase 2 - Patient Ambassadors!

Health Consumers Council led Pilot Program Undertaken at SCGH 2007-2008The patient talking to the patient is a powerful tool.

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Patient AmbassadorsUses consumer advocates to disseminate information to the patients and their carers in the hospital outpatient setting.Commenced at SCGH in the main outpatient clinic areaRostered basis, working in pairsLimited to waiting areasBooklets, leaflets and DVD using a portable DVD player usedExpanded to pre-admission clinic, oncology and respiratory

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Results so farOver 3, 500 patients/families have received information from an AmbassadorMainly 50-70 year age rangeMost popular sections of the information include; rights & responsibilities, informed consent, decision making and privacy.Many patients commented that if they had received the information previously, they would have done things differently.Some patients referred to the Patient Liaison Service.

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Patient satisfaction - SCGH* Source: Annual DOH Survey of Public Hospitals in WA

Chart1

7682.3

8190.4

7579.4

68.975.4

2007/08

2008/09

% of patients that are aware

% of Patients that are Aware of Aspects of their Rights

Sheet1

2007/082008/09

Can ask for a 2nd opinion?7682.3

Can refuse treatment?8190.4

Can refuse students?7579.4

Awareness of complaints process?68.975.4

Sheet1

00

00

00

00

2007/08

2008/09

% of patients responding

% of Patients that are Aware of Aspects of their Rights

Sheet2

Sheet3

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Staff have commented on how valuable the process is for patients and their family/carers.New areas eg. Preadmissions have taken up the process with no hesitations.SCGH Staff

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Ambassador commentspatient took 4 booklets to give to her friends

patient had a grandchild in the system (health) and saw it as a great tool for all the family

patient felt that it gave them more confidence to speak with and ask questions of the doctors ...

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Demonstrated high level of commitment to patient focused careParticularly noteworthy was Patient First and Patient First AmbassadorsVery comprehensive education of patients and the community... ACHS Survey Feedback - 2009

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Keys to SuccessExecutive support from the start.Memorandum of Understanding.Managers/Staff who are willing to give it a go.Active Community Advisory Council.Orientation to the hospital & outpatient setting.Structured training program for Ambassadors.Visual cues/reminders for staff.

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Future ChallengesVolunteer availabilityConsidering use of healthcare studentsDistribution outside of the acute hospital settingGP practices and public librariesExpansion to other hospitals rural (Albany and Kalgoorlie), Womens and Newborns Health Service and Osborne Park Hospital.Keeping information current and user-friendly.

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Challenge for us allHealth services need to consider the education of consumers in parallel to building the information systems of the future, so that consumers can:Understand the information they are given access to;Understand the way the health system works; andCan use the information they are given access to, to be better involved in the provision of their health care and the minimisation of any harm

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Rare events?Further informationFurther information can be obtained by contacting

The Health Consumers Council of WA Tel: (08) 9221 3422, or freecall 1800 620 780 (country callers).E-mail: info@hconc.org.auWeb: www.hcc-wa.asn.au

or: The Office of Safety and Quality in Health CareWestern Australian Department of Health189 Royal Street, East Perth Western Australia 6004Tel: (08) 9222 4080 Fax: (08) 9222 4324 E-mail: safetyandquality@health.wa.gov.auWeb: www.safetyandquality.health.wa.gov.au/patientfirst

Slide *Patient safety, clinical risk, medical error and adverse events are all terms that I have heard more than once during the course of this conference from a number of speakers. I am delighted that the links between strategic planning for health information management systems, now and into the future, appear to have been made with great acknowledgement of the need to provide patient centred care within a safe environment.

On day one, Richard McFadden eluded to the fact that we, in this room, are all shareholders, staff and consumers in our health system. From a patient safety point of view, that is probably good news for us, because when we, or our loved ones, happen to become patients, we generally know how the system works, what to expect, we have the knowledge to be informed and most of all, we generally have the confidence to ask questions and speak up when we have a need for further information or explanation. I know that my experience as an employee has equipped me well, especially as a parent, in the provision of healthcare for my own family. In fact, working in the patient safety field some might argue, is probably the worst thing you can do for your confidence when it comes to actually having to be a patient yourself. Joke with senior colleagues about getting our names and UMRNs tattooed to our foreheads before going anywhere near a hospital as a patient!What I would like to do this morning is focus on the other proportion of the population who are not staff, do not know the health system and are not as well informed about many things including; their care options, their rights and how they can play an active role in ensuring the right treatment is delivered in the right way, by the right person and at the right time, with a safe outcome.Slide *I would like to acknowledge the above organisations who have developed and lead the work that I am presenting this morning and would like to thank them for allowing me to use some of their information within this presentation.Slide *We have already heard that good information is essential to assisting in the safe delivery of care; including issues surrounding clinical governance, consent, medication management and safety alerts.

We also know that the health literacy of our community is increasing thanks to the internet and other technological advances and the realm of reality medical television shows that have hit our screens in the last few years, and with this, the expectations of our health consumers are at an all time high.

We are at a point where our patients are expecting to be engaged, be included in discussions and be involved in making decisions about their health care.

The question is - have they been provided with enough information to allow them to participate effectively?

Slide *Louise Schaper has already kindly given you the frightening statistics about the frequency of adverse events in health care and of course the powerful analogy of this information to that of the aviation industry and of course the dramatic photo of the plane crash.

Of course this is just the tip of the iceberg and Im sure that as many of you are aware, we tend to spend our days trying to prevent our patients from being harmed through things such as falling from bed, acquiring pressure ulcers, avoiding infections and having procedures that perhaps were never intended for them in the first place.

There is now early evidence to suggest that the patient themselves can actually have an impact on minimising incidents of this type and as a result, improve the outcomes of their own care, by being alert, being informed and being confident to question or alert staff to potential problems.

Slide *Patient First is a unique patient information tool that has been developed by consumers and clinicians for consumers to educate them about the complex system within which we work, the fact that there is room for error and where the potential for error lies and provides health information to allow the patient to consider risks and benefits of treatment, how they can keep themselves well and help to reduce medical errors.It is based on original work of the Joint Commission on Accreditation of Health Care Organisations and the Centers for Medicare and Medicaid Services in the USA, who developed the Speak Up program to urge patients to take a role in preventing health care errors. Slide *The tool allows consumers at their own pace and in their own time, to organise key information, digest it, to enhance decision making and facilitate dialogue between them and their clinician or health care provider.

As noted by Chunlan et al, both patients and providers indicate that formulating an agenda of questions is important for patients.

Slide *The Information covers 11 main topics as you can see on the screen and really focuses on ensuring that the patient is aware of their rights and responsibilities, areas of potential risk or error, and things that just generally increase the patients health literacy and perhaps gives them the ability to self-manage their own health issues.

The full version (the Booklet) is a rather large document (42 pages) but is very visual and has room throughout the booklet that allows the patient to take notes to answers or discussions that they have had with their clinician. The last 4 pages consists of a Health Services directory with contact details and descriptions of the type of health services available within WA in an effort to ensure that the patient seeks the right service for their particular needs in the first instance.

Slide *The WA Council of Safety & Quality in health care developed the WA Strategic Plan for S & Q for 2003-2008. A core strategy of the Plan was a commitment to engage consumers as partners at all levels of care. In November 2005, as part of its commitment, the Safety & Quality Office within the DOH, commissioned the Health Consumers Council of WA to work with them to develop the Patient First materials. This included the steps of.

Slide *Today, several formats of the information are available to the community, most of which are being made available to patients and families within the acute hospital setting.

Information available on the website if anyone would like copies.

A review of this information has just been completed and it is anticipated that formats will be amended or revised based on feedback.

Slide *Phase 1 of the Program really concentrated on getting the information out at the coal face and it has been left up to individual sites and hospitals as to how they go about doing this. It is an expectation that all WA public hospitals distribute the information to their patients and most sites are doing this by making it available in waiting areas, at the bedside or through pre-admission distribution.

It has become a KPI for reporting by all health services as part of the annual Operational Plan for WA Health.

DOH survey results

Phase 1 evaluation (focus groups) identified further areas of needparticularly relating to distribution.Slide *Slide *The challenge of promoting, distributing and discussing the Patient First resource appeared insurmountable, until a group of consumers raised the idea of Patient First Ambassadors.

The OSQHC agreed to a pilot of this concept in conjunction with SCGH, with the pilot first commencing at the hospital back in late 2007.

SCGH is an adult acute tertiary hospital located near the beautiful Kings Park here in Perth and was last year noted to be the second busiest hospital in Australia, according to the latest report from the Australian Institute of Health and Welfare. With close to 600 beds, 3000 FTE staff, more than 60,000 inpatient admissions a year and over 300,000 outpatient attendances a year, it is easy to see how challenging it would be to provide information to patients on this large a scale.

While we too, had gone down the path of putting booklets and pamphlets in waiting areas and on wards, the information was not being picked up and if it was, there was no ability for busy staff to explain any of its content if need be.Members of the Health Consumers Council were approached and invited to become Pt First Ambassadors and in November 2007, 12 members of the HCC became the initial ambassadors for this project.

The role of the Ambassador is to approach patients and families (with their consent) in outpatient waiting areas, ask if they would like the materials on offer and then discuss and explain any particular areas of interest further.

Talk to above.Slide *Slide *Because of Sentinel Events?Rare terrible sometimes catastrophicNot just because of these

Also because of multiple governance issues within clinical and healthcare organisations