Re thinking the Experience The Path Forward Dr

Re: thinking the Experience. The Path Forward. Dr Joanne Watson Clinical Director of the King’s Fund Point of Care Hospital Programme Clinical Director of Patient Experience & Consultant Physician, Musgrove Park Hospital, Taunton Quality Improvement Fellow (The Health Foundation & IHI)

Thank you so much!

Re: thinking the Experience. The Path Forward. Dr Joanne Watson Clinical Director of the King’s Fund Point of Care Hospital Programme Clinical Director of Patient Experience & Consultant Physician, Musgrove Park Hospital, Taunton Quality Improvement Fellow (The Health Foundation & IHI)

From a World Class Person - Don Berwick July 1 , 2008 st Put the patient at the absolute centre of your system of care - In its most authentic form, this rule feels very risky… It means the active presence of patients, families and communities in the design, management and assessment and improvement of care. It means total transparency. It means that patients have their own medical records and that restricted visiting hours are eliminated. It means ‘nothing about me without me’.

“Nice but not necessary”

“Nice but too expensive”

There is nothing more powerful than an idea whose time has come. Victor Hugo

What is at the Centre? tiv en es s Safety Eff ec Equity Eff ici e nc y Patient Centred Tim el y

What is at the Centre? tiv en es s Safety Eff ici e nc y Value in Patient Health Experience Care Tim el y Eff ec Equity Patient Centred

What is at the Centre? tiv en es s Safety Eff ici e nc y Value in Health Care Tim el y Eff ec Equity Patient Centred

Outline of this Talk’s Direction of Travel • What are we trying to accomplish? • How will we know that a change is an improvement? • What changes can we make that will result in improvement?

What are we trying to accomplish?

One day Alice came to a fork in the road and saw a Cheshire Cat in a tree. “Which road do I take? ” she asked. “Where do you want to go? ” was his response. “I don’t know” she answered. “Then” said the Cat “it doesn’t matter. ” Lewis Carroll ‘Alice in Wonderland’ 1865

What are we trying to accomplish? The health care professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And some days rather dull. For the individual patient it’s anything but that. Every individual that comes through a hospital is apprehensive. It’s a strange place, you lie in a strange bed, you have strange sheets, you have odd tea in a plastic cup. The whole thing is vibrantly different. Dr Kieran Sweeney, 2009

What are we trying to accomplish? Every patient counts

What are we trying to accomplish? Every patient counts & Compassionate care embedded

Value in Health Care - Porter M and Lee T: 2010, NEJM Dec 23 • How is value defined in health care? • What is important to our customers, the patients? • OUTCOMES, results, consequences, effects, conclusions etc of Health Care

Value = Health Outcomes £ Spent

What are we trying to accomplish? • Delivering health care which adds VALUE through considering what patients need and want • Be accountable for the total care of the medical condition • Develop pride in what we do in health care - working with a sense of achievement and accomplishment

g n rni e Wa h t s i n o i t s ! e e u n q o t l x a i e c n u r e c Th y l l rea

How will we know that a change is an improvement? • Focus on outcomes, as well as process • Meaningful data – a department is too narrow, a whole hospital too broad • Real team work as we cross the silos of medicine’s organisational structure • “If you don’t measure it, you can’t manage it”

Measurement Strategy 1 - Outcome Hierarchy

Measurement Strategy 2 - Key Drivers Primary drivers in building reliability into patient experience. (P= process measure, O= outcome measure) Leadership Executive involvement: Walkround by Executive Sponsor (3 per pthwy per m: P) Reporting of patient experience at Board Level (qualitative: P) Steering group: Time spent per week on this work (P) Attendence at meeting (P) Staff Engagem’t Relational Coordination 3 m survey of different staff groups (O) Sickness monitoring (P) Patient Processes Involvement of Care Cancellations in Care Ways & number of patients involved (P) Pt surveys on involvement in care (O) Literacy scores on reading material for patients (P) Length of Stay (O) Readmission Rate (balancing) Noise at night (P/O) Clinical Outcomes (Safety & Quality) Disciplines to track an important clinical process or outcome e. g. time to first physio consultation post op.

Impact of Relational Coordination on Airline Performance 62% Relational Coordination 28% -1. 35 Airline Performance Index Hoffer Gittell J 2003, The SW Airlines Way, NY Mc. Graw-Hill 1. 32

Impact of Relational Coordination on Surgical Performance Hosp 6 4. 22 Hosp 4 Hosp 5 Relational Coordination Hosp 8 Hosp 9 Hosp 1 3. 84 Hosp 7 Hosp 3 Hosp 2 -. 43 Surgical Performance Index Hoffer Gittell J 2009, High Performance Healthcare . 48

How will we know that a change is an improvement? Dr Foster The Intelligent Board Series The King’s Fund Point of Care NHS Confederation Feeling better? Improving patient experience in hospital

What changes can we make that will result in improvement?

Vital Sign Care Cards SELF CONFIDENCE I want to feel confident in managing my own health RESPECT I want to feel treated with respect SAFETY I want to feel safe COMFORT I want to feel physically comfortable REASSURANCE I want to feel reassured UNDERSTANDING I want to understand my Treatment and condition EFFECTIVENESS I want my treatment to make me feel better HONESTY I want to feel staff are open and honest with me OPPORTUNITY CARD For patient to express any other care needs

Airedale New Venture Charity Airedale General Hospital

Helping families with Supportive Care

The Year of Care Consultation Skills and Philosophy Toolkit ‘Mind your language’

And so to summarise…. • Patient experience is a complex outcome to focus improvement in • Measurement- strategy to cover the breadth & depth of experience relevant to the pathway • Co-ordinated programme to shift overall experience, not random acts of goodness

Speech to the Young. Speech to the Progress-Toward. Say to them, say to the down-keepers, the sun-slappers, the self-soilers, the harmony hushers, “Even if you are not ready for day it cannot always be night. ” You will be right For that is the hard home-run. And remember: Live not for Battles won. Live not for The-End-of-the-Song. Live in the along.