19 May 2015

HA Convention 2015

Parallel session 4

Patient Relations and Complaint Management

THE MYTH OF

PATIENT ENGAGEMENT

Dr. LUI Siu-Fai, MH JP

Prof WONG Lai-yi Eliza

Prof. YEOH Eng-kiong, OBE, GBS, JP Division of Health System, Policy and Management

The Jockey Club School of Public Health and Primary Care

A spectrum of process to achieve better outcome of patient care, (lower cost),

patient relations and experience.

Resource Power

PATIENT RELATION WITH HEALTHCARE WORKERS

In Partnership with Patients What is the matter? What matters to me? Co-design, Co-producing Partnership Empowerment

http://sgh.org.sa/Portals/0/Articles/Engaging%20Patients%20in%20Healthcare.pdf

http://www.kingsfund.org.uk/publications/supporting-people-manage-their-health

Patient activation

- The knowledge, skills and confidence a person has in managing their own health and health care.

- A predictor of health outcomes - The more activated are significantly more likely to attend screenings, check-ups and immunisations, to adopt positive behaviours (e.g. diet, exercise), and have clinical indicators in the normal range (BMI, A1c, blood pressure and cholesterol). - Less-activated patients have costs 8% -21% higher

- Intervening to increase activation can improve a patient’s engagement and health outcomes and is an important factor in helping patients to manage their health.

http://www.kingsfund.org.uk/publications/people-control-their-own-health-and-care

http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

Symptoms Diagnosis Decision Treatment Continue

care

(Individual) Patient Engagement / Empowerment C

are

Pat

hw

ay

Disclosure of Information

Consultation/ Investigation Dialogue

Informed Choice/ Involvement

Shared Decision Making

Partnership/ Ownership

Pat

ien

t En

gage

me

nt

/ Em

po

we

rme

nt

Incr

easi

ng

leve

l of

emp

ow

erm

ent

Continuum of Participation

Address health literacy

Encourage appropriate use of health care resources

Awareness of symptom / disease

Improve communicate skills of HCP

Explain investigation

Explain diagnosis Healthcare professionals (HCP)

Explain treatment options

Discuss with patient on options to make informed decisions about their care

HCP work with patients to agree on treatment options and management plan (shared decision)

Patient’s commitment to treatment (compliance /responsibility)

Educate patients about self-management

Empower patients to manage their own health and health care (treatment adjustment)

11 Proposal by CUHK SPH

Follow up studies of

HA Patient Satisfaction Survey 2010

PATIENT ENGAGEMENT

STUDY 2013

Prof WONG Lai-yi Eliza

Dr. LUI Siu-Fai, MH JP

Prof. YEOH Eng-kiong, OBE, GBS, JP Division of Health System, Policy and Management

The Jockey Club School of Public Health and Primary Care

Communication & Information Sharing

1. Having mutual communication with patients

2. Sharing information of care process & treatment with patients

3. Having coordination with colleagues/ healthcare staff who involve in caring of assigned patients

4. Involving patients’ family/ next of kin

Involvement in Decision-making

5 Addressing patients’ values and preferences in the care process

6 Providing patients a choice in the care process

7 Sharing healthcare professionals’ expectations on care process with patients

8 Implementing shared decision making with patients

9 Treating patients with dignity and respect

Self-care and Safety

10. Strengthening patients’ responsibility for own health

11. Ensuring patients’ compliance with healthcare professional’s advice/ treatment

12. Providing emotional support to patients

13. Ensuring safe care with patients

Essential Components of Patient Engagement Derived from focus group meetings with patients and staff

95 98 90

65

0 0

92 98

40

7 0

10

20

30

40

50

60

70

80

90

100

HealthcareProfessional

Patient HealthcareProfessional

Patient HealthcareProfessional

Patient HealthcareProfessional

Patient

Important Necessary 0 Benefit Negative Impact

Incorporating patient

engagement will

benefit health care

Incorporating patient

engagement will

cause negative impact

on health care

1. Importance, Necessary, Advantage, Disadvantage of Patient Engagement

(% Strongly agree / Agree)

It is important

to incorporate

patient engagement.

It is necessary

to incorporate

patient engagement

* Doctor = 19% Nurse = 43%

Key finding (1)

Important, necessary, benefit, negative

impact of Patient Engagement

• Staff and patient both believe patient engagement

is important and benefit health care.

• Only 65% of the patient strongly agree / agree that it is necessary.

• 40% of the staff have concern on possible negative impact.

Self-care and Safety (10) Strengthening patients' responsibility for own health (P4)

(11) Ensuring patients' compliance with healthcare professional's advice/ treatment (H5,P5)

(12) Providing emotional support to patients

(13) Ensuring safe care with patients (H1,P3)

99

64

82

68 76

86

61

99 91 89

63

98

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13

94 94 95 93 91 92 90 88

97 92 94 92

98

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13

Healthcare Professional’s vs. Patient’s view (Strongly agree / agree)

Communication and Information Sharing (1) Having mutual communication with patients (H4,P2) (2) Sharing information of care process and treatment with patients (3) Having coordination with colleagues/ healthcare staff who involve in caring of assigned patients (H3)

(4) Involving patients' family/ next of kin

Involvement in Decision-making (5) Addressing patients' value and preferences in the care process (6) Providing patients a choice in the care process (7) Sharing healthcare professionals' expectations on care process with patients (8) Implementing shared decision making with patients (9) Treating patients with dignity and respect (H2,P1)

Hea

lth

care

Pro

fess

ion

al

Pat

ien

t

(#1) (#2) (#4) (#5)

(#1) (#2) (#3) (#5)

(#3)

(#4)

3. Mutual communication

with patients

1. Treat patients with dignity and respect

2. Ensure safe care

4. Ensure patients’

compliance

2. Essential Components of Patient Engagement

99

64

82

68 76

86

61

99 91 89

63

98

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13

94 94 95 93 91 92 90 88

97 92 94 92

98

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13

Healthcare Professional’s vs. Patient’s view (Strongly agree / agree)

Communication and Information Sharing (1) Having mutual communication with patients (2) Sharing information of care process and treatment with patients (30%) (3) Having coordination with colleagues/ healthcare staff who involve in caring of assigned patients

(4) Involving patients' family/ next of kin

Involvement in Decision-making (5) Addressing patients' value and preferences in the care process (23%) (6) Providing patients a choice in the care process (16%) (7) Sharing healthcare professionals' expectations on care process with patients (8) Implementing shared decision making with patients (27%) (9) Treating patients with dignity and respect

Self-care and Safety (10) Strengthening patients' responsibility for own health

(11) Ensuring patients' compliance with healthcare professional's advice/ treatment

(12) Providing emotional support to patients (29%)

(13) Ensuring safe care with patients

30%1 23% 27% 3 29% 2 16%

Hea

lth

care

Pro

fess

ion

al

Pat

ien

t

Difference

2. Essential Components of Patient Engagement

Key finding (2) – Essential components

Essential components perceived by staff and patients

• Treating patients with dignity and respect (97% / 99%)

• Ensuring safe care with patients (98% / 98%)

• Having mutual communication with patients (94% / 99%)

• Ensuring patients’ compliance with advice/ treatment (94% / 89%)

Discrepancies perceived between staff and patients:

• Sharing information of care process and treatment (30%)

• Providing emotional support (29%)

• Implementing shared decision making (27%)

• Addressing patients' value and preferences in the care process (23%)

• Providing patients a choice in the care process (16%)

95

68 79

65 64

88

49

98

85 82

60

96

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13

99 98 98 98 95 96 94 94 99 95 98 97 99

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13

3. Degree of Involvement in the suggested aspects in routine work

Communication and Information Sharing (1) Having mutual communication with patients (H3,P3) (2) Sharing information of care process and treatment with patients (H5) (3) Having coordination with colleagues/ healthcare staff who involve in caring of assigned patients )

(4) Involving patients' family/ next of kin (H4)

Involvement in Decision-making (5) Addressing patients' value and preferences in the care process (6) Providing patients a choice in the care process (7) Sharing healthcare professionals' expectations on care process with patients (P4) (8) Implementing shared decision making with patients (9) Treating patients with dignity and respect (H1,P1)

Self-care and Safety (10) Strengthening patients' responsibility for own health (P5)

(11) Ensuring patients' compliance with healthcare professional's advice/ treatment

(12) Providing emotional support to patients

(13) Ensuring safe care with patients (H2,P2)

(#1) (#2) (#3) (#4) (#5)

(#1) (#2) (#5)

19

Hea

lth

care

Pro

fess

ion

al

Pati

ent

(#3) (#4)

1. Treat patients with dignity and respect

3. Mutual communication

with patients

Healthcare Professional vs. Patient (Often / Always / Sometimes)

2. Ensuring safe care

99 98 98 98 95 96 94 94 99 95 98 97 99

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13

3. Degree of Involvement in the suggested aspects in routine work

Healthcare Professional vs. Patient (Often / Always / Sometimes)

Communication and Information Sharing (1) Having mutual communication with patients (2) Sharing information of care process and treatment with patients (30%) (3) Having coordination with colleagues/ healthcare staff who involve in caring of assigned patients

(4) Involving patients' family/ next of kin (20%)

Involvement in Decision-making (5) Addressing patients' value and preferences in the care process (29%) (6) Providing patients a choice in the care process (32%) (7) Sharing healthcare professionals' expectations on care process with patients (8) Implementing shared decision making with patients (44%) (9) Treating patients with dignity and respect

Self-care and Safety0 (10) Strengthening patients' responsibility for own health

(11) Ensuring patients' compliance with healthcare professional's advice/ treatment

(12) Providing emotional support to patients (37%)

(13) Ensuring safe care with patients 20

30% 3 20% 29% 32% 44% 1 37% 2

Hea

lth

care

Pro

fess

ion

al

Pati

ent

Difference

95

68 79

65 64

88

49

98

85 82

60

96

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13

Key finding (3) – Involvement

Involvement of different aspects of Patient Engagement

reported by staff and perceived by patient

• Treating patients with dignity and respect (99% / 98%)

• Ensuring safe care with patients (99% / 96%)

• Mutual communication with patients (99% / 95%)

Discrepancies between involvement reported by staff and perceived by patients:

• Implementing shared decision making (44%)

• Providing emotional support (37%)

• Providing patients a choice in the care process (32%)

• Sharing information of care process and treatment (30%)

• Addressing patients’ values and preferences in the care process (29%)

• Involving patients’ family/ next of kin (20%)

50 47 36

27 21

52

39 30

0

49

78

0

36 28

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14

91 89 94 94 93 97 85

92 85

93 95 91

0 0 0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14

(#1) (#2) (#3) (#4) (#5)

(#1) (#2) (#3) (#4) (#5)

Patient Aspect (1) Improving patients' health literacy (P3) (2) Improving patients' communication skills with healthcare professionals (P5) (3) Improving ways to disseminate/ discuss information to patients (H4) (4) Encouraging patient participation in self-care (H3) (5) Involving patient's family/ next of kin in the care process

Staff Aspect (6) Improving staff's communication skills with patients (H1,P2)

(7) Improving communication among staff

(8) Explaining limitations to patients in current hospital setting

System Aspect (9) Establishing guidelines on patient engagement across hospitals for reference (10) Changing management style to enhance patient engagement (H5,P4) (11) Reducing workload of healthcare staff (H2,P1) (12) Providing staff training (13) Improving existing physical setting of hospital's environment to enhance patient engagement (14) Improving hospitals' atmosphere to enhance patient engagement 22

Healthcare Professional’s vs. Patient’s view (Strongly Agree / agree)

Hea

lth

care

Pro

fess

ion

al

Pati

ent

1. Improve staff’s communication

skill

2. Reduce workload

3. Change management

style

4. Suggested improvement measures towards patient engagement

Key finding (4) – improvement measures

By staff and patients

• Improve staff's communication skills with patients (97% / 52%)

• Reduce workload of healthcare staff (95% / 78%)

• Change management style to enhance patient engagement (93% / 49%)

Way Forward

• To establish further understanding and agreement on the key elements

and processes of Patient Engagement for Hong Kong public setting

(Hospital Authority).

• To address the concern by staff on the perceived possible negative

impact of patient engagement.

• To address the difficulties identified and to explore ways to enhance

Patient Engagement, including

(i) to improve staffs’ communication skill with patients,

(ii) reduce workload of staff and

(iii) change management style to enhance patient engagement.

• To enhance patient’s understanding of patient engagement