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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
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