introductory training presentation july 2010 - hse.ie€¦ · introductory training presentation...

Improving the service user experience

Introductory Training Presentation

July 2010

• Definition of terms

• Context

• Why focus on the service user experience?

• How to improve the service user experience?

• Breakout session

• Five steps

• Joint Community Participation in Community Care Initiative

• Discussion

Overview

Definition of terms

Service user

• People who use health and social care services as patients

• Carers, parents and guardians

• Organisations and communities that represent the interests of people who use health and social care services

• Members of the public and communities who are potential users of health services and social care interventions

Involvement

‘A process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change’

(HeBE 2002)

Context

National Strategy for Service User Involvement in the Irish Health Service

Seven goals of the Strategy

1. Commitment and leadership2. A systematic approach to effective service user

involvement3. Service user involvement in their own care4. A service users charter5. Specific work will ensure the involvement of children,

young people and socially excluded groups6. Develop existing service user structures7. Performance and development

Building a Culture of Patient Safety

Report of the Commission on Patient Safety and Quality Assurance

• service user/carer and service user participation (11 recommendations)

• Knowledgeable service users (4 recommendations)

• Open communication with service users following an adverse event (10 recommendations)

Named Lead Person

• Liaise with service users and work with staff in the organisation to co-ordinate service user involvement activities and feedback

• Work at a high level and be in a position to influence management and clinical leaders in the organisation.

• Feedback and evidence from service user involvement activities should be channelled to the management team through the named lead person and the clinical governance committee

Encourage & support service user involvement in the organisation

Make recommendations for service improvement

Feedback from Clinical Governance Committee to service users and staff

Decide if recommendations are to be progressed

Identify service user safety & healthcare quality issuesLink with Clinical Governance Committee

Review recommendationsReview evidenceCo-ordinate evidence

Management TeamNamed lead person Clinical Governance Committee

Integrated Framework for Quality, Safety and Risk

Management

HIQA

DoHC

MHC

Other

National overview of self-assessment results

• Between January and April 2010, the 50 publicly funded acute hospitals were requested to self-assess performance against the thirteen elements of the Framework.

• Hospitals achieved the lowest scores in the following four elements:

• 1. service user/service user and public/community involvement—51% (element H)

• 2. Outcomes—54% (element M)• 3. Communication and consultation with key stakeholders—55%

(element A)• 4. Clinical effectiveness and audit—56% (element G)

National Guidance

StaffService user panelsAdvocacyService user surveys

Other methods, focus groups, etc

Review of incidents and clinical audit results

Your Service , Your Say The HSE Complaints Process

Framework self-assessment

Using the evidence in your organisation to improve the safety and quality of healthcare services

Framework for involvement – 5 levels

Service user & family


• This level is about the service user and, if appropriate, their carer(s), being actively involved in their own care and treatment

• It refers to strategies for engaging service users in their own healthcare, including techniques for personalisingcare packages and offering service users more choice.


Service user involvement at this level

Service users can play a distinct role in their own healthcare by:– understanding the causes of disease and the factors that influence

health – adopting healthy behaviours to prevent disease.– diagnosing their own conditions and treating the minor ones – knowing when to seek advice and professional help – choosing an appropriate healthcare provider – selecting the most appropriate form of treatment for acute conditions

in partnership with healthcare professionals – managing treatments and taking medications appropriately – monitoring symptoms and treatment effects – being aware of safety issues and reporting them – learning to manage the symptoms of chronic disease


Individual staff member

• The most immediate level of experience for service users and families. The capacity of individual staff members to respond sensitively to service users is always at risk for a number of reasons

• Clinical and administrative staff must categorise events that are unique, profoundly significant and personal to the service user, and turn them into…this type of problem/this procedure

• Natural human defences used to cope with daily contact with strangers who are sick, suffering, in pain or dying, create working practices that protect the staff but are insensitive to the service users.

• All formal clinical and care settings have the potential to de-personalise and de-humanise care giving

Team, department, ward, service

• In general, people who work in hospitals/LHOs/PCTs belong to at least 2 different teams – their peers and the multi-disciplinary team

• This level is about staff working in healthcare organisations developing and providing information, care and treatment to service users at team, unit or department level

• Team leaders and heads of department must pay attention to attitudes and values that may depersonalise contact with service users

• Positive reinforcement and support for nurses and care-givers is required to sustain the hard emotional work of continuously caring for people who are suffering

Healthcare organisation

• The actions and words of senior healthcare organisation leaders have a profound influence on what happens to service users

• They shape the culture of the organisation, the priorities of managers and staff, how they behave, towards each other and towards service users and families and how staff feel about services they provide and about the organisation

Wider healthcare system

• Healthcare organisation strategies and plans are directly affected by national HSE priorities, the actions of healthcare regulators, the actions of performance managers in the wider system and financial rules and regulations.

Why focus on the service user experience?

Service user experience –totality of events and

interactions that occur in the course of episodes of care and the meaning they have for that person at that particular moment in their

life…

Seeing the person in the service user

• Most people access healthcare services at some point in their lives; most are born and die in hospital and it is very important to protect and look after people when they are acutely ill

• Healthcare staff identify strongly with the idea that they should care for service users in the way they would want a member of their own family to be treated

We know that…

• Sharing treatment decisions with service users can lead to better decisions and better, more cost-effective outcomes

• It can improve safety and reduce claims and litigation

Value for money…

• Engaging service users in their healthcare and encouraging people to take responsibility for protecting their health are seen as the best way to ensure the sustainability of health systems and keep future health spending within manageable limits

• Improving the service user experience…justified clinically and therefore in terms of value for money

– Anxiety and fear delay healing

– Good communication with service users contributes positively to well-being and hastens recovery

– Good communication enhances effective self-management

– Staff retention and recruitment

Seeing the person in the service user

How to improve the service user experience?

Quality Improvement

An integrated, corporately led programme of organisational change, designed to engender and sustain a culture…based on customer oriented definitions of quality

Kogan et al 1994

Follow upRecognise good practice

InvestigateReport findings

Facilitate learning

StandardsIndicators

Assess complianceBenchmarking

Analyse concerns

Steps in the CQI process

Constant Dynamic of

Improvement

Drive change

Define

Monitor

Values

Engagement

Unspoken assumptions

Beliefs

Behaviors

Structures

Systems

Processes

OUTCOMEOBJECTIVE

CULTURE

The gross failures in service safety & quality that have been subject to investigation are invariably associated with organisational culture and decision making processes

Healthcare Commission

The iceberg of culture

BEHAVIOR

BELIEFS

VALUES

• Culture is based on the organisational values & beliefsthat provide direction to what people do each day

• Culture – the way we do it around here

• Culture is manifested all around the organisation in performance measures, the language people adopt, and the behaviours that people demonstrate

Culture

• Values are the deeply seated underpinnings that influence individual and organisational behaviour every day

Values

Improving the service users experience flows from a shared

culture, as well as from structures, systems and

processes

1. Create – and communicate - the right vision

2. Articulate the core value(s)

3. Leadership – live the value(s)

4. Reshape (and clarify) your performance measures

5. Create structures to support the culture

6. Create supportive people practices

7. Drive culture from the top down and the bottom up

How to change the things that shape culture?

Lasting success

• Changes initiated in unsupportive cultural environments tend to last less than one year

• In contrast, changes that are supported by the culture are likely to stick

• The desire to attempt change and the likelihood of long-term success are positively related to cultural support

• The culture influences our choices and determines the effectiveness of our individual initiatives. Almost invariably, the long-term individual solution must also be a cultural solution

Core Value

“We will ensure that the service user is central to their own care and to the design and delivery of health and personal social services.”

Core value in detail• Access: Our services are organised to ensure equity of access to public health

care • Respect: We treat service users with respect, dignity and consideration during

provision of care that is respectful of culture, beliefs and values in line with clinical decision making

• Safety: Our services are provided with professional care, skill and• competence in a safe environment• Communication: We communicate clearly with the service user throughout the

period of care • Information: We will provide access to understandable information to empower

patients to participate in their own care • Participation: We involve service users in decision making about care, including• informed consent, prior to any procedure with discussion of the options available• Privacy: We maintain strict confidentiality of personal health and other information

gathered from service users• Being Heard: We facilitate service users to comment on care, to make a complaint

and to have their concerns addressed• Prevention: We provide information to service users on how to take care of

yourself and how to promote and protect your health and prevent the spread of infection

Breakout session

5 Steps

1. Establish the current position

2. Identify areas for improvement

3. Develop plans for continuous quality improvement

4. Implement

5. Evaluate

5 steps “Involving Service Users –Community Care Services”

Establish the current position

IndividualMy say in decisions about care and treatment

CollectiveOur say in planning, design and delivery of services

Information

Feedback

Influence

A conceptual framework for involvement

Information Feedback Influence


Information to patients about treatments (comms)

e.g. complaints/ surveys e.g. Expert patient; advocacy


Information to citizens about services (comms)

e.g. patient experience data (surveys, focus groups); consultation; Trends in complaints data;

Representation and involvement in decision making

OUTCOMES OUTCOMES OUTCOMES


• Effective treatment from professionals you can trust• Fast access to advice, treatment and care• Clear, comprehensible information• Participation in decisions and respect for preferences• Support for self-care/self-management• Attention to environmental and physical needs• Safe care, free from avoidable risks• Emotional support, empathy, and respect• Involvement of, and support for, family• Continuity of care and smooth transitions between services

What do service users want?Quality from the service user’s perspective

• Affordable treatment and careSafety and qualityHealth protection and disease preventionAccessible local servicesUniversal coverage: geographical and social equityResponsiveness, flexibility and choiceParticipation in service developmentsTransparency, accountability, and influence

What do citizens want?Quality from the citizen’s perspective

• Many patients would like more involvement in treatment decisions, BUT the desire to be actively involved tends to diminish when conditions are more serious

• HOWEVER most patients want to be involved in their own care and they need information, education, involvement in treatment decisions and care planning

• Many citizens say they want to be involved in decisions about services, BUT this desire diminishes as the decisions get more complex

• People are more likely to get involved if they are dissatisfied with healthcare provision or plans for reconfiguration, BUT in general most people overstate their willingness to get actively involved only a small proportion turn up when invited…….

The participation paradox

• Responding to surveys about their experiences• Joining committees and public bodies as lay reps• Becoming members of forums / teams, Working as part of healthcare

teams to carry out health care audit • Giving their views on priorities and proposed service changes• Identifying health needs • Working with staff and others to improve services• Joining local patient organisations• Getting involved in service provider voluntary organisations• Supporting community development initiatives• Campaigning for better health and care• Supporting public health initiatives.• Working as advocates

Groups of service users/citizens can get involved by……

Type of involvement that most service users want

Seeking help for a specific healthcare problemAdvice from professionals• – Good communicators• – Up-to-date clinical knowledge and skills• – Expect views and preferences to be taken into account• – Given reliable information about condition and treatment options

Assistance to help themselves• Only a small minority want to sit on policy committees or be

consulted about service developments

Planning services from the user point of view

Involve the public in the planning of healthcare as they are users or potential users and services will be better

If policy makers take into account the user point of view….”only the wearer of the shoe knows where it pinches”

• There is seldom one user viewpoint• Competing perspectives• Common decisions have to be made for different people• Users – potentially everyone• Importance of gathering feedback from representative sample of service

users, therefore need to be clear about who are stakeholders are and use appropriate methods of gathering feedback from all

Current Position

How are service users currently involved? • How do we involve people at an individual level? • How do we involve service users collectively?

• Define who needs to be involved & likely to be affected –identify stakeholders • Agree on the purpose for involvement, Agree on methodologies for involvement

• Identifying needs• What’s important to patients who use our services?

– What do service users say about their experience of community services in Ireland – What evidence already exists

Identify areas for improvement

• Understand the current problems in care delivery • Inform continuous improvement • Help professionals reflect on their own and their teams

performance • Monitor the impact of changes • Facilitate benchmarking • Inform referring clinicians about the quality of services • Help service users choose high quality providers • Enable public accountability • The Journey –measuring the patients experience

Purpose of measurement - gathering evidence on the service users' experience of services

What is the difference?• Satisfaction levels related to age, education level, outcome etc. • Information on the service users' experience points to what

needs to improve and seeks information on what actually happened as opposed to the patents' perception of what happened

• 2011 surveys should measure values set out in the national charter / guide – Bank of questions need to be designed – Tool adapted for different services, maternity, cancer, paediatric – Measures expectations and responsibilities

• One overall question on satisfaction is sufficient

Focus on the service users' experience not on satisfaction

Using patient feedback

• Gather patient feedback is a limited exercise unless something constructive is done with the findings to bring about improvements.

• Having analysed your results, you then • need to decide what to do with them and

where to focus your efforts.

• Excellent resource:• ‘Using patient feedback’

www.pickereurope.org

Develop plans for continuous quality

improvement

Develop plans for continuous quality improvement

1. What is the evidence telling us? • Understand your findings • Agree the main priorities for improvement• Choose areas that show clear potential for improvement

2. Consider the appropriate interventions • Find solutions in partnership with staff and service users• Write QIPs to include all levels• Must consider how to transform organisational culture Servic

e user &

family

QIPs

Identify:• Issue• Interventions/actions• Responsible persons• Timescales• How and when progress will be measured and reported

Service user focused interventions

Service user focused

interventions

Improving health literacy

Improving clinical decision making

Self management

and preventionImproving service

user safety

Improving access to services, signage and

physical access

Improving the care experience

Improving service development

service user participation groups

and forumsservice user surveys

Improving physical access to all

services

Communication skills for health professionals

Written information

Low literacy initiatives

Help lines / information lines

Alternative format resources

Access to medical library resources

Coaching and question prompts for

service users and carers

service user decision aids

service user charter

Self management education

Self monitoring and self treatment

Self help groups and peer support

service user access to personal medical

information

service user centred telecare

Infection control att to physical environ

needs

Adherence to treatment regimes

service user reporting of adverse

drug events

Equipping service users for safer

health care

Preventing wrong site surgery

Improving information on how to access services

Walk in centres

Improved community services

Choice of providers, services, options,

appointments

Advocacy services

Emotional support, empathy and respect

Complaints policy

Consultative and deliberative methods

Lay representation on medical and

professional bodies

Residential committees

Improving health literacy• 80% internet searching relates to health issues • 4 out of five people who read consumer created

content change their behaviour • Health literacy-competencies encompassed

– Basic health knowledge – Reading, comprehending and evaluating health information – Application to health behaviour – Verbal communication with professionals – Health decision making – Advocacy and activism

• Three levels –Functional literacy, Interactive literacy, Critical literacy (inverse information law)

Written information





What do patients want to know? Patient of the future –predictable, preventative, participatory and

personal• Understand what is wrong • Gain a realistic idea of the prognosis • Make the most of consultations • Understand the processes and the likely outcomes of tests and

treatments • Assist in self-care• Learn about available services and sources of help • Provide reassurance and help to cope • Help others understand • Legitimise seeking help and their concerns • Learn how to prevent further illness • Identify further information and self-help groups • Identify the best healthcare providers

Improving health literacy – what works

• Service users want information that is useful to them – that is appropriate, timely, relevant and accessible

• Personalised information has most impact• Future for marketing health –head of Microsoft

Health John Coultard • Combining written and verbal information works

best of all• Objectives of health literacy

– 1) empower patients (participative methodology) – 2) appropriate use of services – 3) reduce health inequalities

Written information





Improving clinical decision making• Shared decision making, informed decision making, not

widely practiced

• Not being properly told about illness and the options for treatment is the most common cause of service user dissatisfaction

• Most service users want more information and a greater share in the process of making decisions about how they will be treated

• What is important is that the healthcare professional should not make assumptions


Coaching and question prompts for service users

and carers



Improving clinical decision making – what works

• Communication skills training for clinicians

• Coaching and question prompts for service users

• Service user decision aids


Coaching and question prompts for service users

and carers


service user charts

CHARTER/ GUIDE

• Is designed to support a healthcare culture that delivers services in a predictable[1], preventative[2], personal and participatory way;

• Is based on the understanding that there are different roles andresponsibilities for both service users and healthcare providers;

• promotes the importance of patients as partners in their own care and that they have the knowledge and expertise that is essentialto their care

• promotes the importance of patients’ as individuals with diverse needs not a medical condition to be treated

A National CHARTER / GUIDE the HSE and You

• The set of common principles presented below form the basis of this document.

1. Access: equity of access to public health care 2. Respect: respect dignity and consideration 3. Safety: promoting safe and competent care 4. Communication: communicating clearly throughout the period of

care 5. Information: access to understandable information is essential

to empower patients to participate in their own care 6. Participation: informed decision making and informed choices7. Privacy: ensuring that personal information is secure 8. Being Heard: commenting on care and having concerns

addressed9. Prevention: information on how to take care of yourself and how

to maintain and protect your health and the prevent the spread of infection health

Improving self management and prevention• Self care consists of day to day management of long term and

chronic illnesses and accounts for up to 85% of healthcare– 80% GP consultations – 60% acute hospital bed admission – 66% ED admissions

• Growing caseload – major challenge for health service

• Professional’s role is to encourage, facilitate and support service users to look after themselves safely and confidently




service user access to personal

medical information


Improving self management & prevention – what works• Conflicting evidence in relation to the effectiveness of

strategies, – Providing people with information is insufficient

• Discerning population/adult education techniques, knowledge hungry society

– Engaging / empowering techniques integral, assess peoples readiness to change and their value systems

• Questioning our own value system and health behaviour • Generic education programmes, motivational

interviewing techniques, confidence building promoting self-efficacy,

• More effective where they are combined with the service ser getting reg lar re ie s ith a healthcare




service user access to personal

medical information


Improving service user safety

• Involving service users in improving safety requires conscious communication strategies and the creation of mechanisms for service users to report safety issues

• If service users understanding of health topics is poor it can endanger their safety

• Service users want more openness about and disclosure of medical errors

Infection control att to physical environ needs


service user reporting of

adverse drug events


health care


Improving service user safety – what works

• Service user involvement in infection campaigns

• Simplifying dosing regimes

• More user-friendly information about medicines

• Service users reporting adverse drug side-effects to drug safety agencies

• Service user access to their healthcare records

Infection control att to physical environ needs


service user reporting of

adverse drug events


health care


Patients roles in the safety of their care and in the promotion of safety

• Making informed choices about providers • Helping to reach an accurate diagnosis • Sharing decisions about treatments and procedures • Contributing to safe medication use • Participating in infection control initiatives• Checking the accuracy of medical records • Identifying and reporting treatment complications and

adverse events • Practicing effective self-management • Shaping the design, delivery and evaluation of services

Improving access

• Access = availability of services, right ‘fit’, physical accessibility and issues of equity– Having access– Gaining access

• Particular problems – people living in rural areas, members of ethnic minority groups, homeless people, prisoners and asylum seekers

• Initiatives to improve access – address the overall supply of services or the reduction of inequalities


services


Walk in centres

Improved community

services

Improving access – what works

• Access / sign posting internally • Target waiting times • More convenient access to health advice

– Walk-in centres– 24 hour advice and information phone service– Remote tele-consultation – Specialist outreach clinics


services


Walk in centres

Improved community

services


• What service users say about services provides valuable information for anyone designing or seeking to improve healthcare

• Complaints, choice and service user feedback together make a considerable volume of ‘service user’ focused information available to service providers

service user surveys

Choice of providers, services,

options, appointments

Advocacy services


Complaints policy

Improving the care experience – what works

• Service user experience surveys – can be used to prompt service improvement and measure its progress over time

• National surveys results can trigger national action. Surveys can benchmark progress against national policies or targets

• Making complaints – can be complex and time-consuming




Advocacy services


Complaints policy

Improving the care experience – what works

• Advocacy services are proven to help marginalised groups

• If service users are given a choice and can ‘vote with their feet’ by choosing/changing provider, it will provide incentives for providers to improve their services

• Service users say there is a gap between the performance information they need and what is available. Little is yet known about what information might best help service users choose providers




Advocacy services


Complaints policy


• There is a wide spectrum of possible involvement mechanisms from information giving, through formal consultation to full user control

• Recruiting people to be actively involved is often difficult

• Public scepticism about the validity and likely impact of consultations, and peoples lack of confidence in their knowledge and ability

service user participation

groups and forums

Consultative and deliberative

methods


professional bodies


Improving service development – what works

• People generally like being involved…

• Citizens juries can be an effective method of involvement – gives the public a clear role, time and support to make considered decisions

• Need to allow those decisions to have a clear impact on services

service user participation

groups and forums

Consultative and deliberative

methods


professional bodies


Be clear about what involvement means• Have a shared understanding of definitions and purpose• Ensure adequate resources - money, time and people

Focus on improvement• Demonstrate change as a result of engagement• Embed systems linking decision-making to impact• Ensure senior commitment and leadership • Support staff and equip them with the necessary skills

Be clear about why you are involving people• Clarify objectives & links to organisational priorities• Explain what can change & what is not negotiable• Use what is already known about people’s perspectives

Effective involvement

Effective involvement

Identify and understand your stakeholders• Define who needs to be involved & likely to be affected • Ensure activities are relevant to stakeholders’ interests

Involving people• Ensure that methods suit the purpose of engagement• Make special efforts to include seldom heard groups• Be clear how views will feed into decision-making • Provide feedback about action you intend to take • Ensure people have support to get involved

Summary

Named Lead Person

Named Lead Person

• Liaise with service users and work with staff in the organisation to co-ordinate service user involvement activities and feedback

• Work at a high level and be in a position to influence management and clinical leaders in the organisation.

• Feedback and evidence from service user involvement activities should be channelled to the management team through the named lead person and the clinical governance committee

Information sessions

Information sessions

• Staff who attended the training workshops on ‘improving the service user experience’ should organise an information session with the management team and present a summary of the next steps for the hospital

• Staff who attended the training workshops should meet with each section (team/department/ward/service area/management team, etc) head and present a summary of the next steps for each section (including any training/information necessary for the section head to progress improvements in this area)

Establish the current position

Establish the areas for improvement

• How are service users currently involved (information/feedback/influence)?

• How do we involve people at an individual level?

• How do we involve service users collectively?



Information

Feedback

Influence


Information Feedback Influence


Information to patients about treatments (comms)

e.g. complaints/ surveys e.g. Expert patient; advocacy


Information to citizens about services (comms)

e.g. patient experience data (surveys, focus groups); consultation; Trends in complaints data;

Representation and involvement in decision making

OUTCOMES OUTCOMES OUTCOMES



• Co-ordinate the evidence

• Understand your feedback

• Core values exercise

• Identify your priorities

Core Value

“We will ensure that the service user is central to their own care and to the design and delivery of health and personal social services.”

THE HSE AND YOU

What service users can expectfrom the HSE and what the

HSE can expect from service users

“People Caring for People”

Consultation

1. Access2. Respect3. Safety4. Communication5. Information6. Participation7. Privacy8. Being Heard9. Prevention

Nine principles to support the core value

Exercise

• Nine components to the core value of ensuring that the service user is central to their own care and to the design and delivery of health and personal social services

• All nine must be addressed by each section team/department/ward/service area/management team, etc) during the 12 month period from July 2010 to July 2011.

Develop plans for continuous quality

improvement

Develop plans for continuous quality improvement

• Use service user focused interventions

• Consider structures, systems, processes and culture

• Consider the 5 levels

• Review performance targets

Service user focused

interventions

Improving health literacy

Improving clinical decision making

Self management

and preventionImproving service

user safety

Improving access to services, signage and

physical access



service user participation groups

and forumsservice user surveys


services


Written information





Coaching and question prompts for

service users and carers






service user access to personal medical

information


Infection control att to physical environ

needs


service user reporting of adverse

drug events


health care



Walk in centres

Improved community services

Choice of providers, services, options,

appointments

Advocacy services


Complaints policy

Consultative and deliberative methods


professional bodies


The iceberg of culture

BEHAVIOR

BELIEFS

VALUES

Framework for involvement – 5 levels


Breakout session

Ongoing Support –Working Together

• Regional Workshops scheduled in 2010• HSE Web-site • Ongoing support provided by phone and e-mail • Library of resources and best practice guidelines

sourced and directed to staff who require same • E-learning programme in the process of being

developed

Contact details

• June Boulger • Advocacy unit• [email protected]• 086-8069829

• Wini Ryan • Quality and Clinical Care

Directorate• [email protected]• 0876297028

Thank You

introductory training presentation july 2010 - hse.ie€¦ · introductory training presentation...

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