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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
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
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/