Essence of Care

-Moving Forward

Maureen Morgan, Department of Health

13th November 2008

Two Main Themes

• The value of benchmarking the environment

• EoC and the new quality landscape

Context

• In 3rd stage of 10yr plan to reform health care

• Underpinned by unprecedented levels of investment

• First two stages concerned with access, structures and systems

• Now, attention on quality, choice and individualised, personalised care

So far – So Good

• Achieved national targets on reducing mortality from cancer and cardio-vascular disease

• On track to reduce MRSA by 50%• Reducing waiting to 18 weeks• HCC survey 92% of patients rated

their care as good or excellent [2007]

BUT……..

• Wide regional variation – SMRs /IMRs in some parts of UK among best in EU – others among the worst

• If 92% of patients rated care as good or excellent – 8% did not!

• There is variation in clinical practice • High profile cases [eg Maidstone]

contributing to loss of confidence that the NHS ‘cares’

• Patients feel ‘at risk’ in our care

Safe from....

• harm• indignity• hunger and thirst

• being de-

humanised• being de-

personalised

BBC Poll 30th June ‘08

Why the Environment?

• Earlier benchmarks arose from patient complaints & untoward incidents

• Patients’ experience of care can be important as clinical outcome

Patients will use what they can see to make assumptions about what they cannot

Often, the first thing a patient will see is the building - before they meet a nurse, AHP or doctor

First Impressions Count

• dirty, worn furniture says – no-one cares – staff don’t have very high

personal standards– you could catch something

nasty here – the kitchens and operating

theatres may be dirty– I’m not safe here!

What you see tells a story

How people are made to feel is vital

• Embarrassment can kill

• People may avoid healthcare because of embarrassment

• People are highly sensitive to loss of dignity and invasion of privacy

More than just an ‘extra’

Research identified • how healing environments

shortened patients’ post-operative recovery

• That stress is a major obstacle to recovery and that well-being and recovery is directly related to physical environment

• Picker Institute showed the environment mattered to patients

Environment Encompasses how Care

is ExperiencedLittle things matter

• the ambience

• the rapport with staff• how staff behave

towards one another• how they look • cleanliness, tidiness

etc

Environment of Care – 11th benchmark

Launched November 2007 – covers – access– culture– maintenance – cleanliness – infection control precautions– personal environment– linen and furnishings

• Crosses all disciplines and care settings

Environment Benchmark

• Access – consider how easy is it get there from leaving home to arrival? Way-finding may be more difficult when one is worried or stressed.

• Culture – norms of behaviour – ‘how we do things around here’ – what sort of culture will generate feelings of safety, dignity and personal care?

• Personal care environment – the space occupied by an individual. People value being able to control their environment – closing curtains, opening windows, operating lights.

What can be done by the staff themselves? What should be brought to the attention of others who can take action?

Relevance of EoC to New Relevance of EoC to New Approach to Managing Approach to Managing

PerformancePerformance • From central targets to self-improving systems From central targets to self-improving systems • Clinically focused and evidence basedClinically focused and evidence based• Responsive to patients, public and staff Responsive to patients, public and staff • Stronger accountability Stronger accountability • Emphasis on qualitative dataEmphasis on qualitative data• Externally validated by CQCExternally validated by CQC

Summary • Focus of reform now on quality & patient experience –

service transformation • Strong performance management systems will require

evidence of continual improvement • EoC can provide mechanism to improve fundamental

aspects of care– harnesses enthusiasm of front-line staff– combines efforts of nurses, AHPs, doctors and others –

helps to create effective health care teams that meet expectations of patients, users and the public –

– help re-new trust and confidence in the NHS• The environment of care is the visible sign quality care

NB – toolkit being refreshed and a new benchmark on pain launched next year