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1©The Point of Care Foundation
Putting patients at the heart of the system
Council of Deans of Health Meeting
Jocelyn Cornwell
October 16 2014
Every system is perfectly designed to produce the results it gets
Starting point 1: systems thinking
Paul Batalden M.DDartmouth Institute for Health Policy and Practice
Starting point 2: design-thinking
(P)PERFORMANCE
How well it does the job, whether it’s fit for purpose.
Functionality
(E)ENGINEERING
Whether it is safe & reliable.Safety
(A)AESTHETICSHow it feels.
How it is experienced.Usability
Every product & every service has 3 distinct elements
5©The Point of Care Foundation
Example 1: a daughter’s story
Overall, my mother received the best care from staff who have treated and respected her as a person, rather than stereotyping her as an elderly person who’s not capable of thinking and doing things for herself.
6©The Point of Care Foundation
Example 1 (contd.)Throughout her time in hospital, staff continually called my mother by the wrong name. She has been called Harriet all her life but it is her middle name, so her first name is written on all her records. We drew this to the attention of staff on the ward; it was important especially as she was suffering from episodes of confusion, but it did not stop. Everyday someone from the family would visit her and wipe the wrong name off the whiteboard.
On one occasion, after tracking down a registrar responsible for her care, we explained the situation and he wrote “likes to be called Harriet” in big letters on the front of her notes but it still had little effect.
7©The Point of Care Foundation
Example 2 A grand daughter’s story
“My grandmother was moved twice in the first couple of days. The second move was carried out at 4 a.m. Agitated on being woken, she pulled out her feeding tube. Her dentures were lost in transit and could not be located despite us repeatedly going to ask staff at the ward she had come from. The lack of dentures left her unable to communicate and increased her difficulty with eating. She developed an aspiration pneumonia which could have been in part due to the lack of dentures. The pneumonia kept my grandmother in hospital for almost a month.”
8©The Point of Care Foundation
Example 1
• Relational care
• Process for listening to families/carers
• Patient’s records
• Team working
• Handover
Where the two examples lead
Example 2
• Relational care
• Management of patients’ belongings
• Decision-making authority
• Bed management
• Targets and priorities
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10©The Point of Care Foundation
Empathy keeps staff in touch with the patients’ feelings
1. Cognitive: the capacity to understand another person’s feelings
2. Affective: the capacity to respond appropriately to another person’s feelings
Our capacity for empathy has two distinct aspects
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11©The Point of Care Foundation Using patient experience to redesign healthcare services
Empathy is normally distributed in the population
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12©The Point of Care Foundation
When empathy is switched off, we are in ‘I’ mode
• Tired, stressed or burned out
• Under pressure to do something else
• Interacting with a person who is ‘unpopular’ for
whatever reason
• Highly emotional - angry, frustrated, distressed or
frightened
• Working with digital equipment
We are more likely to switch off when we are:
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13©The Point of Care Foundation
Effective methods for maximising empathy in individuals
1. Experience based co-design (EBCD)
2. Patient shadowing
3. Patients’ stories
4. Simulation
5. Participant observation
6. Analogous scenarios
Plus attention to self
7. Self-care, reflective practice, mindfulness
Methods to enhance cognitive and affective capacity
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14©The Point of Care Foundation
Enabling conditions: management tasks
Cultural norms
Values in plain English; priorities in human terms
Reject language that objectifies patients; intolerance of rude and unkind acts
Involve patients in governance, improvement and training
Management /team working
Opportunities for reflection (Schwartz Rounds and others)
Train supervisors and hybrid managers to manage others
Systematic, frequent feedback from patients
Systems support
IT and patient records
Actively manage staff numbers and deployment
Relevance for education?
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16©The Point of Care Foundation
Rounds themes
• The patient I’ll never forget
• Am I doing the right thing? Managing risk
• Human too – personal and professional overlap
• Trying to help in impossible circumstances
• Conflict – with patient; family; colleagues
• ‘Unrewarding patients’ – nasty; terrifying; intractable problems; ungrateful; uncooperative; families
• When things go wrong – whistle blowing
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17©The Point of Care Foundation
Impacts of Rounds
US evaluations show that Rounds have a positive effect
•For individuals
•For teams
•For organisations
•This impact increases over time spent attending Rounds
Sanghavi DM (2006) What makes a compassionate patient-caregiver relationship? Joint Commission Journal on Quality and Patient Safety 32(5): 283-292.
Lown, BA, Manning, CF (2010) The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centred communication, teamwork and provider support. Academic Medicine 85(6).
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18©The Point of Care Foundation
Impact in the UK
Increase in:
•Staff confidence in handling sensitive issues
•Beliefs in the importance of empathy
•Actual empathy with patients as people
•Confidence in handling non-clinical aspects of care
•Openness to expressing thoughts, questions and feelings
A number of published studies report positive results
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19©The Point of Care Foundation
The opportunities in education to transform relational care
1. Schwartz Rounds in education
2. Patients and carers –roles as teachers
3. Instruction in observations of care and patients shadowing
4. Mindfulness
5. Other?
Reflections?
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jocelyncornwell@pointofcare foundation.org.uk www.pointofcareoundation.org.uk
Twitter: @JocelynCornwell