rudimental or rudimentary – sharing power in healthcare ...€¦ · presented by: tracey johnson...
TRANSCRIPT
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Presented by:Tracey JohnsonWalid Jammal
Rudimental or Rudimentary – Sharing Power in Healthcare?
The patient management dilemma
8755 hours patients are left to their own devices
5 hours with their doctor or nurse
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Project management insightsTime
Scope Cost
QUALITY
Delivering for patients
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New delivery for patients
• What are your strengths in the job?• What are the areas in which you feel lacking?• What tasks do you want to keep? • What would you like to give up?
It’s all about getting the “best” rather than the “most” out of people Not
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Practice Transformation Steps
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Active?
What is the average waiting time in your practice?
What is the average time spent waiting for instructions?
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Top of ability
A Medical Home partners with patients, carers and family to ensure cultural preferences and values are respected. Patients receive the education and support they need for shared decision making and to manage their own conditions to the extent they are able. Patients have the opportunity to participate in the care design of the medical home.
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Your assessment (1‐5 where 5 is excellent)• We partner with patients, carers & families in care coordination
• Cultural awareness training informs our approach
• Enabling of patient self‐management through education
• Engagement of patients using shared decision making tools
• Monitoring of patient outcomes and self‐management
• We coach patients to support self‐management & access to services
• Patients are formally involved in co‐design
• Patients are involved in practice decision making
Collaborative care
• What titles do you use?• What can patients ask?
What is my diagnosis? What are my treatment options?What are the benefits of each option? What are theside effects? Will I need a test? What is the test for?What will the results tell me? What will the medicineyou are prescribing do? How do I take it? Are there anyside effects? Why do I need surgery? Are there otherways to treat my condition? How often do you performthis surgery? Do I need to change my daily routine?
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Shared decision making
Choice Talk
Option Talk
Decision Talk Decision
Initial Preferences
Informed Preferences
Receptionists as care team
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“TED” = understanding perspective
• “Tell me more about what this job means to you and what a great day looks like”
• “Explain to me what you mean by….”• “Describe what you would want to do if….”
• “So how did you feel when …?”
Empowerment brings joy...with half an hour of preplanning I filled up my next day and achieved lots of good preventative care. I went home really happy and felt that I achieved something" Farrah‐RN, April 2018
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Empowerment Processes
“I care for my patients…”
Shared “medical” appointments
• Programmed over two to eight months• Run by a facilitator (often a nurse or allied health)• The patient’s GP conducts sequential consults
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Situational leadership
Empowerment is safe• Freedom • Discipline• Community• Shared purpose
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Team Leader work
Vision Energises
Living Example
Coach
Analysis
Barriers Busted
Facilitator
Results Catalyst
Leadership Skills Training by The Fisher Group Inc1999
Work teams vs traditional organisationsSelf‐directed work teams
• Patient focussed
• Multi‐skilled work force
• Information shared widely
• Shared goals
• Purpose & achievement oriented
• Highly committed
• Continuously improving
• Self‐controlled
• Values based
Kimball & Fisher 2000 Leading Self‐Directed Work Teams
Hierarchical organisations
• Rules & management driven
• Isolated specialists
• Information protected
• Segregated goals
• Problem solving emphasis
• High management commitment
• Incremental change
• Management controlled
• Policy/procedure based
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4 P’s of Communicating
• Purpose• Picture• Plan• Part
Delegation principles
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Inala Primary Care – Business Rules• We support GPs to be the centre of the patient care
coordination team.
• We ask patients to nominate a preferred GP to oversee their care.
• We ensure at least 2/3rds of our workforce are FRACGPs or FCRRMs.
• We offer minimum 15 minute face to face appointments with our medical team.
• We schedule sufficient “on the day” appointments to deal with acute care needs.
• We take the time to ensure patients are aware of and can optimise their choices.
• We build safety by communicating about concerning patients within our team.
• Where a therapeutic relationship cannot be sustained we arrange handover of care.
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Inala Primary Care – Business Rules• We educate our team so that everyone works to the top of their scope of
practice.
• We partner with patients and families to create a healthcare team.
• We provide continuity of care inclusive of patient homes, aged care and hospitals.
• We invest so that care can be delivered in the right place at the right time.
• We teach to keep ourselves fresh, spread our models and grow a great workforce.
• We use social prescribing and the health neighbourhood to leverage support.
• We are technology savvy and create efficient care support systems.
• We fund attractive, flexible work and care spaces which foster teamwork.
• We love our data and use it to make evidence based decisions.
Karen Schmidt, 2008
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Self‐assessment
• Forward thinking, opportunity mindset?• Nurturing resilience by being realistic?• Enthusiastic about change and outcomes?• Stretching people and possibilities?• Holistic approach to care?
Scale 1‐5 where 1 = hardly ever, 5 = absolutely always
Become more personable
“Transforming systems is ultimately about transforming relationships among people who shape those systems.”
Change efforts fail when leaders fail to grasp this…
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The five system changing behaviours
1. Develop a shared purpose and vision
2. Have frequent personal contact
3. Surface and resolve conflict
4. Behave altruistically
5. Commit to the longer term
Trust and transparency
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Attention to process
The Patient’s perspective• Improved access: “Health care team, be
there when I need you”• Accountability; "Take responsibility for making sure
we receive the best possible health care"• Comprehensive: “Provide or help us get the health care, information and services we need”
• Continuous: “Be our partner in time in caring for us”
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The Patient’s perspective• Co‐ordinated and integrated: “Help us navigate the health care system to get the care we need in a safe and timely way”
• Patient Centred: “Recognise that we are the most important part of the care team, and that we are ultimately responsible for our overall health and wellness”
• Implementation of Oregon’s PCPCH Program: Exemplary Practice and Program Findings. Final Report, September 2016
Your blueprint
• What are you aiming for?• What benefits do you see arising?• What changes have you planned?• What actions can you take next?
How might you “4 P” this when you return?
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Rebellion
I am no longer a captive to history
Whatever I can imagine, I can accomplish
I am no longer a vassal in a faceless system
I am an activist, not a drone
I am no longer a foot soldier in the march of progress
I am a revolutionary!
Thank you
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