EXCELLENCE THROUGH
PATIENT AND FAMILY
CENTRED CARE PROJECT
Averil Boon
RN, Grad Cert HInf, PG DipN
Quality and Patient Safety Coordinator
Bay of Plenty District Health Board
BOPDHB Objective - 2011
To establish a clear organisational
plan, direction and scope with
related priorities for organisational
implementation of the core
concepts of patient and family
centred care (PFCC)
across the continuum of care at
Bay of Plenty District Health Board
Patient and Family Centred Care
“Patient- and family-centred care
redefines relationships in health care. It
places an emphasis on collaborating with
patients and families of all ages, at all
levels of care, and in all health care
settings. Further, it acknowledges that
families, however they are defined, are
essential to patients’ health and wellbeing and are crucial allies for quality and
safety within the health care system.”
(Partnering with Patients and Families, 2006)
PFCC Core Concepts
Dignity and
Respect
Information
Sharing
People are
treated with
dignity and
respect
Health care
providers
communicate
and share
complete and
unbiased
information
with patients
and families in
ways that are
affirming and
useful.
Participation
Collaboration
Patients and
families are
encouraged and
supported in
participating in
care and
decision-making
at the level they
choose.
Patients,
families, health
care providers,
and
organisational
leaders
collaborate in
policy and
service
development,
implementation
and evaluation
“When we want your opinion,
We’ll give it to you”
Quality & Safety Challenge 2012
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Literature Review & Implementation Plan
Presentations – anyone who would listen
Self Assessments – Leaders / Organisation
Identify Opportunities for Improvement /
Action Plan
Stakeholder Analysis / Communication Plan
Site Visits, Conferences / Networking
Developed Resources, guidelines,
templates, training packages
BOPDHB Recommendations / Framework /
Strategic Plan
BOPDHB Values
Healthy, thriving communities
Kia Momoho Te Hapori Oranga
C - Compassion
A - Attitude
R - Responsiveness
E - Excellence
A health care system that actively reflects the
needs and interests of the people it serves…
the patients…..
Health Excellence
Benefits and Risks
When patients feel informed and
empowered to participate in their own
healthcare, the results can be:
• Improved patient safety
• Better clinical outcomes
• People treated with dignity &
respect
• Patients and staff report an
enhanced experience of care
• Reduced costs
The risk of not moving to patient and family
centred care is greater than any perceived
risks
Barriers
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No evidence
Too costly
Patients will have unrealistic demands
Having patients / families at handovers /
rounds / care meetings will inhibit staff from
being open
Families will interfere with care, creating
delays, errors, and lapses in infection control
More work / takes too much time
Requires new construction / single rooms
Patient access to health records violates
confidentiality / privacy requirements
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System-Centred
 The priorities of the system and those who work
within it drive the delivery of health care.
Patient- Focused
 The patient is the focus or unit of care.
Interventions are done to and for him/her, instead
of with the patient. The patient is not viewed
within the context of family or community.
Family-Focused
 While the family is the focus or the unit of care,
interventions are done to and for them, instead of
with them.
Patient- and Family-Centred
 The priorities and choices of patients and their
families drive the delivery of health care.
Institute for Patient and Family Centered Care - www.ipcc.org
Patient Experience
The provision of care is not the
same as the experience of the
illness - both perspectives are
needed
Patients and families are part of
their care and we as caregivers
are part of their experience
Taken from Calgary Health Region Presentation- IHI 2007
It’s not going to happen overnight ….
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Patient and family’s voice is a powerful lever for
system change and improvement.
Can’t simply be rolled out
Initiatives should be aligned with organisational
priorities
Leadership at all levels, especially executive is
required to maximize benefits and sustain
commitment.
Partnership with key stakeholders enhances
capacity, reach and spread message
Not all change is an improvement – use
improvement models and measures to track
changes
Start before you are ready, or you will never
start!
Organisational Self Assessment
Workshop objectives:
 Where do we stand now?
 Where do you want to be?
 Identify Care Improvement Opportunities:
 How are we going to get there?
 Develop Action Plan:
 What is needed to do to get there?
 Who is going to do it?
 How are they going to do that?
BOPDHB Results
BOPDHB
1.
2.
3.
4.
DIGNITY & RESPECT
INFORMATION SHARING
PARTICIPATION
COLLABORATION
TOTAL
30/04/2012
Workshop 1
03/05/2012
Workshop 2
10
16
2.5
4
32.5
13
13
6
4.75
36.75
Two workshops held in same week,
participants were:
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Board members
Executive
Quality and Patient Safety Team
Cluster Leaders
Consumers
Decision Support Analysts
Average
11.5
14.5
4.3
4.4
34.6
46%
BOPDHB Action Plan
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Volunteer Patient
Advisors
Priority projects:
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Family Presence &
Support - aka Visiting
Food options for
different ethnic
groups
Signage and way
finding
Family participation
in ward rounds
Patient goal setting
and communication
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Consumer Feedback
Professional standards
(Shared Expectations)
Review of role
descriptions
Education, orientation,
training and in-services
Experience based codesign projects
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ED
Clinical Physiology,
Cardiac Nurse Practitioner
nurse-led clinics,
Medical Day Stay
What other doors opened?
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Admission to Discharge Planner
Web page redevelopment
Questions project
Outpatient booking
Bay Navigator
Mental Health – “Working on Recovery” project
Patient Education Information
Orientation & Customer Service training –
looking at including in all training
Hospital information booklet
Linking with “capturing the consumer voice” –
surveys, patient stories, videos etc.
……… looking and hoping for more
Experience Based Co-design
Waitemata DHB – http://www.healthcodesign.org.nz
The Kings Fund - http://www.kingsfund.org.uk/ebcd/
NHS ebd approach - http://www.institute.nhs.uk/
Environment, Relationships and Challenges
Clinical Outcomes
Measurement
Orientation
Excellence
Education
Values
BOPDHB
Values
Health Excellence
1.
2.
3.
4.
Leadership
Strategic Planning
Customer Focus
Measurement,
Analysis and
Knowledge
Management
5. Workforce Focus
6. Operational Focus
7. Results
Patient Safety
Resources
PFCC Concepts
Targets
Stakeholder Analysis
Professional Standards
Communication Plan
Policies & Protocols
• Dignity & Respect
• Information
Sharing
• Participation
• Collaboration
• Compassion
• Attitude
• Responsiveness
• Excellence
Remove Barriers
Evidence Based Co-Design
Patients
&
Families
Patient Advisory Group
Recognise & Celebrate Success
Discussion & Questions
Our journey has been great fun, hugely successful so far and
more progress achieved faster than I could have believed possible
And is still gaining momentum!
Good Luck!
References
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Australian Commission on Safety and Quality in Health Care (2011), Patient centred care: Improving quality and safety through
partnerships with patients and consumers, ACSQHC, Sydney.
Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI
Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available on www.IHI.org)
Boyd H, McKernon S, Old A. 2010. Health Service Co-design: working with patients to improve healthcare services. Auckland: Waitemata
District Health Board. (Available on www.healthcodesign.org.nz)
Charmel, P, & Frampton, S. (2008, March). Building the business case for patient centred care. Healthcare Financial Management, 80-85.
Retrieved December 15, 2011
Conway, J et al. Institute for Healthcare Improvement and Institute for Family-Centred Care. (2006). A Roadmap for the Future. In
Partnering with Patients and Families to Design a Patient- and Family-Centred Health Care System. Bethesda, MD: Institute for FamilyCentred Care.
Frampton, S et al. (2008). Improvement Guide. In Patient-Centred Care. Derby, CT: Picker Institute and Planetree. Retrieved December
14, 2011
Institute for Patient and Family Centered Care. Strategies for leadership. In Advancing the practice of Patient and Family Centered Care.
Retrieved December 2, 2011
Johnson, B. et al. (2008). Recommendations and Promising Practices. In Partnering with Patients and Familes to Design a Patient and
Family Centred Health care System. Bethesda, MD: Institute for Family-Centred Care. Retrieved December 14, 2011
Ministry of Health. 2000. The New Zealand Health Strategy. Wellington, New Zealand: Ministry of Health.
Ministry of Health. 2002. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health
Ministry of Health. 2011. Whānau Ora: Transforming our futures. Wellington: Ministry of Health.
National Quality & Risk Managers. (2011). Draft - How to Guide: Capture the Consumer Experience. Wellington, New Zealand: Health
Quality & Safety Commission.
National Research Council. 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. Washington, DC: The National
Academies Press, 2004.
Planetree. (2009). White paper. In Patients as Experts, Patients as Partners: Integrating the Patient and Family Voice into Hospital
Operations. N.p.: Author. Retrieved December 14, 2011, from www.planetree.org
Shaller, D. (2007). Revised report for joint publication by Picker Institute and the Commonwealth Fund. In Patient-Centred Care: What
Does It Take. Stillwater, MN: Shaller Consulting. Retrieved December 10, 2011, from http://cgp.pickerinstitute.org/wpcontent/uploads/2010/12/shaller.pdf
The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centred Care: A Roadmap for
Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.
The NHS Improvement Plan. (2004). In Putting People at the Heart of Public Services. London, England: HM Government. Retrieved
December 8, 2011, from http://www.dh.gov.uk/
Websites:
The Picker Institute - http://pickerinstitute.org/
Planetree - www.planetree.org/
The Institute for Patient- and Family-Centred Care - www.ipfcc.org/
The Schwartz Center - www.theschwartzcenter.org/
The King’s Fund - www.kingsfund.org.uk/
Websites (cont):
Institute for Healthcare Improvement - www.ihi.org/
World Health Organization - www.who.int/
The Health and Disability Commissioner Office – www.hdc.org
New Zealand Ministry of Health - http://www.moh.govt.nz
NHS Institute for Innovation and Improvement http://www.institute.nhs.uk/