Clinical Services Redesign Program Improving the patient and
carer experience Slide 2 Clinical Services Redesign Program
Patients take journeys through the health care system. They involve
a series of steps in the delivery of health care. These steps
should be predictable, with decision points along the way The
journey may be short with a few steps. For people with chronic
illness, the journey may take a lifetime with continuous stops
along the way. Patient Journey Slide 3 Clinical Services Redesign
Program Patient and Carer Experience patient + carer perspective of
journey shaped by information; the way it is given what they see,
feel, hear all affects their choices includes gaps between clinical
care different from patient satisfaction Slide 4 Clinical Services
Redesign Program 3 reasons why it matters 1. NSW State Health Plan
Strategic Direction 2 CREATE BETTER EXPERIENCES FOR PEOPLE USING
THE HEALTH SYSTEM Slide 5 Clinical Services Redesign Program 2.
CSRP Objective Deliver better patient journeys by improving Access
Safety Patient and carer experience Slide 6 Clinical Services
Redesign Program CSRP Work Orders "How the Proposed Project will
understand and improve patient and carer experiences" Slide 7
Clinical Services Redesign Program 3. Because you care VEM High
Level Stakeholder Study Consumer Involvement Audit Slide 8 Clinical
Services Redesign Program Patient experience isnt that just
customer service?? Slide 9 Clinical Services Redesign Program Basis
of good customer service Who are your customers? What do they
value? What types of value give a competitive edge? Slide 10
Clinical Services Redesign Program Which partner said this?
Governments are at a critical juncture for service success. Leading
executives recognize they have reached the limit with their current
approaches to customer service. They are re-assessing and
re-crafting their customer service strategies, not just to satisfy
citizens, but also to create lasting value. They are also veering
away from a best practice, one-size-fits-all templateand putting
the custom back in government customer service. Slide 11 Clinical
Services Redesign Program Todays purpose To learn how to Really
understand patient and carer experience Monitor change in patient
and carer experience Slide 12 Clinical Services Redesign Program
What is the carer? person who supports the patient on their health
care journey. involved in decision making has information about
patient and their journey may or may not be carer when patient is
back home Slide 13 Clinical Services Redesign Program What do
patients and carers value? 1.Access to Care 2.Respect for Patients
values, preferences, and expressed needs 3.Coordination and
integration of care 4.Information and education 5.Transition and
continuity 6.Physical comfort 7.Emotional support and alleviation
of fear and anxiety 8.Involvement of family and friends Slide 14
Clinical Services Redesign Program When we redesign patient
journeys, we can embed systems and processes that contribute to
better patient and carer experiences. Slide 15 Clinical Services
Redesign Program In your project Have you talked to patients and
carers to identify opportunities for improving the patient and
carer experience? How will you know if you achieve this? Slide 16
Clinical Services Redesign Program After morning tea What method
are you using to understand/measure patient and carer experience?
What do you see as the pros and cons of this method? Slide 17
Clinical Services Redesign Program What we need for clinical
redesign Data something we can measure and compare results over
time Juice detailed insights into what is not working from patient
and carer perspective. Information that informs practical solutions
Slide 18 Clinical Services Redesign Program Measuring Patient
Experience Richness of detail for CRU projects (juice) Data,
results comparable over time Slide 19 Clinical Services Redesign
Program Patient Experience Measures Richness of detail for CRU
projects (juice) Patient story Good insight into patient experience
but how valid is this story? Data, results comparable over time
Slide 20 Clinical Services Redesign Program Data, results
comparable over time Richness of detail for CRU projects (juice)
Recognised tool. Annual data can be compared across AHSs and
internationally. Great for the dashboard. Not much juice for
Clinical Redesign and not regular enough for project evaluation.
Patient Satisfaction survey Slide 21 Clinical Services Redesign
Program Richness of detail for CRU projects (juice) Patient story
Patient Satisfaction survey CRU tool delivers data and juice
suitable for redesign projects Use Picker categories to align these
tools Data, results comparable over time Slide 22 Clinical Services
Redesign Program An example Slide 23 Clinical Services Redesign
Program Patient Experience of Waiting Patient and Carers Perception
of timeliness of care Overall the perception of timeliness of care
received is good, with the majority of respondents ranking
timeliness of care as good or better. Waiting room patients/ carers
are markedly less positive in their perception of the timeliness of
their care than that of the observation area patients Have you been
waiting too long? Again, the majority of patients, overall, do not
feel they have been waiting too long for treatment. Waiting room
patients are more likely to feel they have been made to wait too
long for treatment. Overall, patient and carer satisfaction survey
results are encouraging with the majority of respondents reporting
a positive experience. However, when there is a breakdown between
waiting room and observation area respondents a clear distinction
becomes apparent between the two groups in the perception of care,
with the waiting room respondents far less than satisfied with the
timeliness of care and level of communication causing more negative
emotions. Slide 24 Clinical Services Redesign Program Feelings
generated by waiting. Although there was a proportion of
Observation area respondents who felt they were waiting too long
for treatment, waiting room patients/ carers are the only
respondents to express anger at waiting for care. How well have we
communicated with you about what is happening in your stay? Waiting
room patients/ carers were far less satisfied with the level of
communication received. Waiting room respondents the only ones to
report poor communication. Patient Experience of Waiting Actions
taken from these survey results include - An awareness and
education program highlighting the need for ongoing and regular
communication with patients and carers located in the ED Waiting
Room. Continuing work by the triage Working party to address these
issues. Identification and training of nurses ready for the CIN
role. Further to these actions, it is anticipated that the recent
appointed Advanced Practice Nurse should help to address the issue
of prolonged waits for low, clinical priority patients. Slide 25
Clinical Services Redesign Program Fast Access to reliable health
care Attention to Physical + Environmental Needs Clare says she is
used to waiting hours, sometimes days in the ED for a psychiatric
registrar to arrive. All that time under fluorescent lights she
says you never know if its night or day. Clare once spent 6 days in
a hospital ED waiting for a bed. (Clare Mental Health) Slide 26
Clinical Services Redesign Program How do we understand and improve
patient and carer experience? For each journey being redesigned:
1.At the beginning, ask patients and carers about their experience
2.Analyse areas for improvement 3.Respond with solutions that will
improve patient and carer experience* 4.Re-evaluate
post-implementation by asking a new group of patients and carers
Slide 27 Clinical Services Redesign Program Morning tea Slide 28
Clinical Services Redesign Program CRU trial method for measuring
patient and carer experience Slide 29 Clinical Services Redesign
Program The CSRP method Focuses on patient experience, not
satisfaction Qualitative method (discourse analysis, background
narrative enquiry) Requires skilful facilitation Delivers juice and
data for Clinical Redesign Projects Slide 30 Clinical Services
Redesign Program Based on.. Learnings from Picker Institute VEM
CSRP Evaluation tool Literature PLUS Common sense Commitment to
practical, achievable method for CSRP Slide 31 Clinical Services
Redesign Program Step by step 1.Identify and invite individual
patients and carers to a discussion 2.Set up discussions
3.Facilitate the discussions 4.Record and analyse insights
5.Present the results 6.Use the knowledge: design solutions
7.Remeasure to see whats changed Slide 32 Clinical Services
Redesign Program Method Not compulsory Trial by willing CRUs
Aug-Dec 2006 Support, knowledge sharing and resources provided by
CSRP Slide 33 Clinical Services Redesign Program Slide 34 Slide 35
Lunch break Slide 36 Clinical Services Redesign Program Remember
our motivation: to understand and improve patient and carer
experience Slide 37 Clinical Services Redesign Program Step by step
1.Identify and invite individual patients and carers to a
discussion 2.Set up discussions 3.Facilitate the discussions
4.Record and analyse insights 5.Present the results 6.Use the
knowledge: design solutions 7.Remeasure to see whats changed Slide
38 Clinical Services Redesign Program Step 1 Identify and invite
individual patients and carers to participate Slide 39 Clinical
Services Redesign Program Step 1: Invite patients and carers Define
target population Invite them to take part How many to interview?
Avoiding bias Slide 40 Clinical Services Redesign Program Step 2
Set up the discussions Slide 41 Clinical Services Redesign Program
Step 2: Set up the interviews Where to interview Who should
interview How long will it take? Slide 42 Clinical Services
Redesign Program Step 3 Facilitate the discussions Slide 43
Clinical Services Redesign Program Step 3: Facilitate the
discussions Introductions Skilful listening and questioning
Identifying best and worst aspects of experience Ending the
discussion Consent form Note: CSRP has a workshop available to
practice these skills Slide 44 Clinical Services Redesign Program
Slide 45 Slide 46 Step 4 Record and analyse insights of patients
and carers Slide 47 Clinical Services Redesign Program Step 4:
Record and analyse the insights of patients and carers Enter your
notes from discussion record into webform on archi and receive
summary Enter data into MS excel spreadsheet Slide 48 Clinical
Services Redesign Program Slide 49 Slide 50 Step 5 Present the
results Slide 51 Clinical Services Redesign Program Step 5:
Presenting the results Data graphs of top issues Analyse what
improvements patients and carers would value most, and what is
already working well Juice constructive comments that point to
practical solutions Slide 52 Clinical Services Redesign Program
Slide 53 Slide 54 Slide 55 Clear comprehensive information "They
gave me lots of printed information about what I considered the
less important stuff, and not enough about the risks of the
procedure. I received nothing written about the risks. The surgeon
rattled off a set of risks as fast as you can speak and in a
monotone. I pulled out my notebook and started writing down notes
and asking questions. It wasn't all clear and I had to clarify the
risks. I'd like to see the percentage of each risk that was given
to me verbally written down. The psychologist actually asked me if
I knew the percentage of risk of death from this procedure - if I
hadn't written it down, I wouldn't have remembered. Violet elective
surgery Slide 56 Clinical Services Redesign Program Clear
comprehensive information I could not fault my care and treatment
from all providers.but after moving from the Critical Care Unit to
the step-down ward, communications and getting information about my
condition and progress became more and more difficult (Alex Cardiac
Care) Slide 57 Clinical Services Redesign Program Continuity of
care + smooth transitions Each doctor was focused on his or her bit
of Terry, sometimes to his detriment. The neurosurgeon had
apparently said that Terry could start to move about (although no
one came and told Terry or Ros that for some time). The orthopaedic
surgeon said that Terry shouldnt move because of his pelvis. Staff
could not clarify the situation until the orthopaedic surgeon came
to look at the x-rays. It took a week for him to come and look at
the x-rays. (Terry: Critical Care, as told by mother Ros) Slide 58
Clinical Services Redesign Program Fast Access to reliable health
care Attention to Physical + Environmental Needs Clare says she is
used to waiting hours, sometimes days in the ED for a psychiatric
registrar to arrive. All that time under fluorescent lights she
says you never know if its night or day. Clare once spent 6 days in
a hospital ED waiting for a bed. (Clare Mental Health) Slide 59
Clinical Services Redesign Program Step 6 Use the knowledge to
improve patient and carer experience Slide 60 Clinical Services
Redesign Program Step 6: Using the knowledge to improve patient and
carer experience Any other data sources? Target the top problems
Use juice to design solutions Discuss your solutions with other
patients + carers before and during implementation Who else needs
to know what you found? Slide 61 Clinical Services Redesign Program
Step 7 Re-measure to see if your solutions worked Slide 62 Clinical
Services Redesign Program Step 7: Remeasure to see if your
solutions worked Immediately after implementation Then
periodically, to see if your solutions stick Slide 63 Clinical
Services Redesign Program Our commitment CSRP will support you with
Tools and resources archi.net.au Practical coaching Jane and Karen
Discussion group on archi - sharing knowledge and lessons learned
Practical training on facilitating discussions Sharing knowledge
and lessons learned Slide 64 Clinical Services Redesign Program
Slide 65 What next? 1.Is this method practical and do you think it
will help you improve patient and carer experience? 2.Are you
prepared to try it in your current/next project and help perfect
the method?
