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PHASE 1 FINAL REPORT EXCELLENCE THROUGH PATIENT AND FAMILY CENTRED CARE BAY OF PLENTY DISTRICT HEALTH BOARD

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Page 1: Excellence through Patient and Family Centred Care · Excellence through Patient and Family Centred Care 4 | P a g e excellent in many ways, it often reflects the needs of providers

PHASE 1 FINAL REPORT

EXCELLENCE THROUGH PATIENT AND FAMILY

CENTRED CARE

BAY OF PLENTY DISTRI CT HEALTH BOARD

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PHASE 1 FINAL REPORT

Averil Boon RN, Grad Cert HInf, PG DipN

Bay of Plenty District Health Board

Cameron Road

Private Bag 12024

Tauranga 3143

Phone (07) 5798000

June 2012

Disclaimer:

This project was sponsored with funding from the Health Quality & Safety Commission as part of the Quality & Safety Challenge 2012. Publishing of project resources on the Commission’s website does not

necessarily constitute endorsement of the views or approach taken by the project, the Commission’s intent in publishing is to showcase the achievements of the Challenge projects and share learnings

across the health sector.

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TABLE OF CONTENTS

Excellence through Patient and Family Centred Care Project ............................................................ 3

Phase 1 Final Report ................................................................................................... 3

Aims and Objectives ....................................................................................................... 3

Background ..................................................................................................................... 3

Risk ................................................................................................................................. 4

What is Patient and Family Centred Care ....................................................................... 5

Recommendations .......................................................................................................... 0

1. Leadership: .......................................................................................................... 0

2. Patient, Family and Community Engagement: ...................................................... 0

3. Education: ............................................................................................................ 1

4. Communication: ................................................................................................... 1

5. Creating a culture of excellence that supports PFCC............................................ 1

6. Performance Measurement and Monitoring Progress: .......................................... 2

7. Where to next? ..................................................................................................... 2

Summary ..................................................................................................................... 3

References .................................................................................................................. 4

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EXCELLENCE THROUGH PATIENT AND FAMILY CENTRED CARE

PROJECT

PHASE 1 FINAL REPORT

“Patient and family centred care is an approach to planning, delivery and evaluation of

healthcare that is grounded in mutually beneficial partnerships among patients, families

and healthcare providers” (Institute for Family Centred Care, 2004).

Organising the delivery of health care around the needs of patients and families may

seem like a simple and obvious approach but in a system as complex as a health care

organisation, little is simple. Moving any organisational culture to one that is grounded in

the values, behaviours, and approaches of patient and family centred care (PFCC) is an

on-going process, not a one-time event. It is very appropriately called “a journey”. There

is no end-point, but rather a continual evolution toward the goal of creating partnerships

among healthcare practitioners, patients, and families that will lead to achieving the best

outcomes and enhance the quality and safety of healthcare.

AIMS AND OBJECTIVES

Phase 1 of the Excellence through Patient

and Family Centred Care Project (Jan-12 –

Jun-12) aimed to identify best practices and

system changes that will enable the Bay of

Plenty Health Board (BOPDHB) to become

and remain patient and family centered by

bringing the perspectives of patients and

families directly into the planning, delivery

and evaluation of health care and by building

on our existing Health Excellence framework

to improve quality and patient safety.

Increasingly, patients are asking to be

partners in their care. A patient and family-

centred health care system can help achieve

that partnership in a variety of ways. Studies

show that orienting health care around the

preferences and needs of patients has the

potential to improve patients’ satisfaction with

their care, as well as their clinical outcomes

and to reduce both underuse and overuse of

medical services.

BACKGROUND

BOPDHB health professionals are as well intentioned, competent, and dedicated

individuals as others worldwide who believe they provide patient and family centred care

as a matter of course but that assumption often lies at the heart of the problem.

Research has shown that far too often health professionals only see their interactions

with patients and families through their own eyes. The self-assessment of the

organisation indicates that BOPDHB follows overseas trends that show, while care is

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excellent in many ways, it often reflects the needs of providers and does not always

adequately respond to the needs and concerns of patients and their families.

RISK

The public is increasingly concerned about patient safety, medical errors and adverse

events and today’s consumers can obtain information about hospital performance from a

variety of sources. Research by the Picker Institute in 2009 showed that patients want:

Fast access to reliable health advice

Effective treatment delivered by trusted professionals

Participation in decisions and respect for preferences

Clear, comprehensible information and support for self-care

Attention to physical and environmental needs

Emotional support, empathy and respect

Involvement of, and support for family and carers

Continuity of care and smooth transitions.

Hospitals that provide patient and family centred care can reap a number of financial

benefits, including reduced length of stay, lower cost per case, decreased adverse

events, higher employee retention rates, reduced operating costs and decreased

complaints.

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WHAT IS PATIENT AND FAMILY CENTRED CARE

Unlike the traditional system‐centric approach to healthcare, where services are

organised around the needs of the system and those who work in it, Patient and family centred care is about providing respectful, compassionate, culturally responsive care that

meets the needs, values, cultural backgrounds and beliefs, and preferences of patients

and their family members in diverse backgrounds by working collaboratively with them.

PFCC has the following four core concepts developed by the Institute for Patient‐ and

FAMILY‐CENTERED CARE (IPFCC):

The Institute for Patient‐ and Family‐Centered Care (IPFCC) identifies three different

driving forces for the delivery of healthcare services:

System Centred Care - Care that is organized for the system and those that

work in it,

Patient and family Centred Care - The system and care providers try to

incorporate patient needs in their organization and their practices, but it is still

doing “to” and “for” patients

Patient and Family Centred Care - Care that is determined with patients and

their families to meet their needs and wants

In 2011 the Board reviewed BOPDHB values and selected CARE as embodying values

that are important to the BOPDHB, namely:

Recognising that values can be aspirational – we may not be there yet, but it is

something we aspire to achieve – our next step is to embed CARE throughout the

Res

pec

t a

nd

Dig

nit

y

Healthcare providers and staff listen to and honour patient and family perspectives and choices.

Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

Info

rma

tio

n S

ha

rin

g

Healthcare providers and staff communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.

Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision‐making

Pa

rtic

ipa

tio

n

Patients and families are encouraged and supported in participating in care and decision‐making at the level they choose.

Co

lla

bo

rati

on

Patients, families, healthcare providers, staff, and leaders collaborate in policy and program development, implementation and evaluation; in healthcare facility design; in professional education; and in the delivery of care.

Car

e Everyone we come into contact with will feel cared for and respected

Positive culture and environment

Att

itu

de Partnership model

High levels of staff engagement

Positive behavioural modelling

An employer of choice. R

esp

on

sive

ne

ss

Cultural sensitivity and responsiveness

Adaptability

Flexibility Exce

llen

ce

Consistently high achievement

Resource prioritisation

Continuous improvement

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organisation (Arns, 2012). To achieve system‐wide adoption of PFCC, its values and

principles must be embedded as core values in the Bay of Plenty District Health

Board environment and be ingrained in the “fabric” of the entire organisation. This

means that PFCC becomes the binding thread in BOPDHB’s quest for Excellence

and must be incorporated in every activity from health promotion and disease

prevention to end of life care. It must also run through all, human resources policies,

quality improvement initiatives, patient safety initiatives, policies and programs

designed to improve access to care and care coordination.

Excellence

Patient & Family Experience

Patient & Family - staff partnerships, care

transitions

Quality

Best practice - Publicly reported measures - Peer review - Mortality - Organisational

improvement

Safety Regulartory Compliance - Safety Culture - National

Safety Goals - Infection Control

Bay of Plenty District Health Board Patient & Family Centred Care Framework

Compassion

Attitude

Responsiveness

Excellence

Dignity &

Respect

Information

Sharing

Participation

Collaboration

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From this: Organisation focused – work is arranged around the needs of the business

Information is presented from the viewpoint of staff

Any changes made are a result of being reactive to patients demands

Teams do not routinely collect or do much with experience feedback

The focus is on functional aspects of care

Most staff feel that they are not empowered to change things for patients and people are only rewarded for efficiency

There is a silo working culture

Efficiency, productivity and clinical outcomes are considered most important

To this: Patient centred – see the organisation through the lens of people who actually use the services

Information provision is planned with patients and is two way

Service users are part of the decision making process and the organisation can demonstrate that this leads to service improvements

Pathways are mapped to illustrate experience and patient experience data is routinely collected and acted upon

The focus is on relational aspects of care and the emotional side of care is widely recognised

Staff experience is aligned to patient experience and people are rewarded for providing a positive patient experience

Work is based around the patient journey, providing more consistent / integrated care

There is a positive learning approach to complaints handling and complaints and compliments are shared widely

Patients are supported to be partners in their care and share decisions

Bay of Plenty District Health Board Patient & Family Centred Care

Recommendations

Recom

mendations

Leadership

Understanding

Concepts & Values

Remove Barriers

Provide Resources

Set Targets

Patient, Family & Consumer Engagement

Stakeholder Analysis Communication Plan

Consumer Engagement

Patient Advisory Group

Patient Advisor Roles

Evidence Based Co-design

Education - Staff & Patient Advisors

Training

Orientation

Culture of Excellence

Dedicated Resource

Recognise & Celebrate successes

Professional Standards

Policies & protocols

Performance measurement

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RECOMMENDATIONS

1. LEADERSHIP:

The role of leadership is critical for transforming the culture of an organization.

Inadequate or inappropriate leadership has been identified as a key factor for the failure

of cultural transformation (Scott et al, 2003).

To create a strong leadership commitment to PFCC, it is important for BOPDHB Senior Leaders to:

Understand first what PFCC is and what it means to their consumers, patients and families who are the users of their BOPDHB service;

Incorporate PFCC concepts and values into BOPDHB’s services and communicate them frequently with staff;

Remove barriers that may prevent staff and other providers from adopting PFCC;

Provide adequate resources and support for adopting PFCC;

Set targets for adopting PFCC and hold staff and other providers accountable in meeting these targets.

2. PATIENT, FAMILY AND COMMUNITY ENGAGEMENT:

The most important element of PFCC is the development of true collaborative

partnership that is based on mutual respect among healthcare policymakers and

providers, and patients, families and communities.

These partnerships can occur across the care continuum from primary health care to

acute care, rehabilitation services, long‐term care, home care and palliative care. To

engage patients and families at any point of the care continuum, BOPDHB will need to

encourage patients and families to participate in shared decision making about their own

care at the level they choose, however some patients and families may choose not to

engage in decision‐making and may still want their care providers to make decisions on

their behalf and / or to recommend a course of actions.

To fully embed the core concepts of PFCC it is recommended that BOPDHB:

Complete full stakeholder analysis, establish communication

networks and develop on-going communication plan with status

reports to all key stakeholders.

Continue investigation of opportunities to collect consumer feedback

to evaluate patient satisfaction results based on the Capturing

Consumer Experience evaluation strategies.

Recruit Patient Advisors and establish BOPDHB Patient Advisory

Group including Terms of Reference, process, orientation and

training.

Develop a process and facilitate on how to engage and support

patients/consumers, families and health care providers in working

together to integrate patient and family centred care initiatives within

and throughout the organisation e.g. email survey groups, linking

with project groups, establishing process for appointing Patient

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Advisor to sit on other organisational committees.

Support staff / Wards / departments and services in experience

based co-design

Experience-based co-design (EBCD) is an approach that enables staff and patients (or

other service users) to co-design services and/or care pathways, together in partnership.

The approach is different to other service improvement techniques. The approach was

developed within and for the NHS, although similar ‘user-centric design’ techniques have

been used by leading global companies for years (The King’s Fund, 2012).

3. COMMUNICATION:

Having a common, shared understanding of PFCC among all healthcare providers,

staff, patients and families will be critical for successful adoption of PFCC. This may

only be achieved through effective communication.

Develop a communication plan to ensure that all project

stakeholders are informed about the project in a way that they find

attractive and appropriate according to their role and interest in the

project.

Develop a strategy to communicate the results with staff and a way

to celebrate the successes.

4. EDUCATION:

Education and training are key elements for any successful cultural transformation. To

ensure that all staff at all levels of care have the same shared understanding of PFCC, it

is important to provide staff with education and training opportunities, supports, and

tools.

For sustainability of PFCC, it is recommended that education be an integral part of this cultural transformation. Effective ways to educate BOPDHB healthcare professionals may include:

Provide PFCC training workshops and introduce and support the

process of experience based co-design;

Incorporating PFCC values, principles and skills and engaging

patients and families into all training, orientation and education

processes for new and existing staff;

Develop and provide comprehensive orientation, training and

support programme for Volunteer patient Advisors.

5. CREATING A CULTURE OF EXCELLENCE THAT SUPPORTS

PFCC

Patient and family centred healthcare organisations do not only strive to meet the full

range of patient and family needs, but also those of staff by creating a healthy,

supportive work environment where they feel empowered to deliver quality of care based

on PFCC values and principles and where their efforts and dedication to putting patients

and families first are recognised and rewarded. Successful day‐to‐day implementation

and sustainability of PFCC requires the dedicated focus of an individual champion at the

operational level (Frampton et al, 2009).

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To create this PFCC work environment, it is recommended that the BOPDHB:

Create and appoint to a position that will take a key leadership role

in improving the experience of patients, families and staff who will

serve as a catalyst for a Patient and Family Centered culture while

supporting the organization s values (CARE – Compassion, Attitude

Responsiveness and Excellence).

Engage staff at all levels, in the process of adopting PFCC;

Empower staff to provide PFCC in their own practice;

Recognise and acknowledge the efforts and dedication made by

staff in putting patients and families at the centre of care;

Incorporate PFCC principles and standards into human resource

policies (e.g. recruiting, hiring, orientation, training, assessing

performance, etc.)

Review ‘Shared Expectations’ to reflect the expected professional,

care performance, customer service and patient and family centred

care standards.

Ensure that patients’ and families’ perspectives are reflected in

policies, protocols and other initiatives.

6. PERFORMANCE MEASUREMENT AND MONITORING

PROGRESS:

Performance measurement and reporting on progress toward short and long‐term goals

are key elements for achieving sustainable cultural transformation.

In order to measure impact or outcomes of PFCC, BOPDHB may need to develop a performance measurement framework that includes desired outcomes and indicators:

Develop a reporting system to track progress on a regular basis.

Repeat the Organisational Self-Assessment as recommended in

November 2012.

7. WHERE TO NEXT?

Care Improvement Opportunities (CIOs) are the identification of processes for improving,

advancing, promoting or growing desirable qualities to progress toward what is better.

The Organisational Workshops held in May 2012, identified several care improvement

opportunities.

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It is recommended that BOPDHB prioritise and develop an action plan to progress on the care improvement opportunities as identified in the organisational self-assessment:

Food options are available to meet the preferences of different

ethnic groups

Patients can easily find their way from the parking areas to their

destination.

Family” is defined by the patient and are not viewed as “visitors”.

Patients and families are encouraged to participate in ward rounds,

shift handover, multidisciplinary meetings and discharge planning

from the beginning of hospitalisation.

Patients can set their own daily goals for what they would like to

accomplish each day.

Processes are in place to reinforce and assess comprehension of

information and instructions provided at discharge.

A patient and family advisory council meets regularly and actively

provides input to organisational operations and strategic direction.

Visiting is flexible and patient-directed. (Exceptions may exist)

SUMMARY

Patient and family centred care is not a new approach and there are pockets of

excellence in providing PFCC throughout the BOPDHB. PFCC is not just “nice things to

do”, but is “essential” for improving the experience of patients and families and their

health outcomes; improving staff satisfaction; and reducing the costs.

Patient and family centred care is not a “thing” that can be implemented within a short

time period, but is about changing the mind set of healthcare providers and staff from the

traditional medical centric model to an approach that focuses on providing

compassionate, respectful care that is responsive to the needs, values, beliefs, and

cultural backgrounds of patients and families through creating collaborative partnerships.

Achieving this cultural transformation within the BOPDHB will take time and will require a

system wide buy‐in and commitment.

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REFERENCES

1. Arns, J. (2012, May). Growing CARE. Check Up, p15.

2. Australian Commission on Safety and Quality in Health Care (2011), Patient centred

care: Improving quality and safety through partnerships with patients and consumers,

ACSQHC, Sydney.

3. Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and

Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper.

Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available

on www.IHI.org)

4. Boyd H, McKernon S, Old A. 2010. Health Service Co-design: working with patients

to improve healthcare services. Auckland: Waitemata District Health Board.

(Available on www.healthcodesign.org.nz)

5. Charmel, P, & Frampton, S. (2008, March). Building the business case for patient

centred care. Healthcare Financial Management, 80-85. Retrieved December 15,

2011

6. Conway, J et al. Institute for Healthcare Improvement and Institute for Family-

Centred Care. (2006). A Roadmap for the Future. In Partnering with Patients and

Families to Design a Patient- and Family-Centred Health Care System. Bethesda,

MD: Institute for Family-Centred Care.

7. Frampton, S et al. (2008). Improvement Guide. In Patient-Centred Care. Derby, CT:

Picker Institute and Planetree. Retrieved December 14, 2011

8. Institute for Patient and Family Centered Care. Strategies for leadership. In

Advancing the practice of Patient and Family Centered Care. Retrieved December 2,

2011

9. Johnson, B. et al. (2008). Recommendations and Promising Practices. In Partnering

with Patients and Familes to Design a Patient and Family Centred Health care

System. Bethesda, MD: Institute for Family-Centred Care. Retrieved December 14,

2011

10. Ministry of Health. 2000. The New Zealand Health Strategy. Wellington, New

Zealand: Ministry of Health.

11. Ministry of Health. 2002. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health

12. Ministry of Health. 2011. Whānau Ora: Transforming our futures. Wellington: Ministry of Health.

13. National Quality & Risk Managers. (2011). Draft - How to Guide: Capture the

Consumer Experience. Wellington, New Zealand: Health Quality & Safety

Commission.

14. National Research Council. 1st Annual Crossing the Quality Chasm Summit: A Focus

on Communities. Washington, DC: The National Academies Press, 2004.

15. Planetree. (2009). White paper. In Patients as Experts, Patients as Partners:

Integrating the Patient and Family Voice into Hospital Operations: Author. Retrieved

December 14, 2011, from www.planetree.org

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16. Shaller, D. (2007). Revised report for joint publication by Picker Institute and the

Commonwealth Fund. In Patient-Centred Care: What Does It Take. Stillwater, MN:

Shaller Consulting. Retrieved December 10, 2011, from

http://cgp.pickerinstitute.org/wp-content/uploads/2010/12/shaller.pdf

17. The Joint Commission: Advancing Effective Communication, Cultural Competence,

and Patient- and Family-Centred Care: A Roadmap for Hospitals. Oakbrook Terrace,

IL: The Joint Commission, 2010.

18. The NHS Improvement Plan. (2004). In Putting People at the Heart of Public

Services. London, England: HM Government. Retrieved December 8, 2011, from

http://www.dh.gov.uk/

Websites:

19. The Picker Institute - http://pickerinstitute.org/

20. Planetree - www.planetree.org/

21. The Institute for Patient- and Family-Centred Care - www.ipfcc.org/

22. The Schwartz Center - www.theschwartzcenter.org/

23. The King’s Fund - www.kingsfund.org.uk/

24. Institute for Healthcare Improvement - www.ihi.org/

25. World Health Organization - www.who.int/

26. The Health and Disability Commissioner Office – www.hdc.org

27. New Zealand Ministry of Health - http://www.moh.govt.nz

28. NHS Institute for Innovation and Improvement - http://www.institute.nhs.uk/