Patients as Partners: at the Forefront of Service Redesign An Introduction to Patient Focus Public...
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Transcript of Patients as Partners: at the Forefront of Service Redesign An Introduction to Patient Focus Public...
Patients as Partners:at the Forefront of Service Redesign
An Introduction to
Patient Focus Public Involvement
Policy context
• Designed to Care: Renewing the National Health Service in Scotland (1997)
• Our National Health: A Plan for Action, a Plan for Change (2000)
• Patient Focus & Public Involvement (2002)
• Partnership for Care (2003)
Independent Advice and Support Servicefor Users of Local Health and Community Care Services A National Service Framework March
2006
Provide:• advice and support services to patients wishing
to make a complaint or raise concerns about NHS services
• information and advice to patients on a variety of issues that impact on their health and well-being in order to maintain or improve these
Duty to encourage public involvement
It is the duty of everybody….to take action with a view to securing, as respect to health services for which it is responsible, that person to whom those services are being, or may be provided, are involved in, and consulted on-– the planning and development, and– decisions to be made by the body significantly
affecting the operation,
of those services. National Health Service Reform (Scotland) Act 2004
Building a Health Service FIT FOR THE FUTURE
(2005)
Moving public consultation to the front end of service change rather than as a last step:
• involving the public in the planning and delivery of services
• involvement of individual patients in decisions about their own care
What are patients and the public
telling us about their experience?
‘Satisfaction is clearly linked to a number of factors, notably waiting times – the shorter the wait (for any kind of consultation or appointment or admission), the higher the level of satisfaction, both with the individual service and with the NHS as a whole’.
Public Attitudes to the NHS in Scotland 2004 Survey
Patients prioritise improvements for A&E as follows:
LowPriority
Medium Priority
High Priority
Televisions
Reducing waiting times to see receptionist/triage nurse
Drinks machines/refreshments
Doctors/nurses will not rush patients
Waiting area will be a clean and pleasant environment
Children’s play areas
Staff will be friendly and caring
Privacy (most feel that this is already adequate)
Explanations in layman's terms, of relevance to their situation
Reducing waiting times to see doctor/ get treatment
Plenty of information available in waiting areas (on screens/and from staff)
Staff will all be polite and sensitive to patients’ situation
Mrs Foley
Consider the journey **
‘Every system is perfectly designed to get
the results that it gets
If we want to change the patient
experience, we must change the system
To change the system, we must think in
fundamentally different ways’Donald Berwick
Institute of Health Care Improvement
A Patient Focus in Public Involvement
• Questionnaire
• Focus Groups
• Patient Mapping
• Patient Tracking
• Patient Shadowing
• Patient Diaries
• Discovery Interviews
Patient journey analysis
Improving the
experience
Increasing detail of analysis
Questionnaire/ Patient Satisfaction Survey
Focus Group
Patient Flow Analysis
Patient Mapping
Individual Patient
Patient Tracking
Patient shadowing
Patient Diaries
Questionnaires
• Can target a wide audience or sample • Critical mass for service reconfiguration and
redesign of provision• Includes benchmark scores and/or written
comments• Un-ambiguous and easy to count
Picker Institute
Picker Institute Europe works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice. We undertake a unique combination of research, development and policy activities which together work to make patients' views count.
http://www.pickereurope.org/
Expert patients/ focus groups
• Focus groups of patients
• Delegates from focus groups meet with staff to discuss improvements to service
• A plan is agreed and staff select actions to take forward
Flow mapping• Views the system from the patient perspective
following their journey across organisational boundaries
• Helps staff understand how complex and confusing processes appear to the patient
• Organisation specific• Diagnostic, and used as a basis for redesign,
actively involving frontline staff in the process
Patient tracking
• Validate or challenge process and flow map
• Identifies patterns in presentation of patients
• Identifies frequent ‘Hand-offs’ of patients or paper
• Identifies periods of waiting
Patient shadowing
• Patient, member of staff or volunteer accompanies patient
• Provides objective observational feedback
• Builds up comprehensive picture of patient and staff perception of service.
Flow Analysis Tool
A&E Major receptionist checks patient is expected
A&E Major receptionist logs patient onto A&E IT system
BB bleep SHO
BB create paper record
BB fax A&E & MAU
BB request patients notes
BB log patient onto BB IT system
GP rings BBGP rings BB again
GP rings for ambulance
Patients wife rings GP
Patient Collapses
Patient assessed by GP
Patient & his wife arrive A&E
Patient triaged on Majors
0:152:30 2:00
GP Bed Bureau
GP Bed Bureau
A&E Receptionist
A&E Receptionist
Triage Nurse
GP Ambulance Triage Nurse
Patient diaries
• A patient record of events throughout their healthcare
• Offers a personal account
• Can be in any format - written, visual or audio – patient’s choice
• Diaries are confidential and agreement must be made before any material is shared
Discovery interviews
• Semi-structured interviews of patient and/or carer
• Follows a framework to interview
• Allows local teams to gain insight and identify needs
• Patient consent, confidentiality and anonymity are essential
• Ethical approval may be required
In groups discuss the statement…
‘I am going in completely blind – I have no idea what is expected of me, if anything for that matter. Am I just a token gesture or am I there as somebody who has some impact?’
Patient